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TOOLS:
PANDEMIC BRIEFINGS
Egypt: #H5N1--75th and 76th
confirmed cases [May 28 Cairo]--The Ministry of Health of
Egypt has reported two new confirmed human cases of avian influenza
on 26 May 2009. The two cases are from two separate districts of
Sharkia Governorate.
The first case is a 4-year old male from Hehia City, Hehia District.
His symptoms began with fever on 24 May 2009.
The second case is a 4-year old female from Abo Hammad District. Her
symptoms began with fever on 23 May 2009.
Both cases were admitted to Zagazig Fever Hospital where they
received oseltamivir and are in a stable condition.
Investigations into the source of infection indicated that the above
two cases had close contact with dead and sick poultry. Both cases
were confirmed by the Egyptian Central Public Health Laboratories on
26 May 2009.
Of the 76 cases confirmed to date in Egypt, 27 have been fatal.
Egypt: #H5N1--70th, 71st, 72nd,
73rd, and 74th confirmed human cases [May 22
Cairo]--Between 13 to 20 May, the Ministry of Health of Egypt
reported five new confirmed human case of avian influenza.
The first case is a 4-year old boy from Kafr Sakr District, Sharkia
Governorate. His symptoms began on 10 May 2009 and he was admitted
to Zagazig Fever Hospital on 11 May. He is in a stable condition.
The second case is a 3-year old boy from Mahalla District, Gharbia
Governorate. His symptoms began on 12 May and he was admitted to
Mahalla Fever Hospital on 15 May 2009. He is in a stable condition.
The third case was a 4-year old girl from Meet Ghamr District,
Dakahlia Governorate. Her symptoms began on 9 May 2009 and she was
admitted to Mansoura Chest Hospital on 17 May 2009. She died on 18
May 2009.
The fourth case is a 4-year old boy from Sherbin District, Dakahlia
Governorate. His symptoms began on 18 May 2009 and he was admitted
to Mansoura Chest Hospital on the same day. He is in a stable
condition.
The fifth case is a 3-year old boy from Sohag District, Sohag
Governorate. His symptoms began on 17 May 2009 and he was admitted
to Sohag Fever Hospital on 18 May 2009. He is in a stable condition.
Investigations into the source of infection indicated that all the
above cases had close contact with dead and sick poultry. All five
cases have been confirmed by the Egyptian Central Public Health
Laboratory.
Of the 74 cases confirmed to date in Egypt, 27 have been fatal.
Egypt: 69th confirmed human
cases of H5N1--deaths of previously confirmed cases [May
18 Sohag]--The Ministry of Health of Egypt has reported a new
confirmed human case of avian influenza. The case is a 5-year old
female from Tama District, Sohag Governorate. Her symptoms began on
7 May and she was admitted in Sohag Fever Hospital on 9 May where
she received oseltamivir. She is in a stable condition.
The case was confirmed by the Egyptian Central Public Health
Laboratories on 10 May 2009.
Investigations into the source of infection indicate close contact
with dead and sick poultry.
The Ministry of Health of Egypt has announced the deaths of
previously confirmed cases of H5N1 as follows:
6-year-old male from Qaliobia Governorate;
33-year-old female from Kfr El Sheikh Governorate
25-year-old female from Cairo Governorate
Of the 69 cases confirmed to date in Egypt, 26 have been fatal.
Scotland: Ensuring resilience
to pandemic outbreak with 'Cauld Craw' exercise [Apr 22
Edinburgh]--The Scottish Government will be running an emergency
exercise next week to make sure it is prepared for any pandemic flu
outbreak that may occur.
'Cauld Craw' will be the government's main civil contingencies
exercise for 2009 and is part of a programme of events to ensure
Scotland is well prepared to deal with the consequences of any
emergency.
The four week exercise, involving a range of agencies across the
country, will test resilience and improve knowledge and
understanding of how to handle the issues Scotland would face in the
event of a pandemic.
Speaking ahead of Cauld Craw, Justice Secretary Kenny MacAskill
said: "Although there has been no change to the level of risk of a
flu pandemic, an outbreak has been identified as one of the main
risks Scotland could face.
"Scotland is not immune from the consequences of major incidents as
highlighted by the Glasgow Airport attack and more recently the fuel
disputes.
"It is vital that we continue to build on the expertise and
knowledge we have already developed in dealing with these kinds of
emergencies. Exercise Cauld Craw will test how ready we are and help
us strengthen our plans for the future"
Exercise Cauld Craw will involve a number of responder agencies
across Scotland including the emergency planning Strategic Co-ordinating
Groups in Tayside, Dumfries and Galloway and Strathclyde. The NHS
Boards of Ayrshire & Arran, Dumfries & Galloway, Greater Glasgow and
Clyde, Lanarkshire, Tayside, and the State Hospital will also
participate, as will the Scottish Ambulance Service, NHS24, National
Procurement, The Golden Jubilee Hospital and Health Protection
Scotland.
The exercise will run over four weeks from April 27 and all
participants will be conducting business as usual during this
period.
A pandemic flu outbreak has been identified as one of the main risks
Scotland could face along with terrorism, extreme weather and
widespread utilities failure. These four risks form the priority
issues which Scottish Resilience - the part of the Scottish
Government which works with frontline organisations on emergency
planning - is currently focussing on. The Scottish Government is
currently working with the UK Government to develop a national
pandemic flu communications strategy.
Egypt: 65th and 66th human
cases of H5N1 infection confirmed [Apr 22 Cairo]--The
Ministry of Health of Egypt has reported two new confirmed human
cases of avian influenza.
The first case is a 25-year old pregnant female from El Marg
District, Cairo Governorate. Her symptoms began on 6 April and she
was hospitalized at Ain Shams University hospital on 11 April where
she was started on oseltamivir on 16 April. She is in a critical
condition. Investigations into the source of her infection indicated
close contact with sick poultry prior to becoming ill.
The second case is 18-month old female from Kellin District, Kafr
Elsheikh Governorate. Her symptoms began on 15 April and she was
hospitalized at Kafr Elsheikh Fever Hospital on 18 April where she
was started on oseltamivir on the same day of hospitalization. Her
condition is stable. Investigations into the source of infection
indicated close contact with dead and sick poultry prior to becoming
ill.
For both cases, infection with H5N1 avian influenza was confirmed by
the Egyptian Central Public Health Laboratory and subsequently
confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3).
Of the 66 cases confirmed to date in Egypt, 23 have been fatal.
United States: FDA researchers
contribute insights into avian flu virus [Apr 22
Rockville MD]--An in-depth analysis of blood from patients
recovering from the H5N1 avian influenza virus has provided
important insights into how to combat the potentially lethal virus.
The findings by U.S. Food and Drug Administration scientists and
collaborators better explain what part of the “bird flu” virus is
seen by the immune system once a person becomes infected. As one
result of this research, a protein of the bird flu virus called
PB1-F2 was identified as a potentially potent target for attack by
immune systems to stop the spread of the virus.
“Analysis of blood from patients recovering from the H5N1 avian
influenza virus can lead to new tools for testing the potential
protective activity of vaccines under development,” said Karen
Midthun, M.D., acting director of the FDA’s Center for Biologics
Evaluation and Research (CBER). “The findings could also lead to new
tests to detect infections, and improved therapies.”
Since 2003, more than 400 people worldwide have been infected with
the bird flu virus. About 60 percent of them have died. No cases of
avian flu have been reported in the United States. Most of the avian
flu infections in humans involve people who have had direct contact
with infected poultry. However, there is a potential risk for a
global influenza pandemic should the virus acquire the ability to
spread directly from person to person.
The study, titled “Antigenic
Fingerprinting of an H5N1 Avian Influenza Using Convalescent Sera
and Monoclonal Antibodies reveals Potential Vaccine and Diagnostic
Targets,” appears in the April 20, 2009,
edition of the online journal PLoS Medicine.
The researchers adapted an existing technique using genetically
modified viruses (phages) to create a library of fragments
representing all of the proteins found in the H5N1 virus. Scientists
mixed these fragments with antibodies from five Vietnamese patients
recovering from the H5N1 infection and observed which fragments
attracted the patient’s antibodies.
Several targets that are likely to trigger strong antibody responses
to the H5N1 virus were identified, including PB1-F2, a protein that
researchers believe contributes significantly to the virus’s ability
to cause disease.
“We believe this is the first evidence of the human immune system
reacting this strongly against PB1-F2,” said Hana Golding, Ph.D.,
chief of CBER’s Laboratory of Retrovirus Research and senior author
of the article. “This is an indication that it may be a good target
for a drug or vaccine.”
The study’s other authors include first author Surender Khurana,
Yonaira Rivera, Jody Manischewitz, and Lisa R. King (FDA); Kanta
Subbarao, Amorsolo L. Suguitan Jr. (National Institute of Allergies
and Infectious Diseases); Cameron P. Simmons (Hospital for Tropical
Diseases, Ho Chi Minh City, Vietnam); and Antonio Lanzavecchia
(Institute for Research in Biomedicine, Bellinzona, Switzerland).
Tibet: China confirms bird flu
outbreak in Lhasa [Apr 22 Beijing]--China's Ministry of
Agriculture (MOA) confirmed Sunday a new outbreak of bird flu in
Lhasa, southwestern Tibet Autonomous Region.
The national bird flu laboratory confirmed that the H5N1 bird flu
virus was found in poultry sold at a poultry wholesale market in
Chengguan District of Lhasa on April 12.
Emergency measures have been taken and the epidemic has been brought
under control, the MOA said in a brief notice, and 1,679 fowl were
culled after the outbreak.
According to the local health department, no abnormalities were
found among people in contact with the poultry, the ministry said.
Egypt: 64th human case of H5N1
infection confirmed [Apr 20 Cairo]--The Ministry of
Health of Egypt has reported a new confirmed human case of avian
influenza . The case is a 33 year old female from Kellin district,
Kfr El Sheikh Governorate. Her symptoms began on 7 April and she was
hospitalized at Kfr El Sheikh Fever Hospital on 15 April where she
was started on oseltamivir the same day (15 April). She is in a
critical condition.
Infection with H5N1 avian influenza was confirmed by the Egyptian
Central Public Health Laboratory on 15 April.
Investigations into the source of her infection indicate a history
of close contact with dead and sick poultry prior to becoming ill.
Of the 64 cases confirmed to date in Egypt, 23 have been fatal.
Egypt: 61st, 62nd and 63rd
human cases of H5N1 infection confirmed [Apr 8
Cairo]--The Ministry of Health of Egypt has reported 3 new confirmed
human cases of avian influenza.
The first case is a 2 year-old boy from Kom Hamada District, El
Behira Governorate. He developed symptoms on 27 March and was
admitted to Naaora Fever Hospital on the 30 March where he was
started on oseltamivir the same day (30 March). He remains in a
stable condition.
The second case is also a 2 year-old boy from the same district and
was detected through the investigation around the above-mentioned
case. He developed symptoms on 31 March and was admitted to Damanhor
Fever Hospital on 1 April where he was started on oseltamivir the
same day (1 April ). He remains in a stable condition.
Both boys had contact with sick/dead poultry prior to the illness
onset. Close contacts of both boys have been identified and none has
shown symptoms of the infection .
The third case is a 6 year-old boy from Shubra El Khema District,
Qaliobia Governorate. He developed symptoms on 22 March and was
admitted to Ain Shams University Hospital on the 28 March where he
was started on oseltamivir on 3 April. He was exposed to sick/dead
poultry prior to the illness onset. He is in a critical condition.
For all of the three cases reported above, infection with H5N1 avian
influenza virus was tested positive by the Egyptian Central Public
Health Laboratory and subsequently confirmed by the U.S. Naval
Medical Research Unit No. 3 (NAMRU-3).
Of the 63 cases confirmed to date in Egypt, 23 have been fatal.
Viet Nam: 110th human case of
H5N1 infection confirmed [Apr 8 Chau Thanh District]--The
Ministry of Health in Viet Nam has reported a new confirmed case of
human infection with the H5N1 avian influenza virus. The case has
been confirmed at the National Institute of Hygiene and Epidemiology
(NIHE).
The case is a 3 year old boy from Chau Thanh District, Dong Thap
Province. He developed symptoms on 12 March, was hospitalized on 13
March, and died on 19 March.
Investigations into the source of infection indicated a history of
close contact with sick and dead poultry prior to the onset of
symptoms.
Of the 110 cases confirmed to date in Viet Nam, 55 have been fatal.
Egypt: 60th human case of H5N1
infection confirmed [Mar 31 Qena District]--The Ministry
of Health and Population of Egypt has reported a new confirmed human
case of avian influenza. The case is a two and a half year old
female from Qena District, Qena Governorate. Her symptoms began on
23 March. She was admitted to Qena Fever Hospital on 24 March where
she was started on oseltamivir the same day (24 March) and remains
in a stable condition. Infection with H5N1 avian influenza was
confirmed by the Egyptian Central Public Health Laboratory on 26
March.
Investigations into the source of infection indicate a history of
close contact with dead and sick poultry prior to becoming ill.
Of the 60 cases confirmed to date in Egypt, 23 have been fatal.
Egypt: 59th human case of H5N1
infection confirmed [Mar 23 Elfath District]--The
Ministry of Health and Population, Egypt has reported a new
confirmed human case of Avian Influenza. The case is a 38-year old
female from Elfath District, Assiut Governorate. Her symptoms
started with a fever and headache on March 14. She was admitted to
Assiut Fever Hospital on March 14 where she was started on
oseltamivir the same day (March 14) and remains in a stable
condition. Infection with H5N1 avian influenza was confirmed on 18
March by the Egyptian Central Public Health Laboratory.
Investigations into the source of her infection indicate a history of
close contact with dead and sick poultry prior to becoming ill.
Of the 59 cases confirmed to date in Egypt, 23 have been fatal.
Egypt: Bird flu cases among
children raise concerns [Mar 17 Cairo]--An 18-month-old
child contracted the H5N1 bird flu virus on 10 March, bringing the
number of human cases in Egypt to 58 since records began in 2006,
and prompting the World Health Organization (WHO) to ask for a study
to be undertaken of the causes.
The child - from Manoufiya Province in northern Egypt - is one of
several recent cases of young children to have contracted the deadly
virus in a country where over five million families raise poultry
for a living.
Egyptian Health Ministry spokesman Abdel Rahman Shahin told IRIN the
girl exhibited symptoms of infection on 6 March after reported
contact with infected birds. She was taken to hospital on 9 March
and given the antiviral vaccine Tamiflu.
"Her case has stabilised but she will remain at the hospital for
further check-ups," Shahin said.
The child’s case is the latest in a rapidly growing number of cases
of child infection in Egypt, causing concern among WHO officials.
On 4 March, a two-year-old boy from the coastal city of Alexandria
(220km from Cairo) contracted the virus. The boy is being treated
with Tamiflu.
Another two-year-old boy from Fayum, 85km southwest of Cairo, was
infected by the virus on 1 March, Nasr al-Sayyid, the assistant
health minister, said.
According to the Egyptian Ministry of Health, five cases of bird flu
have been registered in 2009; 23 people have died from the virus
since records began in 2006.
The rapid growth rate of bird flu infections in children is
worrying, said John Jabbour, senior epidemiologist with WHO, which
is asking the Health Ministry to investigate why so many children
aged 2-3 are being infected.
Jabbour speculated that the reason for the increased number of cases
in this age group was that families were no longer as alert as
immediately after the last awareness campaign.
He warned that families with poultry must be on their guard at all
times, given UN Food and Agriculture Organization (FAO) warnings
that the H5N1 strain was endemic in poultry.
"This is a problem that will not go away in poultry, hence people
who deal with birds cannot afford to relax. Those who come in
contact with birds must make caution part of their daily routine,"
he said.
Changing the mindset
Jabbour said social behaviour and attitudes also played a vital role
in tackling bird flu. "We are not just fighting bird flu only; we
are also trying to change the mentality which says reporting a case
of bird flu infection in poultry will destroy income," he said.
Assistant Health Minister Sayyed said poultry keepers were often
reluctant to report suspected cases for fear that health officials
would cull not only their birds but those of neighbouring families.
Egypt does not run a compensation scheme for farmers who lose
poultry in a cull.
According to the latest WHO statistics, some 410 people in 15
countries and regions have contracted the virus and 256 of them have
died of the disease.
While H5N1 rarely infects people, experts fear it could mutate into
a form that could easily be passed from one person to another,
leading to a pandemic which could kill millions.
Egypt: 58th human case of H5N1
infection confirmed [Mar 11 Menofia]--The Ministry of
Health and Population of Egypt has reported a new confirmed human
case of avian influenza. The new case is a one and a half year old
female from Menofia Governorate. Her symptoms began on 6 March and
she was hospitalized on 9 March where she remains in a stable
condition. Infection with H5N1 avian influenza was confirmed on 10
March by the Egyptian Central Public Health Laboratory.
Investigations into the source of her infection indicate a history
of close contact with dead and sick poultry prior to becoming ill.
Of the 58 cases confirmed to date in Egypt, 23 have been fatal.
Egypt: 57th human case of H5N1
infection confirmed [Mar 11 Alexandria]--The Ministry of
Health and Population of Egypt has reported a new confirmed human
case of avian influenza. The new case is a two and a half year old
male from Amaria District, Alexandria Governorate. His symptoms
began on 3 March and he was hospitalized at Alexandria Fever
Hospital where he remains in a stable condition. Infection with H5N1
avian influenza was confirmed by the Egyptian Central Public Health
Laboratory on 4 March.
Investigations into the source of infection indicate a history of
close contact with dead and sick poultry prior to becoming ill.
Of the 57 cases confirmed to date in Egypt, 23 have been fatal.
Australia: Important discovery
in research for vax against bird flu [Mar 7 Melbourne
VIC]--A vaccine to protect humans from a bird flu pandemic may be
within reach after a new discovery by researchers at the University
of Melbourne, Australia
The discovery, published today in the prestigious Proceedings of the
National Academy of Sciences, reveals how boosting T cell immunity
could better protect humans from a bird flu pandemic.
The continued spread of the highly virulent "bird flu" virus has
experts worried that we are facing a new potential influenza
pandemic which could transfer between humans. Furthermore, given the
bird flu is new, there is no pre-existing immunity in the population
and current vaccine formulations would be useless.
"The 'Killer T cell' is the hit-man of the immune system. It is able
to locate and destroy virus-infected cells in our body helping rid
us of infection," said A/Prof Stephen Turner, from the Department of
Microbiology and Immunology at the University of Melbourne who is a
lead author on the paper.
"Unfortunately, current influenza vaccines are poor at inducing
killer T cell immunity. Therefore, we wanted to see if we could
improve the current vaccine formulation to induce killer T cells
after vaccination," he said.
"We added a compound, known to increase immunity, to the flu vaccine
in an animal model. The addition of this compound promoted
significant generation of potent killer T cell immunity and provided
protection from infection.
"The significance of these findings is that rather than having to
design a new vaccine altogether, we can improve current flu vaccines
by adding this potent immune modulator.
"With appropriate clinical testing, we could see improvements to
current vaccines within the next five years."
Dr Turner said the key to vaccine effectiveness was ensuring a match
between the vaccine and the current circulating flu strain. However,
the spike proteins varied over the course of a flu season rendering
the current vaccine ineffective. As such, the vaccine needs to be
updated every year to match the likely strain for that winter.
"It is a different situation for influenza pandemics. Pandemics
arise due to the introduction of a new influenza virus into human
circulation. As such, there is little or no pre-existing immunity to
the bird flu virus enabling it to spread rapidly."
"'Killer' T cells recognise components that are conserved between
different influenza viruses. Therefore, a vaccine strategy that
induced killer T cells pre-emptively would provide protection from a
potential pandemic."
India: Status report on avian
influenza outbreak for Mar 5 [Mar 6 West Bengal]--West
Bengal
District Darjeeling
Department of Animal Husbandry, Dairying & Fisheries, GOI has
notified Avian Influenza outbreak in Punding Forest Busty [block
Kurseong], district Darjeeling on 24th February, 2009. A central
Rapid Response Team of MoHFW has been deputed to assist the State
health authorities. Containment operations are on. Culling of birds
has been completed. A total of 644 birds have been culled. 54
cullers are under chemoprophylaxis.
Surveillance in 0-3 Km and 3-10 Kms is continuing. The total
population of 3448 in 0-3 Km area is covered on daily basis. 11
cases of fever/URI have been identified but none had exposure
history to dead/sick poultry. In 3-10 Km area population is covered
in phases. On 4.3.2009 a population of 11,325 have been covered and
no cases of URI/fever have been detected.
In the identified health facility, 14 cases of fever/URI have been
identified but none had exposure history to dead/sick poultry
The district authorities have been provided adequate logistics like
Oseltamivir capsules, PPE and N-95 masks.
District Dakshin Dinajpur
Central Rapid Response Team of MoHFW is assisting the state health
authorities. Culling activity has been completed on 21.2.2009. A
total of 8273 birds have been culled.
Surveillance activities is continuing in 0-3 Km and 3-10 Km. In 0-3
Km area the total population of 22251 is covered on daily basis. 5
cases of fever/URI have been identified on 4.3.2009 but none had
exposure history to dead/sick poultry. In 3-10 Km area surveillance
is conducted in phases. On 4.3.2009 a population of 50,044 have been
covered and 392 cases of fever/URI have been identified but none had
exposure history to dead/sick poultry
In the identified health facility, 88 cases of fever/URI have been
identified but none had exposure history to dead/sick poultry
State Govt. has adequate stock of Oseltamivir, personal protective
equipments etc.
Situation is being monitored on a daily basis.
China: Chicken carcass
confirmed positive for H5N1 [Mar 6 Tung Ping Chau]--A
spokesman for the Agriculture, Fisheries and Conservation Department
(AFCD) said today (March 6) that a chicken carcass found in Tung
Ping Chau was confirmed to be H5N1 positive after a series of
laboratory tests.
The carcass was found floating in the sea off Kang Lau Shek, Tung
Ping Chau, on March 2. It was highly decomposed when found and
required a series of confirmatory tests for avian influenza. Test
results available today confirmed that the dead bird was H5N1
positive.
The spokesman said there were no poultry farms within three
kilometres of where the dead bird was found. No unauthorised keeping
of poultry has been observed during inspections.
"The AFCD has contacted poultry farmers reminding them to strengthen
precautionary and biosecurity measures against avian influenza. Pet
bird shop owners, licence holders of pet poultry and racing pigeons
have also been reminded to take proper precautions," the spokesman
said.
The spokesman said the department would conduct frequent inspections
of poultry farms, the wholesale market and the Yuen Po Street Bird
Garden to ensure that proper precautions against avian influenza had
been implemented. The department would continue its wild bird
monitoring and surveillance.
The Food and Environmental Hygiene Department (FEHD) will continue
to be vigilant over imported live poultry as well as live poultry
stalls. It will also remind stall operators to maintain good
hygiene.
The Department of Health will enhance health education and
distribute health advice leaflets.
The AFCD, the FEHD, the Customs and Excise Department and the Police
will strive to deter the illegal import of poultry and birds into
Hong Kong to minimise the risk of avian influenza outbreaks brought
by imported poultry and birds that have not gone through inspection
and quarantine.
All relevant government departments will continue to remain highly
vigilant and strictly enforce preventive measures against avian
influenza.
"The public can call 1823 Call Centre for follow up if they come
across suspicious sick or dead birds, including carcasses of wild
birds and poultry," the spokesman said.
Members of the public are reminded to observe good personal hygiene.
They should avoid personal contact with wild birds and live poultry
and their droppings. They should clean their hands thoroughly after
coming into contact with them. Poultry and eggs should be thoroughly
cooked before consumption.
Advice on biosecurity measures for people working in poultry farms,
wholesale and retail markets and health advice for the public are
available at the "H5N1 Health Advice" of the AFCD's website at
www.afcd.gov.hk
The website also includes the latest information on the H5N1
infected birds found in Hong Kong this year.
China: Investigation group
releases report on avian influenza outbreak in Yuen Long chicken
farm [Mar 6 Hong Kong]--The Investigation Group on
Epidemiological Study appointed by the Secretary for Food and Health
today (March 5) released its report on the investigation into the
highly pathogenic avian influenza H5N1 outbreak in a chicken farm in
Ha Tsuen, Yuen Long, in December 2008.
The investigation group examined the details of the outbreak,
revisited the regulatory regime of poultry farms, analysed the virus
recovered from the index farm and test samples taken from other
local farms, and recommended improvement in biosecurity measures for
the index farm and other local farms.
Outlining the report findings on the avian influenza outbreak at a
press conference today, the convenor of the investigation group, Dr
Thomas Sit, said, "The investigation group noted that the outbreak
was confined to the index farm in Ha Tsuen. The outbreak was
detected early to enable immediate action to be taken to prevent
further spread of the disease. There was no indication of spread of
infection to other farms."
Genetic analyses showed that the virus belongs to the family Clade
2.3.4, a clade which is commonly found in the south China region.
The virus was most closely related to and shared a common ancestry
with isolates detected in poultry retail markets in Hong Kong in
June 2008 and a dead wild bird found in Tsing Yi in March 2008. No
mutation associated with virulence in mammals was found.
"As with many epidemiological studies of this nature, it is
difficult to determine the exact cause of the outbreak. The
investigation group considered that the H5N1 virus was most likely
to have been introduced to the farm by wild birds. Droppings of wild
birds could have contaminated the dust and dirt near the entrance of
one of the two affected sheds which was subsequently blown into the
shed area during windy days. Once the virus had gained entry, farm
workers could have contributed to its spread to the other shed via
contaminated hands/gloves and/or clothing," Dr Sit explained.
Also speaking at the press conference, the Director of Agriculture,
Fisheries and Conservation, Miss Cheung Siu-hing, noted that the
investigation had revealed some biosecurity vulnerabilities and
breaches on the index farm, including wild bird protection, and
possible non-compliance by workers with biosecurity measures
(including hand/glove hygiene) relating to entry into the chicken
sheds.
The investigation group recommended the following measures for
improving the biosecurity on the index farm:
* modify the structure of one of the affected sheds so that the shed
area is fully covered by its roof and add a solid partition on the
side facing north to protect against wind gusts;
* cover all open soak away pits and wells to avoid gathering of
aquatic birds on the farm; and
* improve bird protection facilities.
The investigation group also put forward improvements to biosecurity
measures for all poultry farms to strengthen the procedures for
prevention of avian influenza infection, which include:
* further tightening of biosecurity through tailor-made biosecurity
plans, record keeping in standard templates, provision of hand
washing facilities and refresher courses;
* facilitating early detection by increasing the inspection
frequency and sampling size of blood tests for vaccinated chickens;
and
* preventing spread of avian influenza through scattered
distribution of sentinels and segregating the operations relating to
the rearing of breeder and broiler flocks.
"The Agriculture, Fisheries and Conservation Department (AFCD) has
taken on board the recommendations and will facilitate the
implementation of enhanced biosecurity on local farms. Discussions
and planning with individual farmers are already underway.
"Biosecurity measures on the farms are one of the most important
preventive measures against the threat of avian influenza virus. We
call on the farmers to stay vigilant and comply with the biosecurity
requirements at all times. The AFCD will continue to work with them
and provide the necessary support," Miss Cheung said.
The investigation group's convenor was the Assistant Director of
Agriculture, Fisheries and Conservation (Inspection & Quarantine),
Dr Thomas Sit. Members of the group included the Head of the
Department of Microbiology of the University of Hong Kong, Professor
Yuen Kwok-yung; Head of the Laboratory Animal Unit of the University
of Hong Kong, Dr Lo King-shun; and representatives of the AFCD,
Department of Health and Food and Environmental Hygiene Department.
The full report has been uploaded onto the AFCD's website,
www.afcd.gov.hk
for public viewing.
China: SFH attaches great
importance to biosecurity of local chicken farms [Mar 6
Hong Kong]--The Secretary for Food and Health, Dr York Chow, said
today (March 5) that Hong Kong should continue to stay on full alert
and stringently implement various preventive measures against avian
influenza which posed an imminent threat to the world community.
"To help achieve such a task, the biosecurity measures of local
chicken farms will be vital to minimise the risk of avian
influenza," Dr Chow said.
He was commenting on the Epidemiology Report of the Agriculture,
Fisheries and Conservation Department (AFCD) on the outbreak of
highly pathogenic avian influenza H5N1 last December in a chicken
farm in Ha Tsuen, Yuen Long.
He said: "The findings of the report show that stringent biosecurity
measures play a crucial role in preventing outbreaks of avian
influenza in local farms."
Dr Chow noted the report made a number of recommendations for
improving the biosecurity standards and measures of local farms,
such as stepping up inspection on farms and blood tests on chickens
to ensure the health of chickens and reduce the chance of farm
workers being infected with avian influenza.
He added that the effective implementation of these new measures
would hinge on the joint efforts by the chicken farmers and the
Government which could enhance the farms' capability in safeguarding
against avian influenza.
He said: "I have asked the AFCD to maintain close liaison with
chicken farmers when implementing the recommendations and render
assistance to them to adapt to the new measures. It is hoped that
the new measures can be implemented smoothly and as soon as
possible."
In addition, the Government will carry out preventive measures to
rigorously guard against avian influenza at various levels,
including the import of live chickens, wholesale market and retail
outlets, with a view to protecting public health.
The Food and Health Bureau set up the Investigation Group on
Epidemiological Study, chaired by the Assistant Director of the AFCD,
Dr Thomas Sit, following the outbreak of highly pathogenic avian
influenza H5N1 at a chicken farm in Yuen Long.
The investigation group released the report today and made a number
of recommendations to further enhance the biosecurity measures of
local farms to guard against avian influenza.
India: Status report on avian
influenza outbreak for Mar 2 [Mar 4 West Bengal]--West
Bengal, District Darjeeling
Department of Animal Husbandry, Dairying & Fisheries, GOI has
notified fresh Avian Influenza outbreak in Punding Forest Busty
[block Kurseong], district Darjeeling on 24th February, 2009. A
central Rapid Response Team of MoHFW has been deputed to assist the
State health authorities. Containment operations are on. Culling of
birds has been completed. A total of 644 birds have been culled. 54
cullers are under chemoprophylaxis.
Surveillance in 0-3 Km and 3-10 Kms has started. The total
population of 3448 in 0-3 Km a population is covered on daily basis.
In 3-10 Km area population is covered in phases. Surveillance data
is awaited.
The district authorities have been provided adequate logistics like
Oseltamivir capsules, PPE and N-95 masks.
District Dakshin Dinajpur
Central Rapid Response Team of MoHFW is assisting the state health
authorities. Culling activity has been completed on 21.2.2009. A
total of 8273 birds have been culled.
Surveillance activities is continuing in 0-3 Km and 3-10 Km. In 0-3
Km area total population of 22251 is covered on daily basis. In 3-10
Km area surveillance is conducted in phases. Surveillance data is
awaited.
State Govt. has adequate stock of Oseltamivir, personal protective
equipments etc.
Situation is being monitored on a daily basis.
Egypt: 56th case of human
infection with H5N1 confirmed
[Mar 2 Cairo]-- The
Ministry of Health and Population of Egypt has reported a new
confirmed human case of avian influenza on 1 March 2009. The new
case is a two-year old male from Yousef el seddik district of Fayoum
Governorate whose symptoms began on 25 February.
He was hospitalized and treated at the Manshiet Elbakry general
hospital on 28 February and is currently in a critical condition.
Infection with H5N1 avian influenza was confirmed by the Egyptian
Central Public Health Laboratory on 1 March.
Investigations into the source of infection indicate a history of
close contact with dead and sick poultry prior to becoming ill.
Of the 56 cases confirmed to date in Egypt, 23 have been fatal.
Nepal: Bird flu returns
[Mar 2 Kathmandu]--Bird flu has reappeared in Jhapa District, nearly
500km south-east of the capital, Kathmandu, despite government
efforts to control the deadly virus.
The Himalayan nation confirmed its first case of the H5NI virus on
16 January.
Barely a week earlier the government reported that the risk had been
contained after culling more than 28,000 chickens and other birds in
the area.
But on 20 February, the Central Veterinary Laboratory in Kathmandu
and the World Organisation for Animal Health (OIE) Reference
Laboratory, Weybridge, in London confirmed the H5NI strain in six
chicken samples collected from a poultry farm in Sharamati Village
Development Committee (VDC) in the district. The samples had been
sent to the labs after 150 chickens died.
“Our rapid response team [RRT] has been working actively to control
the virus,” said senior government official Hari Dahal, a spokesman
for the Ministry of Agriculture and Cooperatives (MOAC), which is
leading control efforts.
According to the agriculture minister, the rapid response teams have
culled more than 1,000 chickens, ducks, pigeons and eggs in the
areas around Sharamati.
Places including Pathnapada, Biringkhola, Tangandubba and Mechetole,
near the Indian border in the south, have been declared emergency
areas.
The government hopes to complete the culling process soon given that
there are not many poultry farms with more than 9,000 chickens.
Growing concerns
However, even government officials expressed concern that as a
landlocked country, Nepal remained at risk given its geographical
proximity to China and India, which have a history of bird flu
epidemics.
A week ago, a team of experts from the UN Crisis Management
Centre-Animal Health (CMC-AH) warned of significant risks after
visiting affected areas in the eastern region in the first week of
February.
They stressed the urgent need for more laboratory equipment and
upgrades for effective diagnosis. In addition, there was a crucial
need for active surveillance.
Officials told IRIN the government was already planning a
three-month-long surveillance campaign in the affected areas. It has
also banned the transportation of poultry products countrywide.
The MOAC has issued strict instructions to officials to quarantine
border areas, with particular attention to the Nepal-India border,
which stretches about 1,800km in the south.
Meanwhile, the west of the country has also been put on high alert,
according to officials.
"There is no case of bird flu virus but we have been taking extra
precautions to avoid any risks,” said Muni Lal Chaudhary, chief of
the western region’s Regional Livestock Quarantine Office.
He explained that active testing of poultry had started on farms in
Banke, Bardiya and Dang districts and others, more than 500km west
of the capital.
At the same time, government teams have been mobilised to alert
local communities about the potential dangers.
According to the World Health Organization (WHO), since 2003 there
have been 408 confirmed human cases of avian influenza worldwide, of
whom 254 died.
WHO remains concerned that the H5N1 virus might mutate or combine
with a highly contagious seasonal influenza virus to spark a
pandemic that could kill millions of people.
Viet Nam: Death of previously
confirmed human case of H5N1 infection [Feb 27 Kim Son
district]--The Ministry of Health in Viet Nam has announced the
death of a previously confirmed case of H5N1 infection. The 32 year
old male from Kim Son district, Ninh Binh Province died on 25
February.
Of the 109 cases confirmed to date in Viet Nam, 54 have been fatal.
England: Avian influenza in
poultry on premises in East of England [Feb 26
London]--The Department for the Environment Food and Rural Affairs (Defra)
has today confirmed avian influenza in poultry on two premises in
the East of England.
Avian influenza remains predominantly a disease that affects birds
and there have been no reports at present of any illness in staff at
the poultry farm.
Early laboratory tests have ruled out the H5 and H7 strains. Further
investigations are underway.
As a precaution and until more definitive evidence is available, the
Agency has advised that a precautionary approach should be adopted –
staff should use high levels of personal protective equipment to
protect them from infection.
Nonetheless, any possibility of exposure is taken very seriously and
the local Health Protection Unit is working closely with the
premises owners, Defra and local NHS partners to ensure that all the
necessary actions are being taken to protect those people who may
have been exposed to the virus. We are also monitoring the health of
those exposed to the poultry and there have been no reports at
present of any flu like illness in staff.
Avian influenza, or 'bird flu', is a contagious disease of birds
caused by viruses that normally only infects wild birds and, rarely,
other species including domestic poultry. There is no evidence of
sustained human-to-human transmission.
Dr Joe Kearney, Regional Director of the HPA in the East of England
said: "Despite this occurrence the current level of risk to humans
from avian flu is extremely low. To date there has been no evidence
that current avian influenza viruses have adapted to spread easily
in humans."
Viet Nam: Death of a previously
confirmed human case of H5N1 infection [Feb 25 Dam Ha
District]--The Ministry of Health in Viet Nam has announced the
death of a previously confirmed case of H5N1 infection. The 23 year
old female from Dam Ha District, Quang Ninh Province died on 21
February.
Of the 109 cases confirmed to date in Viet Nam, 53 have been fatal.
China: Crested Myna confirmed
positive for H5N1 virus [Feb 20 Tung Ping Chau]--A
spokesman for the Agriculture, Fisheries and Conservation Department
(AFCD) said today (February 20) that a dead Crested Myna found in
Tung Ping Chau was confirmed to be H5N1 positive after a series of
laboratory tests.
Under the present avian influenza surveillance programme on dead
wild birds, the Crested Myna carcass was found and collected on
February 12 at Sha Tau, Tung Ping Chau.
"The public can call 1823 Call Centre for follow up if they come
across suspected sick or dead birds, including carcasses of wild
birds and poultry," the spokesman said.
Members of the public are reminded to observe good personal hygiene.
They should avoid personal contact with wild birds and live poultry
and their droppings. They should clean their hands thoroughly after
coming into contact with them. Poultry and eggs should be thoroughly
cooked before consumption.
Nepal: Avian influenza outbreak
contained but risks remain [Feb 18 Kathmandu]--The H5NI
virus has been brought under control after a month-long outbreak in
poultry in Jhapa district, nearly 500km south-east of the capital,
according to government officials.
The first confirmed case of bird flu reported in this Himalayan
nation was confirmed on 16 January in Kakarvitta town, Jhapa.
The government responded swiftly by culling more than 23,000
chickens as well as hundreds of pigeons, ducks and parrots, and
destroying over 5,000 eggs and hundreds of sacks of feed, according
to the Ministry of Health.
The swift response by a joint team of staff from the Ministry of
Agriculture and Cooperatives, the Ministry of Health and Population
and the UN World Health Organization (WHO) swiftly contained the
epidemic, said government officials.
"We have already banned production, consumption, sale and
transportation of poultry products in Jhapa," said Manash Kumar
Banarjee, coordinator of the World Bank-supported and government-run
Avian Influenza Control Project (AICP).
As an added precaution, the government conducted bird flu
assessments in major cities, including Kathmandu, Pokhara, Surkhet,
Rupendehi, Biratnagar and Sindhuli, where there are large poultry
markets, but found no evidence of the virus after examining more
than 100 samples, according to the AICP.
"The bird flu outbreak has been contained for now," said Pravakar
Pathak, director of the government-run Department of Livestock
Services.
Risks
However, the potential for new outbreaks is great, according to
avian influenza specialists.
A team of experts from the UN Crisis Management Centre-Animal Health
(CMC-AH) visited the country recently. CMC-AH was established in
October2006 by the UN Food and Agriculture Organization (FAO) with
the World Organisation for Animal Health (OIE) to enhance FAO's
ability to help countries prevent and cope with disease outbreaks.
The CMC-AH team stated after their assessment that while the
government's response was efficient and thorough, there were still
major risks of outbreaks.
"The response has been robust and with impressive speed but there is
still a need for … heightened awareness," said David Hadrill,
mission leader of CMC-AH.
Government officials have also said the country remained at risk
given that its neighbours, particularly China and India, have a
history of bird flu outbreaks. Nepal's huge poultry industry also
relies largely on imports from West Bengal and Bihar in India.
Ongoing concerns
Government officials expressed concern over the critical shortage of
trained veterinarians, the lack of adequate laboratories for testing
and supplies of disinfectants for spraying contaminated areas. There
is also a lack of communication equipment to increase public
awareness about prevention measures, they said.
The CMC-AH team agreed there was an urgent need for more lab
equipment, facility upgrades and consumables to safely and
effectively perform diagnostic assessments. It has recommended the
Nepalese government consider scenario planning and a financial fund
to deal with multiple outbreaks should they occur.
It added that the surveillance was very crucial in the coming months
and more resources should be allocated to training. The government
is already planning a three-month-long surveillance campaign in the
affected areas of east Nepal.
"Fortunately, the bird flu occurred in only one place [Jhapa]. We
would be unable to control the outbreak if it had taken place in
more than three places [simultaneously]," a government official, who
requested anonymity, told IRIN.
Viet Nam: 109th human case of
H5N1 infection confirmed [Feb 18 Kim Son district]--The
Ministry of Health in Viet Nam has reported a new confirmed case of
human infection with the H5N1 avian influenza virus. The case has
been confirmed at the National Institute of Hygiene and Epidemiology
(NIHE).
The case is a 32-year old man from Kim Son district, Ninh Binh
province. He developed symptoms on 5 February 2009 and was
hospitalized on 13 February 2009. He is currently in a serious
condition. The case is known to have had recent contact with sick
poultry prior to the onset of his illness.
Further investigations are currently underway. Control measures have
been implemented and close contacts are being identified and
monitored.
Of the 109 cases confirmed to date in Viet Nam, 52 have been fatal.
China: Preventive and control
measures on seasonal influenza and avian influenza - Q&A in the Hong
Kong Legislative Council [Feb 16 Hong Kong]--Following is
a question by the Hon Audrey Eu and an oral reply by the Secretary
for Food and Health, Dr York Chow, in the Legislative Council today
(February 11):
Question:
A number of confirmed cases of human infection of avian influenza
have occurred on the Mainland since January this year, resulting in
five deaths. At the same time, the World Health Organisation (WHO)
has indicated that there is an increasing likelihood of a major
global outbreak of influenza on a scale similar to that in 1968. In
this connection, will the Government inform this Council:
(a) of the latest information about the avian influenza epidemic on
the Mainland that the Government has obtained through the exchange
and notification mechanism on infectious diseases; and
(b) in the face of the recent spate of fatal avian influenza cases
on the Mainland and WHO's warning, what measures the Government will
take to prevent the outbreak of influenza and human infection of
avian influenza in Hong Kong?
Reply:
President,
Hon Eu's question touches on seasonal influenza and avian influenza.
First of all, I would like to explain the differences between the
two.
Seasonal influenza is caused by different strains of influenza virus
transmitted among people. There are three known categories of
influenza: A, B and C. The most common types of influenza in Hong
Kong are influenza A H1N1 and H3N2. Minor changes of the antigen of
influenza viruses every year lead to seasonal influenza. As such,
reformulation of the influenza vaccine is required every year to
cope with the mutation of viral strains. Influenza is mainly
transmitted through air or droplet in crowded and enclosed areas, or
through direct contact with the secretions of a person suffering
from the disease.
As for avian influenza, it is usually caused by influenza A H5N1 and
H9N2. While avian influenza normally infects birds, poultry are
especially vulnerable to infections resulting in epidemics.
According to the World Health Organisation (WHO), there have been
over 400 human cases of avian influenza H5N1 globally since 2003,
with the fatality rate of about 60%. Cases of human infection of
avian influenza are usually the result of close contact with live
poultry and their droppings. Wild birds are not a major channel of
spreading avian influenza to human. Up till now, there is no
epidemiological evidence to show that avian influenza can be
transmitted to humans through consumption of properly cooked poultry
according to WHO. Neither is there any evidence of efficient
human-to-human transmission of the virus. In the circumstances, our
strategy to prevent avian influenza is primarily on prevention of
poultry from avian influenza infection, and minimising contact
between the members of the public and live poultry.
An influenza pandemic occurs when there is an extensive
human-to-human transmission of a new influenza virus or an influenza
virus which has not been around for a long time. An influenza
pandemic takes large toll as the majority of the population lack
immunity to the virus.
My replies to the two parts of the question are as follows :
(a) As at February 10, the Department of Health (DH) has received
notifications from the Ministry of Health (MoH) concerning eight
confirmed human cases of avian influenza A H5N1 so far this year. Of
these cases, five were fatal. Investigations conducted by the
Mainland health authorities reveal that seven cases had contact with
diseased poultry or exposure history to live poultry market in the
Mainland prior to the onset of symptoms. The Mainland Government has
taken preventive and control measures accordingly, including placing
the close contacts of patients under medical surveillance and
carrying out epidemiological investigations. The MoH's investigation
reveals that all eight cases are sporadic cases without
epidemiological linkage and there are no obvious signs of
human-to-human transmission of the virus at the moment. Details of
the cases are at the Annex.
(b) To mitigate the effect of seasonal influenza, the Centre for
Health Protection (CHP) has been closely monitoring the local
influenza situation through different channels, including the
sentinel surveillance in general out-patient clinics, private
clinics, homes for the elderly, child care centres, etc.
We provide free influenza vaccination for some high-risk target
groups under the "Government Influenza Vaccination Programme" every
year. The "Influenza Vaccination Subsidy Scheme" was also launched
in November last year to provide government subsidies to encourage
young children to receive influenza vaccination at private clinics,
so as to reduce their risk of hospitalisation due to influenza.
In addition, at end of last year, we have stepped up our preventive
publicity and education efforts before the arrival of the winter
influenza season. The CHP has set up a dedicated webpage in its
website to publish the updated figures and information on the
influenza daily situation for public reference. The CHP also
disseminates relevant messages and guidelines to doctors, homes for
the elderly, hostels for people with disabilities, schools,
kindergartens and child care centres from time to time, so as to
strengthen the surveillance, prevention and control of influenza.
These measures have not only facilitated effective surveillance of
influenza in Hong Kong, but also significantly heightened public
alertness to influenza.
As for avian influenza, the Government has already put in place a
series of measures to reduce the risk of virus transmission from
poultry and birds to human. These measures include banning the
keeping of backyard poultry, requiring the compliance with
biosecurity measures in local farms, requiring vaccination for
chickens in local farms and imported chickens, banning the keeping
of live poultry overnight at retail level, as well as enhancing the
testing of antibodies for chickens in local farms and imported
chickens. Besides, we have also arranged influenza vaccination for
poultry workers and cullers to reduce the chance of genetic
reassortment between human and avian influenza viruses. We are also
actively pursuing the development of a poultry slaughtering plant to
achieve complete segregation of humans from live poultry.
In respect of surveillance, avian influenza H5, H7 and H9 are
currently notifiable infectious diseases under the Prevention and
Control of Disease Ordinance. In addition to statutory
notifications, the CHP also maintains close monitoring of the avian
influenza situation locally through various means including
laboratories and hospitals.
On the other hand, DH has implemented temperature screening for
in-bound travellers in all Immigration Control Points and will
conduct further assessment on those with fever or illness. For any
suspected avian influenza cases, rapid diagnosis using molecular
methods will be conducted by DH. Once avian influenza cases are
detected, the DH will conduct epidemiological investigations
promptly and take necessary control measures including contact
tracing, environmental investigation, finding the source of
infection and prevention of the spread of diseases.
We have all along been maintaining close communication and
co-operation with the Mainland and Macao health authorities to
ensure expeditious and effective exchange of important information
about infectious disease outbreaks and incidents of the three
places. Contingency measures have been taken to reduce the chance of
infectious disease outbreak. In addition, we have been maintaining
close liaison with WHO and the health authorities of other regions
to obtain the latest information on avian influenza cases. Regular
exercises and drills are also conducted to test and enhance the
emergency preparedness of government departments in case of public
health emergencies. Besides, health authorities in Hong Kong, the
Mainland and Macao organise joint exercises regularly to review the
emergency response and notification mechanism of the three places in
handling cross-boundary public health emergencies.
Despite the occasional cases of human infection of avian influenza
in other countries and places, there is no evidence yet of efficient
human-to-human transmission of the virus. We will continue to
minimise the risk of avian influenza and influenza pandemics through
the above measures.
China: Crested Myna tested
positive for H5 virus [Feb 16 Hong Kong]--Under the
present avian influenza surveillance programme on dead wild birds,
preliminary testing of a dead Crested Myna found in Tung Ping Chau
has indicated a suspected case of H5 avian influenza, a spokesman
for the Agriculture, Fisheries and Conservation Department (AFCD)
said today (February 15), adding that further confirmatory tests
were being conducted.
The bird carcass was collected at Shau Tau, Tung Ping Chau on
February 12.
The spokesman said there were no poultry farms within three
kilometres of where the dead bird was found.
"In view of the recent cases of H5N1 found in poultry and wild bird
carcasses, the AFCD has phoned poultry farmers reminding them to
strengthen precautionary and biosecurity measures against avian
influenza. Pet bird shop owners, licence holders of pet poultry and
racing pigeons have also been reminded to take proper precautions,"
the spokesman said.
The spokesman said the department would conduct frequent inspections
of poultry farms, the wholesale market and the Yuen Po Street Bird
Garden to ensure that proper precautions against avian influenza had
been implemented. The department would continue its wild bird
monitoring and surveillance.
The Food and Environmental Hygiene Department (FEHD) will continue
to be vigilant over imported live poultry as well as live poultry
stalls. It will also remind stall operators to maintain good
hygiene.
The Department of Health will enhance health education and
distribute health advice leaflets.
AFCD, FEHD, the Customs and Excise Department and the Police will
strive to deter the illegal import of poultry and birds into Hong
Kong to minimise the risk of avian influenza outbreaks brought by
imported poultry and birds that had not gone through inspection and
quarantine.
All relevant government departments will continue to remain highly
vigilant and strictly enforce preventive measures against avian
influenza.
"The public can call 1823 Call Centre for follow up if they come
across suspicious sick or dead birds, including carcasses of wild
birds and poultry," the spokesman said.
Members of the public are reminded to observe good personal hygiene.
They should avoid personal contact with wild birds and live poultry
and their droppings. They should clean their hands thoroughly after
coming into contact with them. Poultry and eggs should be thoroughly
cooked before consumption.
British Columbia: Presence of
H5 avian influenza in second commercial poultry detected
[Feb 14 Fraser Valley]-- On February 11th, the Canadian Food
Inspection Agency (CFIA) announced the presence of H5 avian
influenza virus in a second commercial poultry operation in southern
British Columbia.
All birds on the second infected premises have been humanely
destroyed and will be disposed of in accordance with provincial
environmental regulations and internationally accepted disease
control guidelines.
People are rarely affected by avian influenza, except in a limited
number of cases when individuals have been in close contact with
infected birds. Nevertheless, public health authorities are taking
precautionary measures as warranted.
Tests to date indicate the strain of avian influenza virus on the
second premises is of low pathogenicity and similar to the original
virus identified on the first infected premises. Further testing is
underway to confirm the precise pathogenicity, subtype and strain of
the virus.
The CFIA has applied movement restrictions on commercial poultry
operations within three kilometres of the second infected premises.
This new 3-km radius overlaps the 3-km radius previously established
around the first infected premises. The CFIA has placed quarantines
on an additional 12 premises as a result. Ten of the new quarantines
are within the new 3-km radius and two are for premises that have
had some contact with the second infected premises. Surveillance
activities will be undertaken of these newly quarantined premises
for a minimum of twenty-one days.
The total number of quarantined premises as of February 13, 2009 is
45.
Prior to moving poultry or poultry products off the quarantined
premises, birds must be sampled, tested negative and a license for
their movement must be issued by the CFIA.
Poultry owners in the area are encouraged to take an active role in
protecting their flocks by enhancing their biosecurity measures,
monitoring their flocks regularly and immediately reporting any
signs of illness that could be consistent with avian influenza by
calling 604-227-1753.
Viet Nam: 108th human case of
H5N1 infection confirmed [Feb 14 Dam Ha district]--The
Ministry of Health in Viet Nam has reported a new confirmed case of
human infection with the H5N1 avian influenza virus. The case has
been confirmed at the National Institute of Hygiene and Epidemiology
(NIHE).
The case is a 23-year old woman from Dam Ha district, Quang Ninh
province. She developed symptoms on 28 January 2009 and was
hospitalized on 31 January 2009. She is currently in a serious
condition and is known to have had recent contact with sick and dead
poultry prior to the onset of her illness. Further investigations
are currently underway. Control measures have been implemented and
close contacts are being identified and monitored.
Of the 108 cases confirmed to date in Viet Nam, 52 have been fatal.
Wisconsin: State ranks among
best in national pandemic flu report [Feb 9
Milwaukee]--Governor Jim Doyle today announced that Wisconsin ranked
among the top states in the nation for pandemic flu preparedness in
a 2008 assessment led by the U.S. Department of Health and Human
Services and submitted to the U.S. Homeland Security. The Department
of Health Services' Division of Public Health coordinated the
Pandemic Influenza Operations Plan that was submitted to federal
officials.
"Wisconsin had an impressive ranking in the top tier across 28
categories of pandemic planning activities," Governor Doyle said.
"This strong showing is a result of close, cooperative efforts among
many state and local partners. I have long advocated that our state
and local agencies work together to protect the health and safety of
Wisconsin residents. These results show that approach can pay big
dividends."
Governor Doyle noted some key strengths from the report:
* The Department of Health Services' ability to distribute and
dispense emergency medications and provide protective equipment to
health care workers
* The Department of Public Instruction's work with Wisconsin school
districts to better prepare staff, students and parents for a
pandemic
* The Department of Transportation's efforts were highlighted as a
model for pandemic planning.
* The Department of Military Affairs received high marks for its
ability to share critical information with partners.
Governor Doyle credited the hard work of state staff, local
officials and private sector partners for the high marks in the
preparedness report.
To view the report, go to
http://www.pandemic.wisconsin.gov/
Planning information for individual, families, communities and
businesses can also be found on that site.
Wisconsin: Op-ed as state
receives high marks for pandemic flu preparedness [Feb 9
Milwaukee] by Karen Timberlake, Secretary, Wisconsin Dept of Health
Services--Planning and preparing for emergencies is a continual
process that requires the efforts of federal, state and local
officials. In Wisconsin, we are fortunate to have dedicated partners
that plan, test and exercise preparedness plans that cover a variety
of emergencies, both man made and acts of nature. One of these
emergencies that we plan for is a pandemic flu outbreak.
Recently, Wisconsin's hard work on disaster preparedness and
pandemic flu planning has been recognized nationally. As a result,
our counterparts in other states are modeling the success that
Wisconsin has achieved.
Last December, the Trust for America's Health gave Wisconsin a
perfect score on 10 key preparedness indicators. The report, Ready
or Not, noted improvement in pandemic influenza planning, public
risk communication, disease tracking and tactical communication.
Wisconsin's State Laboratory of Hygiene was praised as "a
first-class operation."
Also, an assessment done in 2008 led by the U.S. Department of
Health and Human Services and submitted to U.S. Homeland Security
ranked Wisconsin among the top states in the nation for pandemic flu
preparedness
Both achievements reflect the hard work of state agencies, local
government and the private sector. For example, receiving and
distributing medications in a public health emergency requires an
orchestrated ballet involving Federal strike teams, state health
officials, Wisconsin's National Guard and State Patrol, local health
departments, healthcare providers, distribution sites, and a
volunteer medical support corps.
Public health, public safety and law enforcement professionals are
planning with businesses, utilities, health care providers,
education and community-service organizations to respond "as one" to
emergencies.
This professionalism and can-do attitude not only helps us prepare
for emergencies that have not yet occurred, but is also demonstrated
by the response to real events that happen in our state now.
Wisconsin's prompt response to last spring's large scale flooding
emphasizes our progress. Thirty counties suffered closed highways,
destroyed homes, contaminated wells, and disruption of business and
tourism.
Throughout the crisis, local, state and federal officials worked
together with each community to save lives, control damage, prevent
disease and injury, supplement human services, and support economic
relief. Intensive prior planning, training and drills helped shape
this response. The lessons learned this time will further improve
our response to the state's next emergency.
We will continue to work with our partners across the state to
continue to prepare and test so that we can help serve the citizens
of our state effectively. We also encourage you to think about what
you can do in your home and community to prepare yourself.
President Eisenhower once said, "Plans are useless but planning is
indispensable." Relationships and skills developed through plans and
drills pay off in unexpected ways during any incident. We look
forward to continuing to work with our partners on the federal,
local and statewide level to help continue our preparation to help
the citizens of our state when they are in need.
Egypt: 55th human case of H5N1
infection confirmed [Feb 9 Cairo]--The Ministry of Health
and Population of Egypt has announced a new human case of avian
influenza A(H5N1) virus infection. The case is a one and a half year
old male from the Maghagha District of Menia Governorate. His
symptoms began on 6 February and he was hospitalized at the Maghagha
Fever Hospital on 7 February where he remains in a stable condition.
Infection with the H5N1 avian influenza virus was confirmed by the
Egyptian Central Public Health Laboratory.
Investigations into the source of his infection indicate a history
of close contact with dead poultry prior to becoming ill.
Of the 55 cases confirmed to date in Egypt, 23 have been fatal.
Egypt: 54th human case of H5N1
infection confirmed [Feb 6 Cairo]--The Ministry of Health
and Population of Egypt has announced a new human case of avian
influenza A(H5N1) virus infection. The case is a 2-year-old male
from Suez Governorate, Ganain District. His symptoms began on 2
February and he was hospitalized at the Suez Fever Hospital on 3
February. He remains in a stable condition. Infection with the H5N1
avian influenza virus was confirmed by the Egyptian Central Public
Health Laboratory.
Investigations into the source of his infection indicate a recent
history of contact with dead poultry.
Of the 54 cases confirmed to date in Egypt, 23 have been fatal.
China: Latest avian influenza
tests positive for three more dead birds
[Feb 5 Hong
Kong]--Under the present surveillance programme on dead wild birds,
preliminary testing of three bird carcasses collected in the past
few days has indicated suspected cases of H5 avian influenza, a
spokesman for the Agriculture, Fisheries and Conservation Department
(AFCD) said today (February 5), adding that further confirmatory
tests were being conducted.
The bird carcasses included a Grey Heron, a Peregrine Falcon and a
chicken.
The spokesman said the dead Grey Heron was collected at Mai Po
Nature Reserve on February 2. There is a chicken farm within three
kilometres of where the bird was found. AFCD has immediately
dispatched staff to inspect the farm and found no abnormal mortality
or symptoms of avian influenza among the chicken flocks. The farm
will be put under enhanced surveillance.
"As a precautionary measure, the Mai Po Nature Reserve will be
temporarily closed to visitors for 21 days starting tomorrow. We
will monitor the situation closely and review the closure period as
necessary," the spokesman said.
On February 3, AFCD staff collected the dead Peregrine Falcon near
Long Beach Gardens, Ting Kau, Castle Peak Road, Tsuen Wan and the
dead chicken in Butterfly Beach, Tuen Mun respectively. There were
no poultry farms within three kilometers of where the two dead birds
were found.
The spokesman said that two more dead chickens were found at Lung
Kwu Tan, Tuen Mun today, adding that preliminary tests for the H5
virus will be arranged.
As regards the avian influenza test results of the 20 bird carcasses
collected on Lantau from February 1 to February 4, preliminary
testing showed that three chickens and two ducks were suspected of
the H5 virus and further confirmatory tests were being conducted; a
duck was confirmed to be H5N1 positive; seven birds tested negative
for the H5 virus; and the test on the remaining seven birds is still
going on.
Separately, AFCD staff collected a dead chicken and a dead duck in
San Shek Wan today. Preliminary tests for the H5 virus are being
arranged.
AFCD staff inspected 169 villages in Hong Kong today and found two
live chickens illegally kept by a man in a household at Ng Ka Tsuen,
Pat Heung. The man will be prosecuted under the Public Health
(Animals and Birds) Ordinance for unauthorised keeping of poultry.
During the inspection, one live chicken in San Uk Tsuen, Fanling and
five live pigeons in Kam Sheung Road, Pat Heung were found
unattended. After taking samples for testing, AFCD has disposed of
all the poultry.
The spokesman said a ban on backyard poultry has been in force since
2006. Unauthorised keeping of five kinds of poultry -chickens,
ducks, geese, pigeons or quails – is an offence with a maximum fine
of $50,000. Repeat offenders are subject to a maximum fine of
$100,000.
All relevant government departments will continue to remain highly
vigilant and strictly enforce preventive measures against avian
influenza.
"The public can call 1823 Call Centre for follow up if they come
across suspicious sick or dead birds, including carcasses of wild
birds and poultry," the spokesman said.
The spokesman reminded the public to observe good personal hygiene
and avoid contact with wild birds or live poultry.
___
Following is the transcript of remarks made by the Secretary for
Food and Health, Dr York Chow, at a stand-up media session after
attending Hospital Authority Spring Gathering 2009 today
(February 5):
Reporter: (inaudible)
Secretary for Food and Health: It is very difficult to postulate
where the three carcasses came from. But from the various
investigations we have done, it is most likely drifting down from
the Pearl River in the last week or two. Some of the new carcasses
we have found are still under investigation. So far we have not
found any extra H5 affected carcasses. But as you know that we are
doing wild bird and dead bird surveillance all the time. We test
about 40 to 80 dead birds all over the territory every day. These
include both those we have discovered in North Lantau and other
areas. If we found any positive test results, we will announce right
away. Every year we found some 10 to 20 such cases. As long as they
are limited to wild birds, the risk to Hong Kong people is not that
high because it has not been reported that wild birds can transmit
the disease directly to human beings. It is usually through
infection of poultry, and then the sick poultry would affect human
beings.
Reporter: (about the risk of avian influenza)
Secretary for Food and Health: I don’t think so because the whole
region is still under the threat of avian flu, particularly during
the whole winter. It is usually after May that the whole region
starts to warm up, we will then see a decline of these incidents.
Reporter: (about the H5N1 virus)
Secretary for Food and Health: Let me talk about the virus samples
we have collected so far. In the three carcasses which we have
isolated the virus, the preliminary discovery is that it is related
to a similar type of virus that happened in the southern part of
China in the last two years, which is clade 2.3.2. But it is
slightly different from what we have discovered last year in our
market and the outbreak in our local farm in December, which is
clade 2.3.4. But these are quite common clades of avian flu in the
southern part of China and Hong Kong. It is certain that there is no
significant mutation of the virus. That is actually what we have
discovered so far. On the eight human infections of avian flu in the
Mainland, we do not have the full report yet. But according to the
preliminary information that is given to us, it is similar to the
various virus that was isolated in northern China in the last one or
two years. So there is no significant epigenic mutation. As far as
the nature of the virus is concerned, we are confident that at this
moment there is no evidence of human to human transmission and no
significant epigenic change.
Reporter: (inaudible)
Secretary for Food and Health: What I have told you is that the
virus has not changed that much. Whether the poultry and reaction to
the virus, and whether the type of vaccine that is given to the
various poultry in different parts of China might have slightly
different response, these are something that we cannot conclude at
this moment.
Reporter: The threat of avian influenza is still there, right?
Secretary for Food and Health: The threat is always there. We should
always be vigilant against infectious diseases, particularly new
diseases. For avian flu, the most important aspect is to prevent
any people from approaching sick poultry or poultry from unknown
source. This is the most important point I want to stress. If we can
stay away from live poultry, particularly sick poultry or poultry
from unknown source, I think we are pretty safe. I hope this will be
the message you can tell all the citizens, particularly those who
might have a habit of shopping in places where the poultry might
come from unknown source, whether it is in Hong Kong or across the
border. This is a very important message for them.
China: Dead goose and two dead
ducks test positive for H5N1 virus
[Feb 4 Shan Lo Wan]--A
spokesman for the Agriculture, Fisheries and Conservation Department
(AFCD) said today (February 4) that the dead goose and two dead
ducks found in Sha Lo Wan, Lantau last week were confirmed to be
H5N1 positive after a series of laboratory tests.
AFCD staff collected the carcasses of a goose and a duck on January
29 at a beach near Sha Lo Wan football pitch. Another dead duck was
found on January 31 at the same location.
The spokesman said that two more dead chickens were collected on the
coast opposite Yeung Hau Temple in Tai O, Lantau today, adding that
preliminary tests for the H5 virus are being arranged.
AFCD will continue to closely monitor the situation and investigate
into the possible causes of the recent discovery of bird carcasses.
The inspections in North Lantau have been completed and no
unauthorised keeping of poultry has been observed. Separately, AFCD
staff inspected 321 villages in Hong Kong today. Five live chickens
and two live ducks were found unattended in Cheung Po, Kam Tin.
After taking samples for testing, AFCD has disposed of all the
poultry.
The spokesman said a ban on backyard poultry has been in force since
2006. Unauthorised keeping of five kinds of poultry -chickens,
ducks, geese, pigeons or quails – is an offence with a maximum fine
of $50,000. Repeat offenders are subject to a maximum fine of
$100,000.
"The public can call 1823 Call Centre for follow up if they come
across suspicious sick or dead birds, including carcasses of wild
birds and poultry," the spokesman said.
"They should avoid contact with wild birds or live poultry," the
spokesman said.
China: Human infection of bird
flu reported in central China [Feb 4 Xupu County]--A
21-year-old female farmer was confirmed infected with bird flu in
central China's Hunan Province, said the provincial health bureau on
Saturday.
The farmer, surnamed Shu, fell ill on Jan. 23 in Xupu County of the
province and was hospitalized at the county's People's Hospital on
Jan. 26, said a statement from the bureau.
Shu was transferred to a hospital in Changsha, capital of the
province, on Thursday. So far she has been in a stable condition and
become better.
According to the test result on Friday from the Chinese Center for
Disease Control and Prevention, the farmer tested positive for the
H5N1 strain of avian influenza.
An investigation found that Shu had contact with fowls that died of
disease before becoming sick.
Hunan has launched an emergency response against the virus. Those
who had close contact with the patient are under medical
observation, but none of them has been found ill so far.
The Health Ministry said it had reported the case to the World
Health Organization (WHO) and informed the health authorities of
China's Hong Kong and Macao special administrative regions and
relevant countries.
According to the health department of Hunan province, a patient from
Guizhou province was diagnosed to be infected with bird flu in
Huaihua of Hunan on January 19, who died a day later.
China reported five deaths from bird flu this year. The rest were a
19-year-old woman in Beijing on Jan. 5, a 27-year-old woman in
Shandong on Jan. 17, a 31-year-old woman in Xinjiang on Jan. 23and
an 18-year-old man in Guangxi on Jan. 26.
According to statistics from WHO, China has reported an accumulated
number of bird flu cases of 38 since 2003, with 25 deaths. The year
2006 saw the peak of bird flu reports by China, with 13 cases and 8
deaths.
China: Fifth death from bird
flu reported in south China [Feb 4 Beijing]--An
18-year-old man died from bird flu on Monday in south China's
Guangxi Zhuang Autonomous Region, the fifth human death from the
H5N1 virus in China this year.
According to a press release posted on the website of the Ministry
of Health, the man surnamed Liang fell ill on Jan. 19 in Beiliu City
of Guangxi.
Liang was transferred to Yulin Municipal Red Cross Hospital on Jan.
24. He died on Monday.
The young man tested positive for the H5N1 strain of avian
influenza, according to the test result on Monday from the Chinese
Center for Disease Control and Prevention.
The ministry said it had reported the case to the World Health
Organization and informed the health authorities of China's Hong
Kong and Macao special administrative regions.
China: SW province reports
sixth human bird flu case in 2009 [Feb 4 Guiyang]--A
29-year-old man had been confirmed as infected with bird flu in
southwest China's Guizhou Province, the sixth case of human bird flu
found in China this year, local authorities said Sunday.
The man, surnamed Zhou, fell ill on Jan. 15 in Guiyang City, the
provincial capital. He was then sent to Guizhou Provincial People's
Hospital, said a provincial health department official.
The man is still in a critical condition, the official said.
Zhou tested positive for the H5N1 strain of avian influenza,
according to the test result on Sunday from the Chinese Center for
Disease Control and Prevention.
Guizhou has launched an emergency response against the virus. Those
who had close contact with the patient are under medical
observation. No one has been found ill so far.
China's Ministry of Health has reported the case to the World Health
Organization and informed the health authorities of the Hong Kong
and Macao special administrative regions.
China: Eighteen persons with
contact of dead birds put under medical surveillance [Jan
31 Sha Lo Wan]--Following the finding of dead birds in Sha Lo Wan,
Lantau, the Centre for Health Protection (CHP) of the Department of
Health is liaising with the Agriculture, Fisheries and Conservation
Department in tracing people who had potential contact with the dead
birds suspected of being infected with H5 avian influenza.
CHP contacted six members of the public who reported the incident
and 12 staff involved in the operation of collecting dead birds.
Seventeen of them are asymptomatic and have been put under medical
surveillance, a CHP spokesman said today (January 31).
The 26-year-old driver who had participated in collecting the dead
birds on January 29 developed fever and symptoms of upper
respiratory infection since January 27. He denied having contacted
with the birds during the operation.
Given the fact that the driver developed symptoms two days before
the operation, the spokesman noted that the chance of him being
infected with avian flu was low.
“However, as a precautionary measure and in order to follow up his
condition more closely, the driver has been admitted to the Princess
Margaret Hospital for observation and further investigation,” he
added.
The spokesman reminded members of the public to remain vigilant
against avian influenza infection and to observe the following
measures:
* Avoid direct contact with poultry and birds or their droppings; if
contacts have been made, they should wash hands thoroughly with soap
and water;
* Poultry and eggs should be thoroughly cooked before eating;
* Wash hands frequently;
* Cover nose and mouth while sneezing or coughing, hold the spit
with tissue and put it into covered dustbins;
* Avoid crowded places and contact with sick people with fever;
* Wear a mask when you have respiratory symptoms or need to take
care of patients with fever; and
* When you have fever and influenza-like illnesses during a trip or
when coming back to Hong Kong, you should consult doctors promptly
and reveal your travel history.
China: Carcasses of a goose and
two ducks tested positive for H5 virus [Jan 31 Sha Lo
Wan]--Preliminary testing of a dead goose and two dead ducks found
in Sha Lo Wan, Lantau has indicated a suspected case of H5 avian
influenza, a spokesman for the Agriculture, Fisheries and
Conservation Department (AFCD) said today (January 31), adding that
further confirmatory tests were being conducted.
The carcasses of a goose and a duck were found and collected on
January 29 at a beach near Sha Lo Wan football pitch. They were
highly decomposed when being found. Today AFCD staff collected
another dead duck at the same location.
The spokesman said there were no poultry farms within three
kilometres of where the carcasses were found. This morning AFCD
staff conducted inspection of the beach and the nearby villages of
Sha Lo Wan Tsuen and Sha Lo Wan San Tsuen. There was no evidence of
any backyard poultry being kept there.
AFCD is very concerned about the incident and will continue to
monitor the situation. Inspections of the beach and its vicinity
will be stepped up. The department is looking into different
possibilities of why the goose and duck carcasses were found at the
beach, including whether they had been washed ashore or dumped.
The spokesman said a ban on backyard poultry has been in force since
2006. Unauthorised keeping of five kinds of poultry -chickens,
ducks, geese, pigeons or quails – is an offence with a maximum fine
of $50,000. Repeat offenders are subject to a maximum fine of
$100,000.
"The public can call 1823 Call Centre for follow up if they come
across suspicious sick or dead birds, including carcasses of wild
birds and poultry," the spokesman said.
The Centre for Health Protection of the Department of Health (DH) is
contacting relevant parties and has put them under medical
surveillance. People are advised to consult their doctors for
medical advice promptly if they develop symptoms of influenza.
Members of the public are reminded to observe good personal hygiene.
They should avoid personal contact with wild birds and live poultry
and their droppings. They should clean their hands thoroughly after
coming into contact with them. Poultry and eggs should be thoroughly
cooked before consumption.
"In view of the case, the AFCD has phoned poultry farmers reminding
them to strengthen precautionary and biosecurity measures against
avian influenza. Pet bird shop owners, licence holders of pet
poultry and racing pigeons have also been reminded to take proper
precautions," the spokesman said.
The spokesman said that the department would conduct frequent
inspections of poultry farms, the wholesale market and the Yuen Po
Street Bird Garden to ensure that proper precautions against avian
influenza had been implemented. The department would continue its
wild bird monitoring and surveillance.
The Food and Environmental Hygiene Department (FEHD) will continue
to be vigilant over imported live poultry as well as live poultry
stalls. It will also remind stall operators to maintain good
hygiene.
DH will enhance health education and distribute health advice
leaflets.
AFCD, FEHD, the Customs and Excise Department and the Police will
strive to deter the illegal import of poultry and birds into Hong
Kong to minimise the risk of avian influenza outbreaks brought by
imported poultry and birds that had not gone through inspection and
quarantine.
The spokesman said the threat of avian influenza remained. The
relevant departments will remain vigilant and continue to strictly
implement preventive and control measures against avian influenza.
China: Notification of a human
case of H5N1 in Hunan Province [Jan 31 Hong Kong]--The
Centre for Health Protection (CHP) of the Department of Health
received notification from Ministry of Health (MoH) tonight (January
31) concerning a confirmed human case of avian influenza H5N1.
A CHP spokesman said the patient was a 21-year-old farmer living in
Xupu, Hunan. She developed symptoms on January 23. She is now
receiving medical treatment. She is in stable condition. She had a
history of exposure to dead sick poultry before onset of symptoms.
Laboratory tests on the patient's specimen by Chinese Centre for
Diseases Control and Prevention yielded positive to H5N1.
Further investigations on her contact history with poultry before
the onset of symptoms are on-going.
The CHP is maintaining close liaison with the MoH to obtain more
information on the case.
The spokesman reminded members of the public to remain vigilant
against avian influenza infection and to observe the following
measures:
* Avoid direct contact with poultry and birds or their droppings; if
contacts have been made, they should wash hands thoroughly with soap
and water;
* Poultry and eggs should be thoroughly cooked before eating;
* Wash hands frequently;
* Cover nose and mouth while sneezing or coughing, hold the spit
with tissue and put it into covered dustbins;
* Avoid crowded places and contact with sick people with fever;
* Wear a mask when you have respiratory symptoms or need to take
care of patients with fever;
* When you have fever and influenza-like illnesses during a trip or
when coming back to Hong Kong, you should consult doctors promptly
and reveal your travel history.
Nepal: On alert against bird
flu [Jan 29 Kathmandu]--The authorities in southeastern
Nepal are stepping up anti-bird flu measures after the first case of
a bird found to have the deadly H5NI virus was discovered earlier
this month. There have been no reports of humans affected.
To date 26 out of 75 districts in the densely populated Terai region
in the south of the country bordering India have been placed on high
alert.
The move follows the virus’s detection in the town of Kakarvitta,
Jhapa District, bordering on the Indian state of West Bengal, nearly
450km southeast of Kathmandu, on 16 January.
“We are taking all measures to prevent further infections among
birds,” said Manas Kumar Banerjee, coordinator of the Health
Ministry’s Avian Influenza Control Project (AICP).
An emergency cabinet meeting on 19 January ordered the culling of
all birds within 3km of Kakarvitta. As of 26 January, more than
23,000 had been culled. All poultry meat, eggs and production
facilities in the area were to be destroyed.
Ban on Indian products
Nepal has been concerned about a possible outbreak since India
reported its first case in 2006: Large amounts of poultry were
imported from the Indian states of West Bengal and Bihar, but Nepal
has now banned the import of all poultry products from its neighbour.
The Word Health Organization (WHO) described a January 2008 outbreak
of bird flu in West Bengal as the worst ever in India.
The decision to ban poultry products would remain in tact unless
international institutions certified that an epidemic no longer
existed in India, according to Dalaram Pradhan, director-general at
the government’s Department of Livestock Services (DLS).
The authorities have also warned Nepalese traders against illegally
importing birds, promising firm action against violators.
Police and health officials have started checking vehicles suspected
of carrying birds or poultry meat from India, and more than 50
families with coughs or respiratory problems have been investigated.
Kathmandu has sought New Delhi's help in controlling the spread of
bird flu, as well as stopping the illegal export of birds.
Preparedness
Since 2006 when bird flu was detected in India, the AICP has been
supported by the UN and World Bank, and the latter has provided a
grant of more than US$18 million for the AICP over four years.
Although there have been bans by the authorities on the import of
Indian poultry and eggs, they were very poorly implemented, said a
local public health expert.
In the past the UN has warned that Nepal was vulnerable, given the
large number of migrating birds.
According to the WHO, since 2003 there have been 399 confirmed human
cases of avian influenza worldwide, of whom 251 died.
WHO remains concerned that the H5N1 virus might mutate or combine
with a highly contagious seasonal influenza virus to spark a
pandemic that could kill millions of people.
Europe: Avian influenza in
China - assessment of recent human cases of H5N1 [Jan 28
Stockholm Sweden]--PUBLIC HEALTH ISSUE: Assessment of the
epidemiological situation in China in relation with 4 confirmed
human cases of influenza A(H5N1) reported in 3 weeks.
DISEASE BACKGROUND INFORMATION
After initial cases in Hong Kong in May 1997, the first human case
of avian influenza A (H5N1) (fatal) in mainland China was reported
in 2003. Since then, 8 cases (5 fatal) were reported in 2005, 13 (8
fatal) in 2006, 5 (3 fatal) in 2007, and 4 cases (all fatal) in
2008. Of the 34 cases confirmed by January 19th in China, 22 were
known to have died (WHO published data).
EVENT BACKGROUND INFORMATION
Including the last 2008 case reported on 7th January 2009, in
Chaoyang District, Beijing Province, China has reported 4 confirmed
cases of influenza A (H5N1) in humans in the past 3 weeks:
* The first case in this temporal series is a 19 year old female in
Chaoyang, Beijing Province, for which exposure to live birds is
documented. She became sick on 24 December 2008, was hospitalised in
Beijing and died there 5 January 2009. The case was reported by WHO
on 7 January
* The second case is a 27 year old female from Jinan City, Shandong
Province. She developed symptoms on 5 January, was hospitalized, and
died on 17 January. The source of her infection is presently under
investigation.
* The third case is a 2 year old female from Luliang City, Shanxi
Province. She developed symptoms on 7 January, was hospitalized, and
is in a critical condition. The source of her infection is presently
under investigation.
* The fourth case is a 16 year old male from Huaihua City, Hunan
Province. He developed symptoms on 8 January, was hospitalized on 16
January, and was reported by WHO to be in a critical condition.
There are informal reports in China that he died on 20 January. The
case had documented exposure to sick and dead poultry.
All 4 H5N1 cases were confirmed by the national laboratory at China
CDC and have been reported by WHO. All contacts have been placed
under medical observation and remain healthy to date. Retrospective
investigations indicated the mother of case three (the 2 year old
girl) had died recently of pneumonia.
ECDC ASSESSMENT OF SITUATION
The occurrence of four or more human cases of avian influenza in a
three week period represents a change in the recent reporting
pattern in China. However aside from a possible mother and child
pair (Case 3) the cases are not related epidemiologically.
The change in number of reports could result from:
* a change in the level of exposure of populations, resulting in
increased number of human cases;
* a change in the characteristics of the virus resulting in an
increased transmission to and among humans;
* an enhancement of the detection, testing and reporting pattern of
cases.
Potential increased exposure
The occurrence of cases of human A(H5N1) cases is known to be more
frequent at this time of year in many countries where highly
pathogenic avian influenza A(H5N1) virus strains are circulating
among poultry and increases in H5N1 poultry outbreaks have been
noted. Besides, preparation for the ‘spring festival’ (‘Chinese New
Year’) taking place at the end of January 2009 always involves a
brisk increase in poultry trade and movements of people, resulting
in increased exposures to poultry for those involved.
Potential increased transmissibility
There is so far no indication of person-to-person transmission
documented in association with these cases aside from the probable
mother and child pair (Case 3). However potential exposures for
cases are still under investigation. Associated cases, if detected
and confirmed, could be related to co-exposure to A(H5N1) virus
infected poultry or in the environment. It should be noted that
limited, non sustained human-to-human transmission of A(H5N1) can be
demonstrated and that has been observed in China and other countries
going back to the Hong Kong cases in 1997.(1-4) Therefore, there is
no indication so far of a change in the transmissibility of A(H5N1)
virus in China, but the same watchfulness must be sustained.
Potential increased detection
ECDC has no indication of a formal change in the detection and
reporting pattern in China. However, the reporting of cases in the
media may increase health care provider referral and testing for
suspected cases of avian influenza A(H5N1) virus infection. Also,
testing capability for human A(H5N1) has become more available at
the provincial level in China.
Cases of human infection by A(H5N1) have been reported in urban
areas in China since 2005 without any obvious association with sick
or dead poultry and has been though to be associated with
environmental contamination, especially in poultry markets. This may
contribute to more cases being identified or equally to missing
isolated human cases. However any such reporting effects should have
less of an impact effect on detection of clusters of human cases.
Increased awareness and testing may have contributed to increase the
efficiency of detection.
China has implemented since 2007 a massive programme of vaccination
of commercial and domestic poultry involving billions of birds
annually. Poultry vaccination is considered to protect birds but not
to eliminate infection. Sometimes it can mask the circulation of
H5N1 in poultry, albeit at lower levels than in unimmunised birds,
and alter the appearance of disease in poultry.
This may further contribute to human cases occurring without seeming
exposure to sick and dead birds. This is making surveillance for
human cases harder as the marker of sick poultry or die-offs has
been lost.
There are strong economic and social reasons behind poultry
immunisation since it reduces the need for culling. It is not
entirely clear how it affects the overall level of risk of isolated
human cases. Where poultry vaccination is carried out well and with
good monitoring of poultry (e.g. in Viet Nam) introduction of
immunisation has been associated with dramatic falls in numbers of
human cases though there are undoubtably other factors contributing.
Equally where it is carried out in an unsystematic way (e.g. in
Indonesia) in it considered one of a number of reasons that are
allowing human cases to continue to occur.
Information on the pattern of vaccination and monitoring for virus
circulation in China beyond that already available would assist in
interpretation of human reports. Such data should be collected when
investigating human cases.
Travellers to China and other affected countries should be reminded
of the importance of following ECDC’s guidance of not handling
poultry and not visiting live poultry markets without practising
good hygiene
http://ecdc.europa.eu/en/Health_Topics/avian_influenza/travelling.pdf.
CONCLUSIONS
These four confirmed cases of avian influenza A(H5N1) in humans all
occurred in geographically distinct areas of China. The cases are
epidemiologically unrelated though one of them may represent a
mother and child pair.
The occurrence of these temporally associated 4 cases in three weeks
does not indicate a change in the characteristics of the H5N1 virus,
but more probably the result of a combination of factors. These are
(1) a natural increase observed at this time each year, (2)
increased exposure of populations in contact with poultry in the
context of the preparation for the Chinese New Year, perhaps
complicated (3) by heightened awareness and testing of potential
cases.
More cases may occur in the coming weeks as the Chinese New Year
will result in large scale travel of populations and in trade and
preparation of poultry.
Such sporadic cases are expected in a country where avian influenza
is entrenched. While these cases not represent any increase in risk
to Europe from A(H5N1) equally there has been no diminution of that
risk. There needs to be continued vigilance and ECDC, working with
WHO, animal health colleagues and international partners will
monitor the situation carefully.
China: 35th, 36th, and 37th
confirmed human cases with H5N1 [Jan 27 Urumqi]--The
Ministry of Health in China has announced three new confirmed human
cases of H5N1 infection. The first, a 31-year-old female from
Urumqi, Xinjiang Autonomous Region had onset of symptoms on 10
January. She received treatment in hospital but died on 23 January.
Investigations into the possible source of her infection indicate
recent visits to a live poultry market. The local authorities are
currently conducting epidemiological investigations and close
contacts are being monitored. To date, no clinical symptoms have
been reported among the contacts.
The second case is a 29-year-old male from Guiyang city, Guizhou. He had
onset of symptoms on 15 January and remains in a critical condition.
Investigations into the source of his infection indicate possible exposure
at poultry market.
The third case is an 18-year-old male from Beiliu City, Guangxi Province.
He had onset of symptoms on 19 January and died on 26 January.
Investigations into the source of his infection indicate a recent history of
exposure to sick and dead poultry. Close contacts of the case are being
monitored and to date all remain well.
Of the 37 cases confirmed to date in China, 25 have been fatal.
India: Status report on Avian
influenza outbreak in Sikkim
[Jan 27 Ravlonga Municipality]--Department of Animal Husbandry,
Dairying and Fisheries has notified outbreak of Avian Influenza in
poultry in the Hospital Road locality of Ravongla Municipality in
South Sikkim District on 19.1.2009. Containment measures are
continuing.
• Culling started on 20.1.2009 and so far 4091 birds have been
culled. Culling operations are over.
• 142 Animal health workers involved in culling operations are on
chemoprophylaxis.
• Active house to house human surveillance is continuing. In 0-3 Km
area the total population of 5171 is being covered on daily basis.
Seven case of URI with fever has been identified but has no exposure
history.
• In the 3-10 km area the total population is 19699 out of which
9732 were covered on 25.01.2009. Twenty six cases of fever with URI
have been detected but none of them has any history of exposure to
infected poultry.
• In the identified health facility at PHC Ravongla, six cases were
identified with URI and fever but have no exposure history.
• Isolation facilities have been set up at PHC Ravongla. Critical
care treatment facility has been strengthened in STNM Hospital,
Gangtok. Two ventilators have been supplied by MOHFW to strengthen
this centre.
• IEC material for print and visual media in Nepali language has
been provided to the State Govt.
• There is adequate stock of Oseltamivir and PPE with the State.
• Daily reports are received from the Control Room established in
Ravongla.
• The central rapid response team from MOHFW is assisting the local
health authorities. Situation is monitored on a daily basis. As of
now there is no suspect human case of avian influenza.
Egypt: 53rd confirmed case of
human infection with H5N1
[Jan 26 Cairo]--The Ministry of
Health and Population of Egypt has announced a new human case of
avian influenza A(H5N1) virus infection. The case is a 2-year-old
female from Manofia Governorate, Shebin Elkom District. Her symptoms
began on 23 January and she was immediately hospitalized. She
remains in a stable condition. Infection with the H5N1 avian
influenza virus was confirmed by the Egyptian Central Public Health
Laboratory.
Investigations into the source of her infection indicate a recent
history of contact with sick and dead poultry.
Of the 53 cases confirmed to date in Egypt, 23 have been fatal.
Indonesia: 140th and 141st
confirmed cases of human infection with H5N1 [Jan 22
Tangerang District]-- The Ministry of Health of Indonesia has
announced two new confirmed cases of human infection with the H5N1
avian influenza virus. A 29-year-old female from Tangerang District,
Banten Province developed symptoms on 11 December 2008, was
hospitalized on 13 December and died on 16 December. The
investigation indicated that she visited a wet market to buy fresh
produce, including chicken meat, on a daily basis. Household
contacts were placed under medical observation, where none developed
illness.
The second case, a 5-year-old female from Bekasi City, West Java
Province developed symptoms on 23 December 2008, was hospitalized on
27 Dec 2008 and died on 2 January 2009. The investigation indicated
that she visited a wet market to buy chicken meat and eggs two days
prior to symptom onset. Contacts were placed under medical
observation, where none developed illness.
Laboratory tests confirmed the presence of the H5N1 avian influenza
virus in both cases.
Of the 141 cases confirmed to date in Indonesia, 115 have been
fatal.
China: Chinese mainland, HK,
Macao SARs test emergency response to avian flu
[Dec 23 Hong Kong]--Health authorities of the Chinese mainland, Hong
Kong and Macao Tuesday conducted a joint exercise to test their
co-operation and co-ordination in the event of a cross-boundary
incident of avian flu involving human cases.
Code-named "Exercise Great Wall 2008", the exercise was jointly
organized by the Ministry of Health, the Health Bureau of Zhejiang
Province, the Health Bureau of Macao, and the Food and Health
Bureau, the Department of Health and the Hospital Authority of Hong
Kong.
Over 60 public health officials and medical personnel took part in
the exercise.
The scenario of the exercise unfolded when a 48-year-old man and his
13-year-old daughter living in Hong Kong were confirmed to have been
infected with avian influenza virus after visiting the man's wife in
the Chinese mainland.
The man's wife was also confirmed to have been infected by the
disease later on.
In the exercise, the Hong Kong government activated the " Serious
Response Level" and notified their counterparts on the Chinese
mainland and in Macao of the cases.
In order to control and prevent the spread of the disease, health
authorities of the Chinese mainland, Hong Kong and Macao immediately
initiated a series of public health measures including investigation
and control of the outbreak, management of patients and exchange of
information.
During the exercise, emergency responses, including notification of
different counterparts, epidemiological investigation of the
affected patients, contact tracing and medical surveillance for
probable cases, were tested through telecommunication facilities.
The exercise ended when experts exchanged information on their
respective actions and the situation was brought under control with
no new cases detected.
This is the third joint exercise organized under the Co- operation
Agreement on Response Mechanism for Public Health Emergencies signed
by the Chinese mainland, Hong Kong and Macao in 2005.
United States: HHS releases
guidance for use and stockpiling of antiviral drugs for pandemic
influenza
[Dec 18 Washington DC]--Health care workers and emergency services
personnel who could have direct contact with individuals who are ill
during an influenza pandemic should be protected with antiviral
drugs throughout the pandemic, even before these workers are exposed
or become ill themselves, according to guidance released today by
the U.S. Department of Health and Human Services.
Stockpiling these antiviral drugs and planning for their use is the
responsibility of employers as part of comprehensive pandemic
preparedness, the guidance said.
The guidance also recommends preventive antiviral drug use for
certain individuals following exposure to someone who is sick with
pandemic influenza. These individuals include people with weakened
immune systems, as well as for health care and emergency services
workers such as law enforcement, firefighters, and emergency
services personnel who do not routinely come in contact with ill
people, and for residents in nursing homes, prisons, and other group
residential settings if an outbreak of pandemic illness occurs in
the facility.
HHS continues to recommend using antiviral drugs to treat people
with pandemic influenza illness as a way to slow the spread of
pandemic disease. National and state antiviral drug stockpiles,
intended primarily for these uses, contain enough antiviral drugs
for more than 72 million people.
By placing responsibility on employers, the new antiviral drug
guidance highlights the importance of preparedness within both the
public and private sectors.
“Planning and preparing for a pandemic influenza requires action by
every part of society, including individuals and families,
communities, and private sector employers as well as all levels of
government,” said Dr. Craig Vanderwagen, HHS assistant secretary for
preparedness and response, a rear admiral in the U.S. Public Health
Service. “Employers will play a key role in protecting employees’
health and safety, which in turn reduces the impact of a pandemic on
the nation’s health, the economy and society.”
In a related document, HHS provided recommendations for employers to
consider broadly, suggesting that antiviral drugs may be part of a
comprehensive pandemic preparedness plan and describing how an
antiviral drug strategy could be implemented.
“Businesses should have a plan in place for responding immediately
at the first sign a pandemic to be sure the business can protect the
health of the workforce and continue to operate,” Vanderwagen said.
“Employers may want to consider stockpiling antiviral drugs as one
part of that plan.”
Using antiviral drugs may provide an additional layer of protection
during a pandemic, along with advising sick employees to stay home
and promoting changes in behaviors and work practices to reduce
close contact between people and to improve hygiene, such as hand
washing.
The HHS guidance recommends that employers have a clear
understanding of the legal, regulatory, ethical, logistical, medical
and economic issues involved in ordering, storing, securing, and
dispensing prescription medications. The guidance also urges
employers to work with their health providers or health services,
and state and local health departments, to plan any stockpiling of
antiviral drugs.
Federal officials developed the new guidance with major input from
state, local, territorial, and tribal public health experts.
Proposed guidance was shared broadly with health care and emergency
services organizations, and other businesses, and further input was
received during a public comment period; antiviral drug
manufacturers were not involved in the development of the new
guidance.
The guidance is not intended as a mandate, but provides
recommendations for a prudent approach to planning for and
responding to an influenza pandemic. Today’s guidance and
accompanying considerations for employers replaces the previous
antiviral drug use recommendations that are included in the 2005 HHS
Pandemic Influenza Preparedness and Response Plan.
Egypt: 51st confirmed case of
human infection with H5N1
[Dec 17 Cairo]-- The Ministry of Health and Population of Egypt has
announced a new human case of avian influenza A(H5N1) virus
infection.
The case is a 16-year-old female from Assuit Governorate, Upper
Egypt whose symptoms began on 8 December 2008. She was initially
hospitalized at the district hospital on 11 December and then
transferred to the Assuit University Hospital on 13 December where
she died on 15 December.
Infection with the H5N1 avian influenza virus was diagnosed by PCR
at the Egyptian Central Public Health Laboratory and subsequently
confirmed by the US Naval Medical Research Unit No. 3 (NAMRU-3)
laboratories on 15 December 2008. Investigations into the source of
her infection indicate a recent history of contact with sick and
dead poultry.
Of the 51 cases confirmed to date in Egypt, 23 have been fatal.
Cambodia: 8th confirmed case of
human infection with H5N1
[Dec 12 Kandal Province]--The Ministry of Health of Cambodia has
announced a new confirmed case of human infection with the H5N1
avian influenza virus.
The 19-year-old male, from Kandal Province, developed symptoms on 28
November and initially sought medical attention at a local health
centre on 30 November. The presence of the H5N1 virus was confirmed
by the National Influenza Centre, the Institut Pasteur in Cambodia,
on 11 December. The patient is currently hospitalised and a team led
by the Ministry of Health is conducting field investigations into
the source of his infection. Contacts of the case are also being
identified and provided with prophylaxis.
Of the 8 cases confirmed to date in Cambodia, 7 have been fatal.
Indonesia: 138th and 139th
confirmed cases of human infection with H5N1
[Dec 9 Jakarta]--The Ministry of Health of Indonesia has announced
two new confirmed cases of human infection with the H5N1 avian
influenza virus. A 9-year-old female from Riau Province developed
symptoms on 7 November and was hospitalized on 12 November. She
recovered and was discharged from hospital on 27 November.
Laboratory tests confirmed the presence of the H5N1 avian influenza
virus. Investigations into the source of her infection indicate
poultry deaths at her home on 2 November.
The second case, a 2-year-old female from East Jakarta, developed
symptoms on 18 November, was hospitalized on 26 November and died on 29
November. Laboratory tests have confirmed infection with the H5N1 avian
influenza virus. Initial investigations into the source of her infection
suggest exposure at a live bird market.
Of the 139 cases confirmed to date in Indonesia, 113 have been fatal.
Common cold virus came from
birds
[Nov 23 Rotterdam The Netherlands]--A virus that causes cold-like
symptoms in humans originated in birds and may have crossed the
species barrier around 200 years ago, according to an article
published in the December issue of the Journal of General Virology.
Scientists hope their findings will help us understand how
potentially deadly viruses emerge in humans.
"Human metapneumovirus may be the second most common cause of lower
respiratory infection in young children. Studies have shown that by
the age of five, virtually all children have been exposed to the
virus and re-infections appear to be common," said Professor Dr
Fouchier. "We have identified sites on some virus proteins that we
can monitor to help identify future dominant strains of the virus."
Human metapneumovirus is related to the respiratory syncytial virus,
measles, mumps and parainfluenza viruses. It infects people of all
ages but is most common in children under five. Symptoms include
runny nose, cough, sore throat and fever. Infection can also lead to
more severe illnesses such as bronchitis and pneumonia, which can
result in hospitalisation, especially in infants and
immunocompromised patients. HMPV infection is most common during the
winter and it is believed to cause up to 10% of respiratory
illnesses in children.
"HMPV was first discovered in 2001, but studies have shown that the
virus has been circulating in humans for at least 50 years," said
Professor Dr Ron Fouchier from ErasmusMC in Rotterdam, The
Netherlands. "HMPV is closely related to Avian metapneumovirus C (AMPV-C),
which infects birds. Because of the similarity, scientists have
suggested that HMPV emerged from a bird virus that crossed the
species barrier to infect humans."
Metapneumoviruses have high evolutionary rates, similar to those of
other RNA viruses such as influenza, hepatitis C and SARS. By
understanding the evolution and emergence of these viruses the
scientists hope to develop ways of monitoring and predicting the
emergence of new pathogenic viruses.
"We investigated the evolutionary history of metapneumoviruses using
genetic information available for numerous strains of HMPV and AMPV-C
circulating in humans and birds," said Professor Dr Fouchier. "We
calculated that the moment of divergence between HMPV and AMPV-C
occurred approximately 200 years ago. Therefore, HMPV probably
originates from an AMPV-C like virus that crossed the species
barrier to infect humans around that time."
"Besides the evolutionary history of metapneumoviruses, we also
investigated the mutation rates and the selection pressures of these
viruses. An understanding of how viruses evolve and how they adapt
to new hosts and their immune systems is important, especially if we
are to prepare for new, potentially pandemic diseases."
Global: Study of ancient and
modern plagues finds common features
[Nov 23 Bethesda MD]--In 430 B.C., a new and deadly disease—its
cause remains a mystery—swept into Athens. The walled Greek
city-state was teeming with citizens, soldiers and refugees of the
war then raging between Athens and Sparta. As streets filled with
corpses, social order broke down. Over the next three years, the
illness returned twice and Athens lost a third of its population. It
lost the war too. The Plague of Athens marked the beginning of the
end of the Golden Age of Greece.
The Plague of Athens is one of 10 historically notable outbreaks
described in an article in The Lancet Infectious Diseases by authors
from the National Institute of Allergy and Infectious Diseases (NIAID),
part of the National Institutes of Health. The phenomenon of
widespread, socially disruptive disease outbreaks has a long history
prior to HIV/AIDS, severe acute respiratory syndrome (SARS), H5N1
avian influenza and other emerging diseases of the modern era, note
the authors.
"There appear to be common determinants of disease emergence that
transcend time, place and human progress," says NIAID Director
Anthony S. Fauci, M.D., one of the study authors.
For example, international trade and troop movement during wartime
played a role in both the emergence of the Plague of Athens as well
as in the spread of influenza during the pandemic of 1918-19. Other
factors underlying many instances of emergent diseases are poverty,
lack of political will, and changes in climate, ecosystems and land
use, the authors contend.
"A better understanding of these determinants is essential for our
preparedness for the next emerging or re-emerging disease that will
inevitably confront us," says Dr. Fauci.
"The art of predicting disease emergence is not well developed,"
says David Morens, M.D., another NIAID author. "We know, however,
that the mixture of determinants is becoming ever more complex, and
out of this increased complexity comes increased opportunity for
diseases to reach epidemic proportions quickly."
For example, more people travel more often over greater distances
and in less time now than at any time in the past. One consequence
of the increased mobility in the modern age can be seen in the 2003
outbreak of the novel illness SARS, which rapidly spread from Hong
Kong to Toronto and elsewhere as infected passengers traveled by
air.
To better understand and predict disease emergence, Dr. Morens and
his coauthors stress the need for research aimed at broadly
understanding infectious diseases as well as specifically
understanding how disease-causing microorganisms make the jump from
animals to humans.
In a narrow sense, epidemics are caused by particular
microorganisms, and the study of infectious disease has historically
been microbe-focused. For example, the Black Death (bubonic plague),
which killed some 34 million Europeans in the middle of the 14th
century, was caused by the bacterium Yersinia pestis.
In a broader sense, however, epidemics are caused by complex and not
fully predictable interactions between the disease-causing microbe,
the human host and multiple environmental factors, the authors note.
The Black Death, for instance, was borne westward along newly
established land and sea trade routes from its probable origin,
China, into multiple European countries.
Similarly, patterns of human movement along trade routes,
specifically truck routes throughout Africa, played a role in the
spread of HIV throughout that continent.
Greater consideration must be given, say the NIAID authors, to
broader, interlinked factors such as climate, urbanization,
increased international travel and the rise of drug-resistant
microbes, and the ways in which these factors combine to spark new
epidemics.
Aside from commerce and travel, the NIAID authors point to several
other factors that underlie many notable emerging diseases: poverty,
the breakdown of public hygiene practices, and susceptibility of
human populations to microbes against which they have no
pre-existing immunity.
This last factor played a key role in the smallpox epidemic that
afflicted the Aztecs of 16th century Mexico. Smallpox had ravaged
European communities for centuries, but until the Spanish arrived on
the Yucatan coast in 1519, the disease was unknown in the New World.
Historians believe that some 3.5 million people in central Mexico
died in the first year of the epidemic.
Epidemics also can spur advances in public health, note the authors.
They point to the yellow fever epidemics of 1793-98, which began in
the then-U.S. capital, Philadelphia. Though the entire federal
government and most Philadelphians fled, those who remained formed
an emergency government and mobilized such marginalized groups as
African-Americans and immigrants to fight the outbreak.
In 1798, Congress established the Marine Hospital System—forerunner
of the modern U.S. Public Health Service—to provide, at public
expense, medical care for sick and injured merchant seamen.
Historians generally agree that a prime impetus for creating the
Marine Hospital System was the yellow fever epidemics.
Modern epidemiology began in reaction to another epidemic, says Dr.
Morens. In the early 1830s, as cholera made its way along waterways
from Asia towards Europe, French officials attempted to prepare
their country in advance of an outbreak. Teams of scientists were
sent to Poland and Russia to observe the outbreaks there. Throughout
France, coastal health agencies and new quarantine stations were
established; in Paris, a network of health inspection offices was
created to coordinate inspection of wells, cesspools and latrines of
both public and private buildings.
Despite these efforts, cholera arrived in Paris on March 29, 1832,
with explosive effect—within two weeks, there were 1,000 cases, 85
percent of them fatal. Daily newspapers published lists of cases
allowing armchair epidemiologists to see trends in illness and
deaths.
"For the first time in history," write the NIAID authors, "a
large-scale emerging epidemic was scientifically investigated in
'real time' using census data in a prospective population-based
approach that featured analyses of morbidity and mortality
stratified by age-group, sex, occupation, socioeconomic status and
location."
Reference: DM Morens,
GK Folkers and AS Fauci. Emerging infections: A perpetual challenge.
The Lancet Infectious Diseases DOI: 10.1016/S1473-3099(08)70256-1
(2008).
Egypt: Contingency planning for
an avian flu pandemic [Nov 22 Cairo]--Egypt, the country
hit hardest by avian flu in the Middle East, is working on
preventative measures to stop a potential human influenza pandemic.
The government, the UN World Health Organization (WHO), the Food and
Agriculture Organization (FAO) and the World Organisation for Animal
Health (OIE) have put together a national contingency plan to boost
rapid containment procedures, and build capacity to cope with a
pandemic.
A potential human influenza pandemic could come about if the H5N1
bird flu virus mutates to allow human to human transmission.
Training exercises - involving the simulated conditions of a
pandemic - are being organised in all 26 governorates. So far
training teams have been formed and assigned to the governorates of
al-Beheria, Menia, Gharbiya, Munufiya, and Sharqiya.
Muhammad Fawzi, director of a committee at the Centre for Future
Studies - a government research institution with representatives
from the ministries of defence, military production, health and
population, interior affairs, environment, and foreign affairs -
worked with governors to create the plan, based on WHO and Egyptian
government recommendations.
“The two main concerns should a pandemic occur would be to keep the
functions and services of the state running while containing the
spread of the pandemic in the most efficient manner. We came up with
a series of probable outcomes in case of a pandemic and from there
began envisioning solutions with necessary procedural, executive
responses from the state and the governors,” Fawzi told IRIN in
Cairo.
Critical decisions
Key officials have been designated who would make critical decisions
such as when to utilise defence forces to maintain security and
order in affected areas, or checkpoints at borders between
governorates, or when to block certain public services to reduce the
spread of the pandemic, Fawzi said.
John Jabbour, a consultant for emerging diseases at WHO, told IRIN
Egypt’s preparations appeared to be on the right track: “We have
seen very good progress from the Ministry of Health and
governorates. Their plan encompasses a macro and micro dimension at
the national and sub-national level: from the top executive level of
the state down to the single role of every village doctor and the
response team assisting him,” he said.
Simulation exercises
Desk simulation exercises conducted by the Health Ministry and WHO
medical teams in Gharbiya (northwest of Cairo) and Munufiya (south
of Gharbiya and north of Cairo) were deemed successful by WHO in
testing the tracking methods and reporting procedures of hospitals
and police stations in the two governorates. The Munufiya and
Gharbiya pandemic plans were recommended as models for other
governorates.
Zuhar Hallaj, an acting WHO representative, however, is concerned
about the extent to which desk simulations are adequate forms of
preparation.
“The experiences of Munufiya and Gharbiya are successful by WHO’s
standards.” said Hallaj. “However, these are desk exercises carried
[out] over the course of a day. No field simulation exercises have
been carried out and we need to ensure that governorates which have
had no cases of infection are as prepared as the ones that did
report infection.”
WHO has repeatedly advised the Health Ministry to carry out field
simulation exercises. Initially, the government’s Information and
Decision Support Centre advised against these for fear of causing
panic among residents.
“Field exercises are difficult to carry out because there is bound
to be a misunderstanding or rumour through the media that an actual
pandemic has hit the area where the field exercise is occurring,”
said Fawzi. “This would cause a huge dilemma for security and order
in Egypt.”
Vaccine
Both WHO and the Health Ministry predict that a vaccination for the
human to human virus would be available, but in limited quantities.
“The maximum global level of vaccine production is 900 million
vaccines. This is certainly not enough for the whole world should a
global pandemic hit,” warns Hallaj.
The humanitarian implications are serious. Since vaccine
manufacturers would probably pass on only small amounts to
developing countries, countries like Egypt would have to give
vaccination priority to a select few, according to the pandemic
preparedness plan.
“Key persons whose prospective illness would be costly to the
functioning of main services and government institutions will be
given vaccination priority. The rest of the population would be
treated with Tamiflu which would be used as chemoprophylaxis”
(preventative medication as oppose to treatment of infection), said
Hallaj.
Business continuity plans have also been put in place: “Any
disruption in key services could cause Egypt trillions of dollars in
losses. We have to ensure that people can still draw money from
banks and ATM machines during a pandemic; that food and medical
supplies are available, water and electricity are running,” Amr
Qandil, a WHO representative at the Ministry of Health, said.
1918 Spanish flu records could
hold the key to solving future pandemics [Nov 10
Melbourne VIC]--Ninety years after Australian scientists began their
race to stop the spread of Spanish flu in Australia, University of
Melbourne researchers are hoping records from the 1918 epidemic may
hold the key to preventing future deadly pandemic outbreaks.
This month marks the 90th anniversary of the return of Australian
WWI troops from Europe, sparking Australian scientists' race to try
and contain a local outbreak of the pandemic, which killed 50
million people worldwide.
Researchers from the University of Melbourne's Melbourne School of
Population Health, supported by a National Health and Medical
Research Council grant, are analysing UK data from the three waves
of the pandemic in 1918 and 1919.
They hope that modern high-speed computing and mathematical modeling
techniques will help them solve some of the questions about the
pandemic which have puzzled scientists for close to a century.
Professorial Fellow John Mathews and colleagues are analysing the
records of 24,000 people collected from 12 locations in the UK
during the Spanish flu outbreak including Cambridge University,
public boarding schools and elementary schools.
He says gaining a better understanding of how and why the virus
spread will help health authorities make decisions about how to
tackle future pandemics.
"In the 1918/19 pandemic, mortality was greatest among previously
healthy young adults, when normally you would expect that elderly
people would be the most likely to die,'' Professor Mathews says "We
don't really understand why children and older adults were at lesser
risk.
"One explanation may be that children were protected by innate
immunity while older people may have been exposed to a similar virus
in the decades before 1890 which gave them partial but long-lasting
protection.
"Those born after 1890 were young adults in 1918. They did not have
the innate immunity of children and as they weren't exposed to the
pre-1890 virus they had little or no immunity against the 1918
virus. We can't prove it but it is a plausible explanation."
Another striking feature is that the pandemic appeared in three
waves, in the summer and autumn of 1918 and then the following
winter.
One theory being examined to explain why some people were only
affected in the second or third wave is that because of recent
exposure to seasonal influenza virus they had short-lived protection
against the new pandemic virus.
"The attack rates in the big cities weren't as high and this is
probably because many people had been exposed to ordinary flu
viruses, giving short-lived immunity,'' he says.
"In the English boarding schools, where there was social
demarcation, children were probably less exposed to seasonal
influenza viruses in earlier years; without that protection,
pandemic attack rates were much higher than in ordinary government
elementary schools.
"If we can provide a detailed time course of epidemics and the
attack rates at different times, that information can be extremely
useful in determining how a future pandemic might progress,'' says
Professor Mathews.
He says initial findings point strongly to the value of short-lived
immunity to provide protection or partial protection against the
early waves of a virus.
This is particularly important when considering the stockpiling of
drugs and vaccines to protect the community against a virus.
"The early implications of our study are that there may be benefit
in providing short-lived immunity that is broadly based rather than
specific,'' he says. "If another flu pandemic were to come along and
you have a vaccine, it may be better to use it even if it is against
a different sub-type of the virus."
Genetics provide evidence for
the movement of avian influenza viruses from Asia to North America
via migratory birds [Oct 31 Reston VA]--Wild migratory
birds may be more important carriers of avian influenza viruses from
continent to continent than previously thought, according to new
scientific research that has important implications for highly
pathogenic avian influenza virus surveillance in North America.
As part of a multi-pronged research effort to understand the role of
migratory birds in the transfer of avian influenza viruses between
Asia and North America, scientists with the U.S. Geological Survey (USGS),
in collaboration with the U.S. Fish and Wildlife Service in Alaska
and the University of Tokyo, have found genetic evidence for the
movement of Asian forms of avian influenza to Alaska by northern
pintail ducks.
In an article published this week in Molecular Ecology, USGS
scientists observed that nearly half of the low pathogenic avian
influenza viruses found in wild northern pintail ducks in Alaska
contained at least one (of eight) gene segments that were more
closely related to Asian than to North American strains of avian
influenza.
It was a highly pathogenic form of the H5N1 avian influenza virus
that spread across Asia to Europe and Africa over the past decade,
causing the deaths of 245 people and raising concerns of a possible
human pandemic. The role of migratory birds in moving the highly
pathogenic virus to other geographic areas has been a subject of
debate among scientists. Disagreement has focused on how likely it
is for H5N1 to disperse among continents via wild birds.
"Although some previous research has led to speculation that
intercontinental transfer of avian influenza viruses from Asia to
North America via wild birds is rare, this study challenges that,"
said Chris Franson, a research wildlife biologist with the USGS
National Wildlife Health Center and co-author of the study. Franson
added that most of the previous studies examined bird species that
are not transcontinental migrants or were from mid-latitude locales
in North America, regions far removed from sources of Asian strains
of avian influenza.
Scientists with the USGS, in collaboration with the U.S. Fish and
Wildlife Service, state agencies, and Alaska native communities,
obtained samples from more than 1,400 northern pintails from
locations throughout Alaska. Samples containing viruses were then
analyzed and compared to virus samples taken from other birds in
North America and Eastern Asia where northern pintails are known to
winter. Researchers chose northern pintails as the focus of the
study because they are fairly common in North America and Asia, they
are frequently infected by low pathogenic avian influenza, and they
are known to migrate between North America and Asia. None of the
samples were found to contain completely Asian-origin viruses and
none were highly pathogenic.
"This kind of genetic analysis - using the low pathogenic strains of
avian influenza virus commonly found in wild birds - can answer
questions not only about the migratory movements of wild birds, but
the degree of virus exchange that takes place between continents,
provided the right species and geographic locations are sampled,"
said John Pearce, a research wildlife biologist with the USGS Alaska
Science Center and co-author of the study. "Furthermore, this
research validates our current surveillance sampling process for
highly pathogenic avian influenza in Alaska and demonstrates that
genetic analysis can be used as an effective tool to further refine
surveillance plans across North America, Pearce added.
Implications of the Research:
* Migratory bird species, including many waterfowl and shorebirds,
that frequently carry low pathogenic avian influenza and migrate
between continents may carry Asian strains of the virus along their
migratory pathways to North America.
* USGS researchers found that nearly half of influenza viruses
isolated from northern pintail ducks in Alaska contained at least
one of eight virus genes that were more closely related to Asian
than North American strains. None of the samples contained
completely Asian-origin viruses and none were highly pathogenic
forms that have caused deaths of domestic poultry and humans.
* The central location of Alaska in relation to Asian and North
American migratory flyways may explain the higher frequency of Asian
lineages observed in this study in comparison to more southerly
locations in North America. Thus, continued surveillance for highly
pathogenic viruses via sampling of wild birds in Alaska is
warranted.
Future surveillance for avian influenza in wild birds should include
the type of genetic analyses used in this study to better understand
patterns of migratory connectivity between Asia and North America
and virus ecology.
Website for USGS northern pintail
avian influenza research.
Avian flu threat: New approach
needed [Oct 24 London England]--As the first globally co-ordinated
plan for the planet's gravest health threats is hatched by
government ministers from around the world this weekend, a new
report sets out a 10-point plan for this new, globalised approach to
infectious diseases such as avian flu.
Ministers of health and agriculture will formulate a global plan to
prepare for, and respond to, the threat of avian flu and other emerging
infectious diseases at the International Ministerial Conference on Avian and
Pandemic Influenza in Sharm el Sheikh, Egypt (October 24-26). The plan -
called the One World, One Health initiative - aims for an unprecedented
integration of animal, human and ecosystem health issues to fight the threat
of the avian flu virus, H5N1.
A new report by Professor Ian Scoones and Paul Forster of the ESRC STEPS
Centre at the UK's Institute of Development Studies lays out 10 key
recommendations for One World, One Health, based on analysis of lessons
learned from the massive $2bn international response to the avian flu over
the past five years, during which time 245 people have died.
According to the report - The International Response to Highly Pathogenic
Avian Influenza: Science, Policy and Politics - ministers need to rethink
current ideas in order to achieve an effective, equitable and resilient
international plan of response to emerging diseases.
The recommendations include rethinking disease surveillance, redefining
health security, new responses to uncertainty and ignorance, emphasising
access and equity as well as questions of organisational architecture and
governance.
"The One World, One Health initiative is a radical departure from the
conventional sectoral approaches to health. It is essential, but presents
many challenges. We have identified 10 challenges for the way ahead, and
urge ministers to rethink rather than repackage their measures. One World
One Health needs to be more than 'old wine in new bottles'," said Professor
Ian Scoones, IDS Fellow and co-director of the ESRC STEPS Centre.
Over the last decade, the avian flu virus, H5N1, has spread across most
of Asia and Europe and parts of Africa. In some countries – including
Indonesia, China, Vietnam, Bangladesh, Nigeria and Egypt – the disease has
become endemic. Although 245 deaths have been reported since 2003 there has,
as yet, been no human pandemic. But somewhere, some time, a new emerging
infectious disease will have major impacts, given changing disease ecologies
and patterns of urbanisation and climate change.
A major international response, backed by over $2bn of public money, has
affected the livelihoods and businesses of millions. Markets have been
restructured, surveillance and poultry vaccination campaigns implemented,
and over two billion birds have died or been culled. Simultaneously
substantial investment has been made in human and animal health systems and
developing drugs and vaccines.
In many countries pandemic contingency and preparedness plans have been
devised. Yet coordination at country level has been found wanting; rivalries
between professions and organisations persist; and funding and capacities
for an effective and equitable global responses to a pandemic remain weak.
The themes addressed in this report are being explored as part of a
project on avian influenza policy responses in Cambodia, Indonesia, Thailand
and Vietnam, in collaboration with the UN Food and Agriculture Organisation.
They are central to the ESRC STEPS Centre's research programme on ecology,
politics, policy and pathways to sustainability.
The full report and its bite-sized companion briefing
may
be accessed online.
THE STEPS CENTRE (Social, Technological and Environmental Pathways to
Sustainability) is a new interdisciplinary global research and policy
engagement hub uniting development studies with science and technology
studies. We aim to develop a new approach to understanding, action and
communication on sustainability and development. The STEPS Centre is
collaboration between the Institute of Development Studies and SPRU Science
and Technology Policy Research at the University of Sussex with a network of
partners in Asia, Africa and Latin America and is funded by the Economic and
Social Research Council.
Find
out more online.
Early pandemic flu wave may
protect against worse one later [Oct 20 Bethesda MD]--New
evidence about the worldwide influenza pandemic of 1918-1919
indicates that getting the flu early protected many people against a
second deadlier wave, an article co-authored by an NIH
epidemiologist concludes.
American soldiers, British sailors and a group of British civilians who
were afflicted by the first mild wave of influenza in early 1918 apparently
were more immune than others to the severe clinical effects of a more
virulent strain later in the year, according to the paper published in the
Nov. 15 issue of the Journal of Infectious Diseasesby medical
historian John Barry, staff scientist Cécile Viboud, Ph.D., of the NIH’s
Fogarty International Center and epidemiologist Lone Simonson, Ph.D., of The
George Washington University.
"If a mild first wave is documented, the benefits of cross-protection
during future waves should be considered before implementing public health
interventions designed to limit exposure," the authors suggested.
Mark Miller, M.D., director of the Fogarty Center’s Division of
International Epidemiology and Population Studies, said the finding could
have implications for future pandemics. “If a 1918-like pandemic were to
repeat itself, the early circulation of less pathogenic pandemic viruses
could provide some level of population immunity that would limit the full
onslaught from the second wave.
"Together with historical data recently uncovered from Denmark and New
York City, this study gives us a different look at the process of adaptation
of novel pandemic influenza viruses to humans and the evolution of
virulence," Viboud said.
The researchers pored over medical data from U.S. Army bases, the British
fleet and several British civilian communities, applying modern mathematical
models to study the pandemic. They determined that in the spring of 1918,
influenza occurred at different levels of severity throughout the United
States, and was not always recognized as a pandemic. By the fall, however,
the rate of illness among soldiers was 3.4 times higher among those who had
not previously had the flu, and the rate of death per case was about five
times as high.
The disparity was not as great for the British sailors and civilians
whose records were studied.
For people who were infected in the first wave, the risk of illness in
the second wave was reduced by between 35 percent to 94 percent, about the
same protection as for modern vaccines — 70 percent to 90 percent. The risk
of death was reduced between 56 percent to 89 percent.
The authors found that while there were variations in overall influenza
cases among the 37 U.S. Army bases in the spring of 1918, soldiers who had
been sick in the spring experienced lower rates of illness and death during
the more lethal pandemic outbreak in the fall. At one base, a regiment that
had transferred in from Hawaii where soldiers were exposed to the spring
wave had a 6.6 percent incidence in the fall compared to 48.5 percent in a
regiment transferring in from Alaska, where soldiers had not been exposed.
The study suggests two possible reasons for the difference in incidence
and lethality between the first two waves: a relatively weak virus mutating
into a stronger one or a respiratory bug in the fall making flu patients
sicker.
The 1918-1919 pandemic killed between 50 million and 100 million people
worldwide and was unusually deadly in young adults, including soldiers.
Asia-Pacific nations lagging in
flu pandemic plans, UN warns [Oct 16 Bangkok]--Most
Asia-Pacific nations are making progress on avian flu control, but
are lagging in plans to tackle the social and economic fallout of a
human flu pandemic, a senior UN influenza specialist has warned.
"In general, the situation is that countries are getting much more
on top of the bird flu," senior UN System Influenza Coordinator (UNSIC),
David Nabarro, told IRIN in Bangkok. "I'm impressed with progress,
but I am saying a lot more needs to be done, particularly on multi-sectoral
pandemic preparedness."
UNSIC in the Asia-Pacific, collaborating with the Asian Disaster
Preparedness Centre and the Kenan Institute Asia, has released
its first compilation of
simulation exercises conducted by countries to prepare for a human
influenza pandemic.
In the book, countries such as Indonesia, Vietnam and China detail
and assess their simulations, which range from table-top discussions
to full-scale exercises; in one 2006 Australian simulation, 800
participants from domestic government agencies responded to a
pandemic originating in a fictional Southeast Asian nation.
The simulations were aimed at testing a range of areas, from
cooperation between government agencies to the efficiency of
standard procedures and the feasibility of existing pandemic
preparedness plans.
Although governments have built experience through simulations,
Nabarro writes in the book that many plans worldwide have yet to
show how essential services will continue in a pandemic, where there
may be high work absenteeism. There is also insufficient preparation
for wider social, economic and political consequences.
David Nabarro, senior UN System Influenza Coordinator (UNSIC), told
IRIN in Bangkok.
"The planning for pandemics that has been done by most countries and
organisations during the last two years has concentrated on health
service planning - making sure that the hospitals are equipped to
keep working, making sure that the medical staff have some
understanding of what they are expected to do," Nabarro told IRIN.
"Yet … our experience is that a pandemic will do much more than
affect the health system, it will affect essential services, it will
affect the operation of government and transport and all other
aspects of society."
Pandemic fears
Since the re-emergence of the highly pathogenic H5N1 influenza virus
in poultry in 2003, 387 cases of human avian flu have been recorded,
of whom 245 died, according to September 2008 figures from the World
Health Organization.
Health experts fear the H5N1 virus will mutate into a form that can
be easily transmitted between humans, leading to a flu pandemic.
Nabarro said the book was aimed at encouraging the testing of
pandemic preparedness through simulations - the most effective form
of preparation.
While governments have the political will to include pandemic
preparedness in their disaster planning, it "sort of comes quite low
down the priority list" for busy government officials, who may also
need to think beyond a pandemic's immediate health crisis, he said.
"The instinctive impression, for example, in the mind of a senior
government figure when pandemic preparedness comes up in discussion
is to say, 'Really, that's the ministry of health's job, isn't it?'"
he said.
While the book has a few exercise examples that move beyond the
health sector to involve countries' finance and tourism sectors,
there are "not enough", Nabarro said.
"If a government is preparing for a pandemic, for the continuity
during a pandemic, it will only really appreciate some of these
broader consequences if it undertakes a simulation," he said.
"If you don't plan for the broader social, economic and political
consequences of a pandemic, if you don't do what we call multi-sectoral
preparedness planning, then you are missing out on the overall
preparation that's necessary."
Pandemic flu models help
determine food distribution and school closing strategies
[Oct 15 Atlanta GA]--The 1918 flu pandemic killed more than 40
million people worldwide and affected persons of all age groups.
While it is difficult to predict when the next influenza pandemic
will occur or how severe it will be, researchers at the Georgia
Institute of Technology have developed models to help organizations
like the American Red Cross and Georgia Department of Education
prepare emergency response plans.
"The models are flexible so that multiple scenarios can be
investigated to see which options meet a certain goal," said Pinar
Keskinocak, an associate professor in Georgia Tech's H. Milton
Stewart School of Industrial and Systems Engineering (ISyE). "This
goal can be different for various groups, such as serving the most
people given the availability of limited resources or minimizing the
number of people infected while not negatively affecting
businesses."
Details of the models, developed with ISyE associate professor Julie
Swann and graduate student Ali Ekici, will be presented on October
12 at the Institute for Operations Research and the Management
Sciences Annual Meeting.
Knowing how many people will need food, how many food distribution
facilities will be necessary, where the facilities should be located
and how the resources should be allocated among the facilities is
very important, according to Marilyn Self, who is the manager of
disaster readiness for the Metropolitan Atlanta Chapter of the
American Red Cross. Self has been collaborating with Georgia Tech
researchers on this project.
"These models have provided solid food distribution data that has
helped us formulate the questions we have to ask and the decisions
that we have to make about food distribution during a pandemic on a
local and statewide level," said Self.
The Georgia Department of Education is using Georgia Tech's models
to investigate whether or not schools should be closed during a
pandemic.
"Closing schools affects both families and businesses because
parents will have to stay home and take care of children," said
Garry McGiboney, associate state superintendent at the Georgia
Department of Education. "We have to worry about important emergency
workers like hospital staff members and law enforcement officers not
being able to work because they have to tend to their children
because schools are closed."
To estimate the number of meals required for a given area or
determine if closing schools would be beneficial, the researchers
first needed to determine how many people and/or households would be
infected. To do this, they constructed a generic disease spread
model, which described how the influenza disease would spread among
individuals.
The researchers used U.S. Census Bureau tract data – including
household statistics, work flow data, classroom sizes and age
statistics – to test the model. Crowded areas, including Atlanta and
its suburbs, were always affected around the same time regardless of
where the disease initiated. However, the time required for the
disease to spread to rural areas depended on where the disease
started.
With this information, the Georgia Tech researchers used the disease
spread model as a forecasting tool to calculate the number of meals
that would be required in metropolitan Atlanta during a flu
pandemic. They tested three major scenarios: feeding every household
with an infected individual (someone symptomatic or hospitalized),
every household with an infected adult, or every household with all
adults infected.
The simulations showed that the 15 counties surrounding Atlanta
would require approximately 2.2 million, 1.4 million or 150,000
meals per day for the respective scenarios during the peak infection
period. For the entire pandemic, the number of meals would reach 62,
38 or 3.8 million for the three scenarios respectively.
The researchers also determined the number of meals that would be
necessary if only those households that fell below a certain income
level were fed. The results showed that 200,000; 120,000 or 14,000
meals per day would be required for the respective scenarios during
the peak infection period in that case.
Interventions such as voluntary quarantine or school closures could
also affect food distribution by changing the number of infected
individuals.
"Voluntary quarantine means that if an individual is sick in a
household, everyone in that household should stay home," explained
Keskinocak. "However, we realize that not everyone will follow this
rule, so the model assumes that only a certain percentage of
infected individuals will stay home."
The researchers investigated the effects of voluntary quarantine on
disease spread, as well as the best time to begin the quarantine and
how long it should last.
The results showed that the number of people infected at the peak
time and the total number of individuals infected decreased as the
length of the quarantine was extended, but there was a diminishing
rate of return. The researchers determined that an eight-week
quarantine was the most effective in terms of reducing the number of
individuals infected during the peak time if it was implemented at
the beginning of the fourth week.
"These results are important because during a pandemic, communities
have limited resources, including food and volunteers to distribute
the food," noted Swann. "If fewer people require the resources,
especially during the peak time period, organizations like the
American Red Cross can meet the needs of more people."
The researchers also compared the two interventions – quarantine and
school closure. The results showed that closing schools reduced the
number of people infected with the virus. However, a four-week
voluntary quarantine was found to be at least as effective as a
six-week school closure for reducing the percentage of the
population infected with the virus and the number of people infected
at the peak time.
The Georgia Department of Education and the Metropolitan Atlanta
Chapter of the American Red Cross have used the models to gain
insight into the best ways for their organizations to respond to a
flu pandemic.
"Running all of these different scenarios has helped us realize that
we will have a lot more people to feed in metropolitan Atlanta
during a pandemic flu than we imagined. The models have provided us
with a realistic idea of where we'll need to locate community food
distribution facilities and how many we might need to have given
certain assumptions and decisions," said Self.
The researchers plan to conduct future work in two areas –
developing models for other states and extending the model to also
include vaccine distribution. The model may also be useful for other
purposes such as estimating hospital capacity needs, according to
Keskinocak.
"While we hope that a pandemic never occurs, our models will help
Georgia and other states across the United States prepare response
plans for the potential," added Keskinocak.
CDC releases 1918 pandemic flu storybook
[Aug 21 Atlanta GA]--The Centers for Disease Control and Prevention
(CDC) released today an online storybook containing narratives from
survivors, families, and friends about one of the largest scourges
ever on human kind – the 1918 influenza pandemic that killed
millions of people around the world. The storybook provides valuable
insight for public health officials preparing for the possibility of
another pandemic sometime in our future.
This year marks the 90th anniversary of the 1918 influenza pandemic.
The internet storybook contains about 50 stories from individuals
from 24 states around the country as well as photos and narrative
videos from the storytellers.
“Complacency is enemy number one when it comes to preparing for
another influenza pandemic,” said CDC Director Dr. Julie Gerberding.
“These stories, told so eloquently by survivors, family members, and
friends from past pandemics, serve as a sobering reminder of the
devastating impact that influenza can have and reading them is a
must for anyone involved in public health preparedness.”
The idea for such a storybook emerged during crisis and emergency
risk communication (CERC) training CDC has been conducting with
health professionals over the past few years. The online storybook
contains narratives from survivors, families, and friends who lived
through the 1918 and 1957 pandemics. The agency welcomes new
submissions and plans to update the book each quarter. Narratives
from the 1968 pandemic are also welcome.
“It′s an excellent resource, not only for public health
professionals, but for people of all ages,” said Sharon KD Hoskins,
a public affairs officer who coordinated the project for CDC. “It’s
probably the closest to experiencing the real thing that many of us
can imagine.”
The storybook
may be accessed
online.
The pandemic potential of H9N2 avian influenza
viruses
[Aug 15 College Park MD]--Since their introduction into land-based
birds in 1988, H9N2 avian influenza A viruses have caused multiple
human infections and become endemic in domestic poultry in Eurasia.
This particular influenza subtype has been evolving and acquiring
characteristics that raise concerns that it may become more
transmissible among humans. Mechanisms that allow infection and
subsequent human-to-human transmission of avian influenza viruses
are not well understood.
In a new study published August 13 in the journal PLoS ONE, Daniel
Perez (of the University of Maryland) and colleagues used ferrets to
characterize the mechanism of replication and transmission of recent avian
H9N2 viruses. The researchers show that some currently circulating avian
H9N2 viruses can transmit to naïve ferrets placed in direct contact with
infected ferrets. However, aerosol transmission was not observed, a key
factor in potentially pandemic strains.
More importantly, Perez and colleagues show that a single amino acid
residue (Leu226) at the receptor-binding site (RBS) of the hemagglutinin
(HA) surface protein plays a major role in the ability of these viruses to
transmit. They also found that an avian-human H9N2 reassortant virus
increases virulence, pathology and replication in ferrets. These results
suggest that the establishment and prevalence of H9N2 viruses in poultry
could pose a significant threat for humans.
Citation: Wan H, Sorrell EM, Song H, Hossain MJ, Ramirez-Nieto G, et al.
(2008)
Replication and
Transmission of H9N2 Influenza Viruses in Ferrets: Evaluation of Pandemic
Potential. PLoS ONE 3(8): e2923.
doi:10.1371/journal.pone.0002923
Nigeria: New bird flu strain confirmed
[Aug 14 Kano]--A highly pathogenic strain of avian influenza never
previously registered in sub-Saharan Africa has been detected in
northern Nigeria but local health officials have downplayed the
significance.
“After a 10-month lull, we have recorded avian influenza outbreaks
in two northern states and laboratory analysis showed that the virus
belongs to the sub-type related to a different kind [of bird flu]
that is found in Europe,” Ibrahim Ahmed, chief epidemiologist in
Nigeria’s Federal Department of Livestock, told IRIN.
The new strain of avian influenza was found on two farms in Kano
state and its northern neighbour Katsina in July. It was confirmed
as avian flu by the World Reference Laboratory in Italy, Ahmed said.
“It is likely the new strain might have been introduced to the
country by migratory birds.”
Avian flu was first recorded in Nigeria on a farm in Jaji in
northern Kaduna state in February 2006. From there it quickly spread
to 25 out of the country’s 36 states, with Kano being the worst hit.
The country has experienced periodic resurgences of the virus, but
up until July 2008, the strain was always the same as the initial
H5N1 found on the farm in Jaji, Ahmed said.
The latest outbreak was first reported on 16 July on a poultry farm
in Fagen-Kawo village where more than half of the village’s 4,249
chickens died and the remaining 1,665 were culled, said Surajo
Ibrahim Gaya, Kano Communication Desk Officer on Avian Influenza.
“This is an indication that our surveillance and control strategies
are working as we have successfully controlled the earlier
introduction and our surveillance network is vigilant enough to
detect this newly introduced strain as soon as it came into the
country”, Ahmed said.
Blood and sputum samples of a 25 year-old poultry worker DanHussaini
Jibrin, who had had contact with sick chickens, were analysed at
Asokoro Reference Laboratory in Nigeria’s capital Abuja where he was
quarantined for two days after complaining of mild fever.
“We were relieved the result of the analyses on the worker’s blood
and sputum showed no bird flu infection,” Gaya said.
Nigeria has so far recorded one human casualty of the avian
influenza in February 2006 when a young girl died of avian flu she
contracted while cleaning chicken houses in the country’s commercial
capital Lagos.
Laos: New veterinary law targets bird flu
[Aug 14 Vientiane]--A new Veterinary Law passed on 25 July is good
news in the fight against avian influenza (AI - bird flu), given
that Laos is surrounded by neighbours that have suffered severe AI
outbreaks.
“This is a significant milestone in infectious disease preparedness
for this country,” Subhash Morzaria, the AI programme team leader of
the UN Food and Agriculture Organization (FAO) in Laos, told IRIN.
“It is an indication that the government recognises the significance
of animal - and public - health and the importance of ensuring
bio-food security,” Morzaria said.
The Veterinary Law 2008 establishes a regulatory framework to
strengthen veterinary services, contains provisions for greater
transparency in reporting AI and other emerging diseases, and sets
out disease control measures, including animal and by-product
movements, bio-security and hygiene standards.
Because poultry is one of the cheapest sources of protein, Morzaria
explained, failure to protect it could worsen food security and
poverty. Strong measures to safeguard the health of animals against
infectious diseases such as AI are therefore of the utmost
importance, he said.
Last year, two people died in Laos from highly pathogenic avian
influenza (HPAI), and another outbreak earlier this year resulted in
the culling of 5,000 poultry in six northern villages of Luang Nam
Thaa Province, according to the authorities.
However, mountainous Laos, with its low population density and
scattered poultry farming, has been spared the severity of AI
outbreaks in Vietnam and China, according to Kristina Osbjer,
operations officer with the FAO AI Programme. Laos thus has some
breathing space to develop disease preparedness strategies, she
said, but the country lacks basic infrastructure, and its porous
borders make it a likely victim of further AI outbreaks.
FAO working with government on capacity building
“Short- and long-term capacity are major issues in Laos,” explained
Osbjer. “We are therefore working with the government to provide
capacity building at grassroots level so they can identify the
disease and respond faster to nip it in the bud before it becomes
entrenched.”
The programme includes training veterinary staff, animal health
workers and village veterinary workers in surveillance techniques;
improved detection; and systematic recording and reporting of
suspected AI cases.
FAO is also leading an active surveillance project on domestic fowl
with the Department of Livestock and Fisheries, focusing on the most
at-risk sites.
To complement the enhanced surveillance and identification
capacities, FAO is expanding the laboratory capacity of the National
Animal Health Centre to conduct improved serology and virus
isolation on an increased number of samples, said Osbjer.
Awareness raising
Reinforcing all this work is the communications programme led by the
UN Children’s Fund (UNICEF) which is ensuring that prevention,
recognition and containment information reaches all strata of
society.
"Getting out the message about the threat posed by AI has been
absolutely central to the whole campaign," said UNICEF head of
communications in Laos Simon Ingram. "Thanks to some generous
funding that we received from the government of Japan in 2006,
UNICEF has supported a massive public information campaign
delivering key prevention messages to millions of families, using
everything from radio and TV spots to touring puppet troupes and
networks of village leaders."
While considerable achievements have been made to prepare Laos for
future AI outbreaks, Osbjer said the new Veterinary Law alone would
not be enough. “We must stress the need for long-term capacity in
the animal and public health sector - not just to deal with avian
influenza but all infectious diseases. And for that, the government
must educate more staff.”
Pandemic research receives
$1.6M funding boost
[Jul 29 Hamilton ON]--Densely populated cities and increased air
travel can be factors which create and spread pandemic disease.
But a McMaster University researcher is working with isolated
Hutterite communities to understand the transmission of pandemic
diseases like influenza.
Dr. Mark Loeb and his research team have received $1.6 million in
funding to carry out the research from the Rx&D Health Research
Foundation (HRF), the Canadian Institutes of Health Research (CIHR)
and the Canadian Food Inspection Agency (CFIA).
Dr. Loeb will work with Hutterite communities in western Canada to
examine the transmission of flu viruses from person to person and
from pigs to humans. Dr. Loeb is an internationally-recognized
expert in infectious disease epidemiology, and has studied SARS (as
founding director of the Canadian SARS Research Network), West Nile
Virus, and antibiotic use and resistance. His team's new research
will detect influenza viruses in humans and pigs in Hutterite
communities, and use computer modelling to analyze the transmission
of the virus.
"Hutterite communities are uniquely well-suited to this sort of
research, because they are active swine farmers and because they
live in isolation from mainstream society," says Loeb. "We hope to
use this research grant to learn important lessons about how disease
spreads and how to prevent it."
"Our foundation supports research in areas that are important to
Canada's health research community and to Canadian society as a
whole." said Dr. Yves Morin, President of the Health Research
Foundation. "Our goal is to augment Canada's position as a
world-class centre for health research and a leader in developing
new ways to prevent, treat and cure disease."
"The SARS outbreak taught us that there are no national boundaries
when it comes to infectious diseases," said Dr. Bhagirath Singh,
Scientific Director of the CIHR Institute of Infection and Immunity.
"Through this partnership, Dr. Loeb and his team will receive the
critical support needed to further advance knowledge in the area of
pandemic preparedness and influenza outbreaks."
This announcement is the first of a series of annual thematic grants
to be made by the HRF on important public health issues. HRF, one of
the leading private granting foundations in Canada, has awarded over
$23 million to over 1,400 researchers in the past 20 years alone.
"It's gratifying to researchers to see funding come from foundations
such as the HRF, as it indicates a willingness to give back and to
further basic and applied research into important subjects," said
Peter George, president of McMaster University. "This is a critical
study, and we're particularly pleased to see Dr. Loeb's innovative
work given well-deserved recognition with this grant."
The research team includes:
Dr. Mark Loeb, McMaster University, Ontario (principal investigator)
Dr. Margaret Russell, University of Calgary, Alberta
Dr. Jonathan Dushoff, McMaster University, Ontario
Dr. David Earn, McMaster University, Ontario
Dr. Kevin Fonseca, Provincial Laboratory for Public Health, Calgary,
Alberta
Dr. Julie Fox, Provincial Laboratory for Public Health, Calgary
Alberta
Dr. Julia Keenliside, Alberta Agriculture and Food, Edmonton,
Alberta
Dr. Mathieu Lemire, McGill University, Quebec and Genome Quebec
Dr. Marek Smieja, McMaster University, Ontario
Dr. Stephen Walter, McMaster University, Ontario
Dr. Richard Webby, St. Jude Children's Research Hospital, Memphis,
Tennessee
Comic book illustrates new way
to reach immigrants and youth about pandemic flu
[Jul 24 King County WA]--A local comics
artist with a personal connection to the great influenza pandemic of
1918 has teamed up with public health officials on an vivid new
comic book about pandemic flu. The comic book No Ordinary Flu
reaches out to immigrants and young people with information about
the pandemic threat, then and now. Starting today, Public Health –
Seattle & King County is making No Ordinary Flu available to
order for free through the Public Health website.
The comic book follows the fictional account of a young
World War I veteran and his family as their world is transformed overnight
by the arrival of the deadly flu virus. No Ordinary Flu also
describes the current threat of a flu pandemic and includes information on
how to prepare.
Artist David Lasky brings a personal connection to his
work on the comic, as his great-grandmother died during the 1918 pandemic
that killed over 675,000 Americans. Her grieving husband left three of his
children to be raised in an orphanage, including Lasky’s grandmother.
“The 1918 pandemic left such a mark on my family, but
until this project, I never really knew much about the pandemic itself,”
commented Lasky. “I was completely surprised to learn how deadly it was, and
how quickly it had spread.”
“A severe pandemic would affect the lives of everyone in
our community, and this comic book helps people to visualize pandemic flu’s
speed and impact, which can be difficult to grasp,” explained Dr. David
Fleming, Director and Health Officer for Public Health – Seattle & King
County. “Everyone needs to prepare for the health and economic impacts of a
pandemic, so we’re delivering the message in a way that reaches diverse
communities.”
The idea for No Ordinary Flu came from requests
from local immigrant groups for emergency preparedness materials that use
pictures to communicate. Public Health educators chose the comic book format
because comics are widely read by people of all ages in parts of Latin
America and Asia. The comic book has been translated into 11 languages to
make it accessible to many of King County’s immigrant populations. All
language versions are available from the Public Health – Seattle & King
County website.
“My great-grandmother who died in the 1918 pandemic was an
immigrant from Russia,” noted Lasky. “So knowing that this comic is
available in multiple languages and could be helping to save lives in
today's immigrant communities makes me very proud to have participated.”
A pandemic flu is a new influenza virus that could be a
much more serious flu virus than seen in a typical flu season. Different
from the typical, seasonal strains of flu, humans would have no or little
natural resistance to a new strain of influenza.
Once a pandemic virus develops, it can spread rapidly with
the ease of global travel, causing outbreaks around the world. The Centers
for Disease Control and Prevention (CDC) predicts that as much as 25% to 30%
of the United States population could be affected. In King County alone, a
severe pandemic flu could make 540,000 people ill, over 59,000 would need
hospitalization, and 11,500 could die in the first six weeks of an outbreak.
Funding for the comic book was provided by the National
Association of County and City Health Officers (NACCHO) Advanced Practice
Center (APC) Program, a diverse network of local health departments actively
working to help the public health community prepare for, respond to, and
recover from public health emergencies and other disasters.
HHS and DHS announce guidance
on pandemic vax allocation
[Jul 23 Washington DC]--The U.S. Departments of Health and Human
Services (HHS) and Homeland Security (DHS) released guidance on
allocating and targeting pandemic influenza vaccine. The guidance
provides a planning framework to help state, tribal, local and
community leaders ensure that vaccine allocation and use will reduce
the impact of a pandemic on public health and minimize disruption to
society and the economy.
"This guidance is the result of a deliberative democratic process," HHS
Secretary Mike Leavitt said. "All interested parties took part in the
dialogue; we are confident that this document represents the best of shared
responsibility and decision-making."
"A severe pandemic has the potential to disrupt our everyday way of
life," said DHS Assistant Secretary for Health Affairs and Chief Medical
Officer Dr. Jeffrey Runge. "This guidance was developed to ensure that our
nation's critical infrastructure remains up and running and we address the
needs of all of our citizens, enabling the country to recover from a
pandemic more quickly."
As part of developing the guidance, HHS held day-long public engagement
and stakeholder meetings throughout the country and received more than 200
written public comments on the goals and objectives of pandemic vaccination.
In all the meetings, stakeholders and the public identified the same four
vaccination program objectives as the most important:
- Protect persons critical to the pandemic response and who provide
care for persons with pandemic illness;
- Protect persons who provide essential community services;
- Protect persons who are at high risk of infection because of their
occupation; and
- Protect children.
The guidance is also firmly rooted in the most up-to-date scientific
information available and directly considers the values of our society and
the ethical issues involved in planning a phased approach to pandemic
vaccination.
The ultimate goal of the pandemic vaccination program is to vaccinate
every person in the United States who wants to be vaccinated. Because
pandemic vaccine cannot be made fast enough for everyone to be vaccinated at
once, federal, state, local and tribal governments, communities, and the
private sector can use the guidance to decide who should be vaccinated
during this early stage to best protect people and communities.
The guidance's vaccination structure defines four broad target groups:
people who 1) maintain homeland and national security, 2) provide health
care and community support services, 3) maintain critical infrastructure and
4) are in the general population.
Everyone in the United States is included in at least one vaccination
target group. People who are not included in any occupational group would be
vaccinated as part of the general population based on their age and health
status.
While vaccines are an important resource in a pandemic, vaccination will
only be one of several tools to fight the spread of influenza if and when a
pandemic emerges. Other tools include community public health measures,
antiviral medications, facemasks and respirators, washing hands, and
covering coughs and sneezes.
Infection control guidance for
critical care now available
[Jul 23 Edinburgh Scotland]--Infection control guidance has now been
issued for critical care and non-invasive ventilation provision.
This document supplements the guidance available in the document:
Pandemic influenza: Guidance for infection control in hospitals and
primary care settings and has been developed to provide more
detailed guidance for critical care units and settings providing
non-invasive ventilation to assist them in planning their response
to a pandemic. The document may be
accessed online.
Study outlines measures to
limit effects of pandemic flu on nursing homes
[Jul 22 Tempe AZ]--The greatest danger in a pandemic flu outbreak is
that it could spread quickly and devastate a broad swath of people
across the United States before there is much of a chance to react.
The result could be a nation brought to its knees by a disease run
rampant.
Among those most vulnerable to a pandemic flu outbreak are the 2.5
million residents of the nation's 18,000 residential care (nursing home)
facilities. Because there are few anti-virals and no vaccines available to
combat such a flu epidemic, these facilities most likely will try to prevent
introduction of the flu through non-pharmaceutical interventions (NPI), like
the use of masks, social distancing, isolating symptomatic persons, etc.
But among NPI interventions, which methods or combinations of methods
will work and be effective in keeping the flu outside the walls of a
facility or keep the flu spread to a minimum among a population that
literally will be sitting ducks in the path of the disease?
Now, a team of researchers, including one from Arizona State University,
has taken a major step in determining what will work by developing
mathematical models and testing scenarios that show which NPIs are
appropriate for which levels of pandemic flu. Their work is published in an
early on-line edition (July 21) of the journal Proceedings of National
Academy of Sciences.
"Our work is the first to provide a flexible road map for prevention and
protection of vulnerable populations living in residential care facilities,
said Gerardo Chowell-Puente, an assistant professor in ASU's School of Human
Evolution and Social Change.
"We found that something previously considered implausible – the
protection of a health care institution against pandemic influenza by using
only non-pharmaceutical measures – may be possible and may be practical,"
Chowell-Puente said. "We want this work to get those concerned with
mitigating the impact of pandemic influenza in such facilities to evaluate
and consider implementation of the recommendations implicit in our study."
In "Protecting residential care facilities from pandemic influenza,"
authors Miriam Nuño of UCLA and the Harvard's School of Public Health; Tom
Reichert of the Entropy Research Institute; Abba Gumel of the University of
Manitoba along with Chowell-Puente, say their roadmap provides an important
planned first line of defense for the pandemic flu.
"Currently, most facilities do not have a ready to implement plan in
place should a pandemic take place," the researchers said. "Our work details
a set of simple interventions that seem workable and may be easily
implemented by current staff members."
Five types of NPIs were evaluated. They included: screening visitors and
staff who leave and then return to the facility; isolating symptomatic
residents; placing restrictions on visitors, like reducing visit times or
having them use electronic communications devices or communicating from
behind transparent impermeable barriers; modifying work schedules, which
could include four full days on site followed by four full days off site
with a period of isolation from the community for a portion of the time off
site; and precautions taken by staff and visitors to reduce their risk of
infection, like washing hands and using protective masks.
"Overall, we found that conventional NPIs sufficed to curtail only mild
outbreaks, and that higher level of NPIs requiring greater social
restrictions and higher levels of cooperation were needed to manage more
severe outbreaks," said Chowell-Puente, who evaluated the NPIs effectiveness
through the use of mathematical models for the study.
"The biggest surprise in our study was identifying the critical role that
staff plays in controlling the spread and preventing the introduction of
disease in the facilities," said lead author Miriam Nuño.
"Many residential facilities (like nursing homes) are chronically
understaffed," Nuño added. "Our research shows the current working demands
of staff need to be improved if we hope to improve our preparedness plans."
Some of the improvements, the researchers note, include more regular work
hours and schedules for care givers, as well as other basic benefits, like
paid sick days.
"Our research shows that work schedules that include multiple days
on-site at the facility are the key to surviving pandemics. With that
practice, employees must go into isolation for several days at home before
coming back to work. But, the benefits from longer work- and off-periods
incorporating isolation periods can only be had if employees can be fully
engaged in the protection of their institution," the researchers stated.
"Facilities must eliminate disincentives. For example, employees sick
themselves with the flu or forced to care for afflicted family members must
be paid for time away. A single act of non-cooperation can bring down an
entire facility. In return, those employees who recover become immune,
become fully available for further service and no longer represent a threat
for introducing the virus," they added.
Report offers resources for
home healthcare response during a flu pandemic
[Jul 12 Washington DC]--Home Health Care During an Influenza
Pandemic: Issues and Resources, a report identifying home
health care as a critical component in providing care during a
pandemic influenza event and offering resources to home health care
providers and community planners to prepare for such an event, was
released today by the U.S. Department of Health and Human Services'
(HHS) Agency for Healthcare Research and Quality (AHRQ) in
collaboration with the Office of the Assistant Secretary for
Preparedness and Response (ASPR).
Home health care agencies already provide routine care for acute and
chronically ill, permanently disabled and terminally ill patients. In fact,
on any given day, there are three times as many patients in home health care
settings as there are in hospitals.
"To date, there has been little information about how home health
providers could meet a sudden demand for services during a public health
emergency, although it is extremely likely that these agencies would be
called on to provide additional services at a time of need," said AHRQ
Director Carolyn M. Clancy, M.D. "This report offers practical advice and
potential strategies to ensure that home health care can meet emergency
demands and continue to provide safe, high-quality care."
The report emphasizes the home health care sector's potential to help
handle a surge in patients during a biologic event and stresses the need for
involvement of home health care agencies in advance planning and
coordination at the local level. It offers resources and suggestions on
addressing key elements of home health care preparedness and includes lists
of existing tools and models throughout.
Examples of issues and strategies addressed in the report include:
- Exploring the use of technology to monitor patients at a distance.
- Collaboration with community partners.
- Legal and ethical considerations of providing care under emergency
conditions.
- Home health care workforce issues, including training.
- Recommendations for additional action and research at the Federal,
State and local levels.
"Community planners, state and local public health departments and health
care systems must look critically at leveraging the existing resources of
home health care agencies to meet the possible surge demands of an influenza
pandemic," said HHS Assistant Secretary for Preparedness and Response RADM
W. Craig Vanderwagen, M.D., whose office initiated and funded the report in
collaboration with the Centers for Disease Control and Prevention.
"Home health care agencies, community-based service providers and area
agencies on aging are an essential fabric of our communities," added
Josefina G. Carbonell, HHS Assistant Secretary for Aging. "The services they
provide are already necessary for home and community living for more than
10.4 million older adults and their caregivers. A pandemic will increase the
need for these services and provide challenges to their delivery."
The report, Home Health Care During an Influenza Pandemic: Issues and
Resources, is based on the findings of an expert panel meeting,
including representatives of home health care, emergency and disaster
planning, professional organizations and federal and state government
agencies.
The
report can be accessed online.
Pandemic mutations in bird flu
revealed
[Jul 10 Bangkok Thailand]--Scientists have discovered how bird flu
adapts in patients, offering a new way to monitor the disease and
prevent a pandemic, according to research published in the August
issue of the Journal of General Virology.
Highly pathogenic H5N1 avian influenza virus has spread through at
least 45 countries in 3 continents. Despite its ability to spread,
it cannot be transmitted efficiently from human to human. This
indicates it is not fully adapted to its new host species, the
human. However, this new research reveals mutations in the virus
that may result in a pandemic.
"The mutations needed for the emergence of a potential pandemic virus are
likely to originate and be selected within infected human tissues," said
Professor Dr Prasert Auewarakul from Mahidol University, Thailand. "We
analyzed specific molecules called haemagglutinin on viruses derived from
fatal human cases. Our results suggest new candidate mutations that may
allow bird flu to adapt to humans."
Viruses with a high mutation rate such as influenza virus usually exist
as a swarm of variants, each slightly different from the others. These are
called H5N1 bird flu quasispecies. Professor Dr Auewarakul and his
colleagues found that some mutations in the quasispecies were more frequent
than others, which indicates they may be adaptive changes that make the
virus more efficient at infecting humans. Most of these mutations were found
in the area required for the virus to bind to the host cell.
"This study shows that the H5N1 virus is adapting each time it infects a
human," said Professor Dr Auewarakul. "Such adaptations may lead to the
emergence of a virus that can cause a pandemic. Our research highlights the
need to control infection and transmission to humans to prevent further
adaptations."
The research has provided genetic markers to help scientists monitor bird
flu viruses with pandemic potential. This means they will be able to detect
potentially dangerous strains and prevent a pandemic. The research also
gives new insights into the mechanism of the genesis of a pandemic strain.
"Our approach could be used to screen for mutations with significant
functional impact," said Professor Dr Auewarakul. "It is a new method of
searching for changes in H5N1 viruses that are required for the emergence of
a pandemic virus. We hope it will help us to prevent a pandemic in the
future."
Political borders, health-care
issues complicate pandemic planning
[Jul 10 West Lafayette IN]--Panic, staffing issues and geographic
boundaries are some of the challenges that public health experts
need to address as they plan for a possible influenza pandemic,
according to a new report from Purdue University.
"Most public health experts who are leading planning efforts for an
influenza outbreak are focusing on specific geographic areas,
usually counties, as defined by political lines," said George Avery,
an assistant professor of health and kinesiology and member of the
Purdue Alternative Care Site Planning Team.
"This is problematic because if there is an outbreak, planners need
to take into account the people and health-care systems that are or
are not around them.
"Counties that border other states may experience nonresidents
seeking treatment in their area, while other counties may be home to
the only isolated hospital system in the region and can expect the
population from other states to travel there for care. Health care,
especially in a crisis, is not defined by county or state lines."
For example, instead of each Indiana county health department making
plans for its individual county, plans should be developed, or at
least coordinated, regionally, Avery said.
Members of the Purdue Alternative Care Site Planning Team
interviewed public health planners in 13 of Indiana's 92 counties
from November 2006 to August 2007 as part of a pandemic planning gap
analysis. The counties are Allen, Clay, Dearborn, Fulton,
Huntington, Lake, Johnson, Montgomery, Orange, Posey, Randolph,
Sullivan and Warrick. Purdue's Healthcare Technical Assistance
Program assembled the team to look at issues about planning for
alternative care sites and other surge capacity issues during a
pandemic such as staffing concerns, medication supplies, and medical
equipment access and health-care system and insurance limits.
The team's findings are published online this week at the Journal of
Homeland Security and Emergency Management.
Influenza hospitalizes 200,000 Americans annually and kills 36,000.
In 2005 global concern was raised about a possible influenza
pandemic because the number of human deaths related to bird flu was
increasing in some Asian countries. There is concern that if the
virus were transmitted human to human, a global outbreak could
result in millions of deaths. As a result, federal, state and local
leaders continue to plan.
"Another significant planning concern is related to staffing,
especially at alternate care sites," said Mark Lawley, an associate
professor of biomedical engineering who specializes in health-care
delivery systems and is part of the research team. "During a
pandemic, we can expect that caregivers will become ill, some
caregivers will be reluctant to work and others will stay home to
care for their own family members. Many planners are suggesting
alternate care sites during an outbreak, but finding additional
staff members for these units will a big impediment."
As a result, alternate sites often are not a feasible alternative,
Lawley said. Also, the strain on the work force will likely affect
the standard of care.
"The public has expectations about the standard of health care," he
said. "For example, doctors prescribe medications and nurses
administer them, but what happens if one group is understaffed
during a crisis? How are roles reassigned and how is that
communicated to the patients?"
In addition to staffing and community coordination issues, the
researchers also found that misunderstandings about projected
mortality and illness rates are creating panic.
"In several counties, many planners are anticipating devastating
impacts that even exceed the worst case scenarios historically,"
Avery said. "The confusion results in a sense of helplessness among
some planning teams because they believe any planning will be
rendered useless by the magnitude of the problem."
To counter this, the researchers suggested more explanations by
federal, state, international and academic experts about statistics
and surveillance.
The research team also observed some contradictions in planning
efforts. Counties planned on limited resources and expected to
compete among themselves for basic medical supplies and other
necessities, while at the same time, the plans acknowledged
assistance would be sought from external groups, such as the
National Guard or governor's office.
The other authors of this study are Purdue professors Barrett
Caldwell and Dulcy Abraham, as well as former and current Purdue
graduate students Sandra Garrett, Marshall P. Durr, Feng Lin,
Po-Ching C. DeLaurentis, Maria L. Peralta and Alice Russell.
Purdue's Healthcare Technical Assistance Program was launched in
2005 as partnership with the Indiana Hospital Association and
Regenstrief Center for Healthcare Engineering based at Purdue's
Discovery Park. In addition to performing pandemic planning gap
analyses, the program is focused on improving the health-care
provider system, public health system, control of employer-paid
health-care costs and medicine safety.
The Indiana State Department of Health funded this study. The Purdue
Alternative Care Site Planning Team will continue to assess pandemic
planning efforts.
European businesses not
properly advised on how to prepare for flu pandemic
[Jun 17 London England]--A new report entitled Business Continuity
Planning and Pandemic Influenza in Europe, published by the London
School of Hygiene & Tropical Medicine (LSHTM), has found huge gaps
and differences across Europe in the level of advice given to
businesses to prepare for a possible influenza pandemic.
The economic impact and disruption to business during a flu pandemic
is likely to be substantial. The report's authors have concluded
that the advice on preparedness given to businesses in the
non-health sector by European governments and independent
organisations, such as consultancy firms, academic bodies and trade
unions, is insufficient to ensure that the private sector is
equipped to deal with a pandemic.
Out of 30 governments surveyed, over a third offered no advice at
all and only 8 provided significant levels of advice. In addition,
much of the guidance in the countries evaluated relies on private
consultancies. However, such firms charge fees for their services,
which are unaffordable for many businesses, in particular small and
medium-sized enterprises.
Dr Richard Coker, Reader in Public Health at LSHTM and one of the
authors of the report said, "We suggest that public and private
advisory organisations take immediate action to develop more
comprehensive guidelines. Moreover, guidance should be explicit
about corporate social responsibilities and actions should be
coherent with corporate strategic goals, operational planning, and
national strategies."
The report found that advice is lacking and inconsistent in many
areas that are crucial to ensure preparedness in case of a pandemic.
Only 10 countries provide planning to support human resources and
the range of estimates suggests that between 15 - 50% of employees
will need to take an extra 5 to 14 days sick leave in the event of a
pandemic. These unusually high rates of absenteeism will severely
disrupt normal activities and put considerable pressure on
businesses to remain operational, especially on those operating in
essential services such as banking, draining and sewerage, energy
communications, water, transport and waste collection.
Other areas of advice which the report considers as lacking or
inconsistent include:
Management of employees suspected to be ill at work
Measures to minimise the spread of the virus in the workplace
Acquisition and distribution of protection equipment and antiviral
medication
Legal issues arising under the circumstances of an influenza
pandemic
The development of business recovery plans
The authors of the report advise that businesses take the necessary
measures to develop a clear overview of the possible risks and
impact of a pandemic on their resources and business activities and
plan accordingly.
Sandra Mounier-Jack, Lecturer at LSHTM commented, "This report
demonstrates that most strategic efforts made so far have been
directed at preparing public health systems and as a result the
non-health sector has been neglected."
"This has the potential to result in unequal levels and
inconsistencies of preparedness in the business sector, with
important implications for all of Europe," added Alexandra Conseil,
Research Fellow at LSHTM.
About the report
The report was published by the London School of Hygiene & Tropical
Medicine (LSHTM) and was written by Dr Richard Coker, Reader in
Public Health at LSHTM, Sandra Mounier-Jack, Lecturer at LSHTM and
Alexandra Conseil, Research Fellow at LSHTM. The LSHTM's mission is
to contribute to the improvement of health worldwide through the
pursuit of excellence in research, in national and international
public health and tropical medicine, and through informing policy
and practice in these areas. The report reviewed the advice offered
by 13 independent advisory organisations and that of the governments
of the EU-27 countries, as well as Turkey, Norway and Switzerland.
The research was undertaken through an unrestricted educational
grant from F.Hoffmann-La Roche Ltd.
The full text of the report can be
accessed online.
New Jersey: State rolls out
public health plan for pandemic influenza
[June 4 Trenton]--Continuing its efforts to prepare for an eventual
pandemic influenza, the New Jersey Department of Health and Senior
Services (DHSS) has launched its pandemic influenza operational plan
that details specific activities that would be performed during a
pandemic and enhances previous planning efforts.
“The Department has been planning for a pandemic influenza for
nearly 10 years,” said DHSS Commissioner Heather Howard. “We now
have an operational plan that will guide the Department in its
public health preparedness and response activities through specific
phases of a pandemic. This plan will not only help the Department
prepare but also our public health partners, and ultimately benefit
the people of New Jersey.”
The plan describes a series of public health actions and activities
that DHSS staff will perform in various phases of a pandemic. The
goal of the plan is the to help minimize illness and deaths during a
pandemic, support New Jersey’s overall pandemic response plan, and
provide guidance to local health agencies and health care
stakeholders in the development of their own plans. This operational
plan will be an annex to New Jersey’s pandemic response plan that
describes how all sectors of government will respond during a
worldwide influenza outbreak.
The plan is divided into 10 technical sections, based on guidance
from the federal Department of Health and Human Services. These
sections include surveillance, laboratory diagnostics, health care
planning, infection control, clinical guidelines, vaccine,
antivirals, community disease control and prevention, public
information and psychosocial considerations.
In each section, there are actions described for 17 pandemic
situations, based on phases outlined by the World Health
Organization (WHO). Pandemic situations in New Jersey’s plan are
based on transmission of influenza to birds and humans, geographic
location of the disease outbreak, the increased and sustained
transmission in the general population and the duration of the
pandemic.
“Each situation is a trigger for action for the Department and our
partners,” said State Epidemiologist and Deputy Commissioner Dr.
Eddy Bresnitz. “Many of the actions and activities occur early in
the pandemic and, in fact, we are already have implemented some of
the activities.
“For instance, we have protocols in place for year-around
surveillance of influenza-like illnesses; we have established a
state stockpile of antirvirals and have increased it each year; and
we continue to conduct public awareness and education programs so
New Jersey residents are familiar with a pandemic and what they can
do if it occurs.”
DHSS will continue its work with local health agencies and
departments, statewide organizations such as the New Jersey Hospital
Association, the Health Care Association of New Jersey, the New
Jersey Association of Homes and Services for the Aging and the New
Jersey Primary Care Association to provide guidance and direction
for their specific plans.
“Pandemic influenza planning is a fluid process that is never
completed,” said David Gruber, Senior Assistant Commissioner for
Healthcare Infrastructure Preparedness and Response, who leads the
state pandemic preparedness effort. “We will continue to refine our
plan and coordinate with federal, state and local agencies in this
process to better protect the health and safety of New Jersey
residents during a pandemic.”
The Department began its pandemic influenza planning activities in
1999 and posted the first version of its overall plan in 2002. The
new plan is in its fourth version. Both the overall plan and the new
operational plan are available on the Department’s website at
www.njflupandemic.gov.
Australia: Flu pandemic medical
help left in the waiting room
[May 31 Canberra ACT]--GPs are not an integral part of Australian
influenza planning, despite the important role they will play in
limiting deaths in the event of a pandemic hitting the country,
according to research from The Australian National University.
Researchers from the University’s National Centre for Epidemiology and
Population Health and ANU Medical School examined 89 Australian and
international pandemic response plans and found general practice involvement
was limited, and sometimes not considered.
Research lead Associate Professor Mahomed Patel says international
evidence from the SARS outbreaks and influenza epidemics illustrates GPs and
allied health professionals have an important role to identify and treat
cases, take on hospital workload and continue to support the chronically ill
in the event of an outbreak.
“Studies in other countries show that during public health emergencies,
most people prefer to see their GPs whom they trust and have a good
relationship with. Yet most plans focused on the responses by health
departments with little reference to collaborations with GPs,” he said.
Despite health experts around the world saying a pandemic was a ‘when not
if’ scenario, pandemic planning is still not seen as an activity to be
jointly prepared by health departments, general practitioners and hospitals,
Dr Patel added.
“With over 97 million visits annually, general practice is Australia’s
single largest health sector. If we do not prepare it well, our responses
will fail in critical points during an influenza pandemic,” he said.
The researchers have devised a framework to guide planning to include
general practice covering clinical care for influenza and other conditions,
public health responsibilities, the internal environment of general practice
and interactions within the broader health system.
General practice coordination was identified as an area of need during
Exercise Cumpston 2006, which tested systems for an influenza outbreak, and
national guidelines for primary care providers are being developed, the
researchers said. The researchers also emphasise the need to move beyond a
paper exercise in planning, to drills, simulations and continuing
collaboration among people who will need to pull together in a crisis
situation.
Battling bird flu by the
numbers
[May 31 Los Alamos NM]--A pair of Los Alamos National Laboratory
researchers have developed a mathematical tool that could help
health experts and crisis managers determine in real time whether an
emerging infectious disease such as avian influenza H5N1 is poised
to spread globally.
In a paper published recently in the Public Library of Science,
researchers Luís Bettencourt and Ruy Ribeiro of Los Alamos’
Theoretical Division describe a novel approach to reading subtle
changes in epidemiological data to gain insight into whether
something like the H5N1 strain of avian influenza—commonly known
these days as the “Bird Flu”—has gained the ability to touch off a
deadly global pandemic.
“What we wanted to create was a mathematically rigorous way to
account for changes in transmissibility,” said Bettencourt. “We now
have a tool that will tell us in the very short term what is
happening based on anomaly detection. What this method won’t tell
you is what’s going to happen five years from now.”
Bettencourt and Ribeiro began their work nearly three years ago, at
a time when the world was wondering whether avian influenza H5N1,
with its relatively high human mortality rate, could become a
frightening new pandemic. Health experts believe that right now the
virus primarily infects humans who come in contact with infected
poultry.
But some health experts fear the virus could evolve to a form that
would become transmissible from human to human, the basis of a
pandemic like the 1918 Spanish Flu that killed an estimated 50
million people.
The Los Alamos researchers set out to create a “smart methodology”
to look at changes in disease transmissibility that did not require
mounds of epidemiological surveillance data for accuracy. The
ability to look at small disease populations in real time could
allow responders and health experts to implement quarantine policies
and provide medical resources to key areas early on in an emerging
pandemic and possibly stem the spread.
Bettencourt and Ribeiro developed an extension of standard
epidemiological models that describes the probability of disease
spread among a given population. The model then takes into account
actual disease surveillance data gathered by health experts like the
World Health Organization and looks for anomalies in the expected
transmission rate versus the actual one. Based on this, the model
provides health experts actual transmission probabilities for the
disease. Unlike other statistical models that require huge amounts
of data for accuracy, the Los Alamos tool works on very small
populations such as a handful of infected people in a remote
village.
After developing their Bayesian estimation of epidemic potential,
Bettencourt went back and looked at actual epidemiological
surveillance data collected during Bird Flu outbreaks in certain
parts of the world. Their model accurately portrayed actual
transmission scenarios, lending confidence to its methodology.
In addition to its utility in understanding the transmissibility of
emerging diseases, the new method is also advantageous because it
allows public health experts to study outbreaks of more common
ailments such as seasonal influenza early on. This can assist
medical professionals in making better estimates of potential
morbidity and mortality, along with assessments of intervention
strategies and resource allocations that can help a population
better cope with a developing seasonal outbreak.
“We are closing the loop on science-based prediction of transmission
consequences in real time,” said Ribeiro. “A program of this type is
something that needs to be implemented at a worldwide level to
provide an integrated way to respond a priori to an emerging disease
threat.”
Global: Experts review
influenza pandemic preparedness guidance
[May 8 Geneva]--With the onging threat of a global influenza
pandemic demanding continued vigilance, 120 influenza and planning
experts from WHO Member States, research institutions and UN
agencies around the globe are meeting in Geneva this week to review
the current WHO pandemic preparedness guidance.
Key scientific and situational developments make the review
particularly important. WHO will release the revised guidance later
this year.
"New concepts and tools including the International Health
Regulations 2005, the global pandemic influenza action plan,
antiviral and H5N1 vaccine stockpiles, pandemic severity scale and a
rapid containment protocol have emerged since the last revision in
2005," said Dr Keiji Fukuda, Coordinator of the WHO Global Influenza
Programme. "Experience gained through dealing with H5N1 outbreaks,
and through active preparedness by many countries makes this review
a crucial exercise."
WHO first provided such guidance in 1999 and since then, influenza
pandemic preparedness has become one of the central public health
planning challenges. With the risk level of an influenza pandemic
unchanged, maintaining appropriate focus on preparedness and
ensuring that efforts contribute to broad public health capacity are
ongoing challenges.
"One day we will face a pandemic but we don't know when,"
acknowledged Dr Fukuda. "So what can we do? We can take action to
improve our ability to decrease the risk of harm from a pandemic. We
hope to improve the guidance and the practical tools we give to
Member States through our efforts this week."
Scotland: Pandemic flu planning
guidance for infection control
[Mar 11 Edinburgh]--Infection control guidance has now been produced
for a range of health and non-health settings. These documents are
intended to assist workers in the course of their daily working
lives, to protect themselves, their colleagues, their families and
those around them, in preventing the spread of pandemic flu.
Health
Guidance for infection control in hospitals and primary care
settings
This guidance document has been developed to facilitate planning by
NHS Boards and provides infection control guidance and tools for
local public health and healthcare officials who are the front line
for managing and containing an influenza pandemic.
*
Guidance for hospitals and primary care settings
A summary of guidance for infection control in healthcare settings
This summary document provides generic information and infection
control advice for all healthcare settings.
*
Summary guidance in healthcare settings
Education
Guidance for infection control for schools and early years or group
childcare settings
This guidance is designed to assist staff in local authorities and
non-residential schools (in both the state and independent sectors)
and early years or group childcare settings in reducing the spread
of pandemic flu.
*
Guidance for schools and early years or group childcare settings
Guidance for infection control for childminders
This guidance explains what childminders can do to control infection
when pandemic flu arrives.
*
Guidance for childminders
Guidance for further education colleges and higher education
institutions
The guidance is designed to assist staff in further education
colleges and higher education institutions. It explains what staff
and students can do to protect themselves and those around them.
*
Guidance for further education colleges and higher education
institutions
Guidance for infection control in residential settings for children
and vulnerable young people
The guidance is designed to assist staff in residential settings for
children, boarding schools, secondary schools with hostels,
residential special schools and children's homes. It may also assist
staff in specialist colleges and residential settings for vulnerable
young people.
*
Guidance in residential settings for children and vulnerable young
people
Justice
Guidance for infection control for the fire and rescue service
This guidance is designed to assist members of the Fire and Rescue
Services to protect themselves and those around them.
*
Guidance for fire and rescue services
Guidelines for funeral directors
This guidance explains how funeral directors, embalmers and other
staff can, in the course of their daily work, protect themselves and
their families.
*
Guidelines for funeral directors
Washington: Business not as
usual: New video helps local businesses and agencies prepare for
pandemic flu
[Feb 5 King County]--Pandemic flu may be out of the headlines, but a
new video will help businesses, government agencies and
community-based organizations prepare for the ongoing threat of what
could be a catastrophic, world-wide event.
Public Health – Seattle & King County has launched Business Not As
Usual: Preparing for Pandemic Flu, a 20-minute training video to
help advance local preparedness efforts.
“It’s essential that businesses, government and social service
agencies can continue to provide critical services to the public
during a severe pandemic flu, which will last for months,” said King
County Executive Ron Sims. “We developed this video to inspire and
support local businesses and organizations in their preparations.”
Created to assist workplace leaders and staff in their pandemic flu
planning efforts, the video describes the threat of pandemic flu and
what life might look like during an outbreak. It also shows the
benefits of being ready, and provides practical tips for creating a
plan.
“Buildings are left standing, and the roads remain open, but the
health impacts of a severe pandemic flu will be felt throughout our
community,” said Dr. David Fleming, Director and Health Officer for
Public Health - Seattle & King County. “Everyone will need to change
how we do business when a pandemic flu comes, so it’s important that
everyone prepares now.”
The video profiles community leaders who share their experience in
preparedness. The cast includes local leaders from Washington
Mutual, Food Lifeline, Puget Sound Energy, Harborview Medical
Center, Chinese Information and Service Center and the Seattle Fire
Department. King County Executive Ron Sims and Public Health experts
also offer their knowledge and experience in disaster preparation.
“At Food Lifeline, we’ve been working hard to create sound plans to
prepare our staff and organization to respond effectively in times
of disaster,” said Linda Nagoette, President & CEO. “Whether the
challenges we face are weather related or stem from pandemic flu,
it’s our responsibility as a service provider to be ready – both at
home, and at work.”
“We here at WaMu take pandemic flu preparedness seriously. We
understand the impact of disaster on our operations goes well beyond
just our people and our business; the broad communities we serve
would be hard hit as well,” said Annie Searle, Senior Vice President
of Enterprise Risk Services at Washington Mutual. “This video is an
important tool to help all our communities become better prepared.”
A pandemic flu is a new influenza virus that could be a much more
serious flu virus than seen in a typical flu season. Different from
the typical, seasonal strains of flu, humans would have no or little
natural resistance to a new strain of influenza.
Once a pandemic virus develops, it can spread rapidly causing
outbreaks around the world. The Centers for Disease Control and
Prevention (CDC) predicts that as much as 25% to 30% of the United
States population could be affected. In King County alone, a severe
pandemic flu could make 540,000 people ill, 270,000 would need
outpatient care, over 59,000 would need hospitalization, and 11,500
could die in the first six weeks of an outbreak.
The video is available on-line now at
www.metrokc.gov/health/pandemicflu/video. A free DVD can also be
ordered, which includes helpful planning materials.
For more information on pandemic flu, visit the Public Health Web
site
www.metrokc.gov/health/pandemicflu
Global: WHO launches influenza
virus tracking system
[Jan 28 Geneva Switzerland]-- Following the Intergovernmental
meeting on Pandemic Influenza Preparedness: Sharing of influenza
viruses and access to vaccine and other benefits held on 21-23
November 2007, a system has been developed by WHO to provide
tracking information of A(H5N1) influenza specimens/viruses shared
with WHO through the Global Influenza Surveillance Network.
This system has been developed on the request made to WHO as
indicated by the Interim Statement.
The Influenza Virus Tracking System is an interim version. It is now
live and can be accessed by the public at
www.who.int/fluvirus_tracker.
USA: Report on Dept of Energy's
Pandemic Influenza Planning
[Dec 29 Washington DC]--Background: According to the CDC, in a worst
case scenario, as many as 90 million people in the U.S., including
30 percent of the U.S. workforce, could become sick from a mutated
avian influenza H5N1 strain. Proactive steps are therefore necessary
to protect U.S. Department of Energy [DOE] personnel and maintain
the Department's mission-essential functions.
On March 29, 2006, the Deputy Secretary of Energy signed a
memorandum, "Development of the Department of Energy Pandemic
Influenza Plans," which required all DOE entities, including the
National Nuclear Security Administration [NNSA], to develop specific
pandemic influenza plans with full implementation by May 31, 2006.
On November 8, 2006, the White House Homeland Security Council
issued a pandemic influenza plan checklist that contained additional
criteria for agencies to follow. The objective of the DOE inspection
was to determine if DOE was taking appropriate and timely actions
regarding its pandemic influenza planning.
Results of inspection: The inspection team concluded that while DOE
Headquarters and many department sites were making progress in their
pandemic influenza planning, much remained to be implemented... Read
the entire report online at:
http://www.ig.energy.gov/documents/IG-0784.pdf
USA: Researcher doubts American
program to track avian flu in wild birds
[Dec 12 Lawrence KS]--A University of Kansas investigator closely
following the spread of the avian influenza known as H5N1 said that
U.S. government monitoring efforts easily could miss the entry of
the virus into North America.
A. Townsend Peterson, University Distinguished Professor of Ecology
and Evolutionary Biology and senior curator in the Natural History
Museum and Biodiversity Research Center, directs teams of scientists
who travel from Kansas to far-flung corners of the globe to map the
spread of avian flu and other pathogens.
Peterson said the governmental scheme to detect the arrival of H5N1
in North America — the Highly Pathogenic Avian Influenza Early
Detection System — overemphasizes testing of wild water birds in
Alaska while neglecting other possible “entry pathways” from
Eurasia.
“If you take a careful look at bird migration in North America, you
probably wouldn’t want to, excuse the pun, ‘put all your eggs in one
basket’,” said Peterson.
The KU researcher said that the Alaskan focus of the program is
sensible for monitoring a set of wild Asian birds that spend winter
in Asia and sometimes summer in Alaska. But other birds possibly
carrying the avian influenza could be overlooked.
“There’s another component of birds which spend the winter in
America,” Peterson said. “They migrate north in the summer and
basically consider western Siberia to be eastern Alaska. That
component of birds migrates deep into the Americas, doesn’t really
stop in Alaska at all, and would be missed by the current monitoring
plan.”
According to Peterson, a more effective system to detect the
appearance of H5N1 would track wild birds all along the Atlantic and
Pacific “flyways” of North America.
“I’m essentially suggesting that we should be considering the entire
coastal regions and that the monitoring scheme should be much more
based on hard data instead of supposition and just eyeballing the
situation,” said Peterson.
Peterson’s team published initial results of its research on the
official H5N1 tracking program earlier this year in PLoS ONE, a
peer-reviewed science journal.
As of this month, government surveillance remains focused on Alaska:
According to the detection system, it sampled 11,819 wild birds in
that state, compared with 4,054 birds in California, the
second-highest state total. No highly pathogenic H5N1 virus has been
found in any of these samples.
Peterson said global efforts to track the avian flu also exaggerate
the role of wild waterfowl, such as ducks and geese.
Early research showed a higher percentage of these birds contained
the H5N1 virus, with lower rates among land birds. “But that seems
to have evolved into the idea that only water birds are the
reservoir of avian flu,” Peterson said. “As near as I can tell,
there are no data behind that. It’s just that prevalances are
higher. What gets forgotten is that numbers of waterfowl are lower.
So, how many bird-fulls of virus are out there in the world flying
around? It could easily be more land birds than water birds.”
These gaps in surveillance plans could slow the response to a
serious public health risk. According to the World Health
Organization, in 2007 there have been 49 human fatalities from H5N1
reported worldwide, out of 74 confirmed cases.
“It has every possibility of turning up in North America, but it
hasn’t essentially gotten in the door yet, that we know of,”
Peterson said. “These are rare events and it can take time. But I
see no reason why anybody would believe that it can’t happen. If it
gets to North America, it’s not going to be a terrible plague or
anything. But it increases the probability of evolving new virus
strains that could turn into something much more dangerous.”
With funding from the U.S. Department of Agriculture, KU research
teams of faculty, technical staff and graduate students have set out
to create a broad-scale, real-world base of quantitative data on
avian influenza, in coordination with other flu-monitoring efforts.
The investigators recently have sampled birds for virus in China,
the Philippines, Ghana and New Guinea, and will be working in Peru,
Mongolia and Bangladesh in coming months.
Ireland: Publication of Irish
influenza pandemic preparedness assessment report
[Nov 28 Dublin]--The Department of Health and Children and the
Health Service Executive today (26th November 2007) published a
report on influenza pandemic preparedness in Ireland. This report
was prepared following a thorough assessment undertaken by a
specialist team from the European Centre for Disease Prevention and
Control (ECDC). The assessment visit took place between February
28th and March 1st 2007.
The assessment which is being undertaken in all European Union
countries covered the key areas that give an indication of how
Ireland is prepared to deal with influenza and pandemic influenza
should it occur. It covers the following
* Seasonal influenza
* Avian influenza
* Pandemic influenza
* Planning and coordination
* Situation monitoring and assessment
* Prevention and reduction of transmission
* Health system response
* Communication
The assessment found that Ireland has made significant progress in
preparing for the next flu pandemic:
* Seasonal influenza surveillance is strong and there is good uptake
of vaccine in the over 65s at over 60%
* Preparedness for outbreaks of avian influenza is proactive and
impressive, with excellent cooperation between the Agriculture and
Health Departments and between public health and animal health
specialists
* Pandemic preparedness is well advanced
* the National Pandemic Influenza Plan, 2007 which was launched in
January 2007 covers virtually all of the essential planning elements
laid out by the European Union and the World Health Organisation
* the Pandemic Influenza Expert Group has provided comprehensive and
sound advice
* the quantity of antivirals in stock is enough to treat almost 2
million people. This compares very favourably with other countries
* one of the few credible hospital plans seen at European level was
presented to the team
* the communication plan is strong and more advanced than many other
countries
* Business Continuity Planning Advice published by the Department of
Enterprise, Trade and Employment and the Enterprise Agencies is an
excellent contribution to the wider planning agenda.
The report also highlights the need to continue work on pandemic
planning over the next two to three years focussing on a whole of
Government approach and detailed planning at the local level.
Speaking at the publication of the report, the ECDC team leader,
Professor Angus Nicoll said:
“Our expert team found that the authorities in Ireland have been
working very hard to improve preparedness. They have made great
progress and have made some very valuable contributions that will
benefit the rest of the EU, notably the work on business continuity
planning and hospital preparedness. At the same time, like all other
countries, we found areas where Ireland still has work to do.”
The Department of Health and Children and the Health Service
Executive are committed to working through the agreed action list
contained in the report. This work has continued during this year
and will continue to be a priority in the coming years.
Pandemic planning requires a co-ordinated response from Government
Departments and from all sectors of society. The Department of
Health and Children is working to drive the agenda at the
inter-Departmental level having regard to advice from the World
Health Organisation and ECDC and examples of best practice from
other countries.
Influenza Pandemic Preparedness in Ireland, Joint Assessment Report,
2007 is available on
www.dohc.ie
and www.hse.ie
Stockpiling influenza vaccine
in Hong Kong [Nov 24 New York NY USA]--In light of
the importance of virus monitoring for pandemic influenza
preparedness and response, Indonesia’s refusal to share samples of
avian flu (H5N1) virus with the WHO for most of 2007 is "distressing
and potentially dangerous for global public health," say two leading
global health experts in an essay in this week's PLoS Medicine.
Laurie Garrett (Senior Fellow for Global Health at the Council on
Foreign Relations, New York) and David Fidler (Professor of Law and
Director of the Center on American and Global Security at Indiana
University) say that Indonesia repeatedly refused to share H5N1
samples unless significant changes were made to allow it greater
access to vaccine derived from samples it shared with WHO.
Typically some 250-300 million influenza vaccine doses are made each
year, based primarily on samples of flu viruses circulating in Asia,
yet most of those vaccinated are residents of rich countries. Some
developing countries, say the authors, have challenged this strategy
by asking “What’s in it for us? We share virus samples, and
pharmaceutical companies make vaccines from them that primarily
benefit rich countries. Without better access to vaccine, why should
we share virus samples?”
Garrett and Fidler offer a novel proposal to overcome the virus
sharing impasse. They propose that annually updated supplies of more
than 500 million doses of highly specific influenza vaccine, plus
antiviral medicines, protective masks and gloves, and germicide
washes be stockpiled in Hong Kong. They select Hong Kong, they say,
because it has shown "absolute transparency regarding disease
emergences going back several decades," it is a dynamic center of
virus research and response, and it sits in the middle of the
ecological zone that has spawned the bulk of all flu strains known
to have emerged over the last three decades.
"We advocate that the strategic stockpile be fed continuously and
its specificity updated based on circulating forms of viruses," say
the authors. "These objectives would be accomplished through an
Advance Market Commitment (AMC) mechanism in which the G-8 nations
and Asian powerhouses China, India, Singapore, South Korea, and
Japan set aside a fund to guarantee purchase of stockpiled products.
The Asia-Pacific Economic Cooperation forum (APEC) should manage the
AMC fund and the stockpiled materials in Hong Kong. APEC has proven
to be one of the most dynamic and effective of the world’s regional
organizations."
Citation: Garrett L, Fidler DP (2007) Sharing H5N viruses to stop a
global influenza pandemic. PLoS Med 4(11): e330.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040330
HPA releases national framework
for responding to an influenza pandemic
[Nov 23 London England]--The Health Protection Agency welcomes
publication of the Government's National Framework for Responding to
an Influenza Pandemic. The Framework provides information and
guidance to assist and support organisations in developing and
improving their pandemic preparedness plans.
Professor Nigel Lightfoot, of the Health Protection Agency said “The
framework sets out the Government's strategic approach to preparing for an
influenza pandemic and gives guidance to all public and private
organisations to further develop their plans for a flu pandemic. The plan
will support flu preparedness and help reduce the impact of pandemic flu on
the UK population.
“The Agency helps people prepare for a flu pandemic. UK planning and
preparedness is well advanced and a significant number of exercises to test
these plans have been carried out locally, regionally and at a national
level”.
The HPA plays a key role in informing public health policy development on
pandemic influenza, through its expert advice, modelling and reference
virological services. It has produced a suite of guidance documents for
control of infection in health and non-health settings. The HPA has produced
protocols and algorithms for the investigation and management of early cases
and contacts, and it keeps a watch on the global avian influenza situation
by carrying out periodic risk assessments. During a pandemic the HPA will
provide surveillance information and real time modelling of the expected
impacts to inform Government decisions.
Published: 22 November 2007
This document describes the Government's strategic approach for
responding to an influenza pandemic published jointly by the Department of
Health and the Cabinet Office. It provides background information and
guidance to public and private organisations developing response plans. It
updates and expands upon health advice and information contained in previous
plans issued by UK health departments and is intended to replace those
documents. Supporting guidance includes an ethical framework and operating
guidance for adult social care, ambulance services, community and acute
healthcare.
Invitation to comment
Published: 22 November 2007
The UK’s plans for responding to an influenza pandemic are set out in the
recently published Pandemic Flu: A national framework for responding to an
influenza pandemic. To assist responders in developing their local plans
further draft guidance has been produced with the participation and advice
of subject experts and representatives from key stakeholder groups. We are
seeking wider comments on these drafts and would particularly welcome views
and contributions from those individuals and organisations involved in
pandemic influenza planning and preparedness. These will be collated and
analysed in depth and used to inform final guidance on this issue, which
will be available on the DH website in the summer. We would be grateful for
your comments by 22 February 2008.
Pandemic influenza: guidance for infection
control in hospitals and primary care settings
Published: 22 November 2007
This guidance document replaces the infection control guidance published
in October 2005. The changes and amendments in this edition are detailed on
page 4 and include updated advice on aerosol- generating procedures. This
advice takes into consideration and addresses the categorisation of such
procedures in the recently published interim guidance from the World Health
Organization on 'Infection prevention and control of epidemic- and
pandemic-prone acute respiratory diseases in health care' (June 2007).
Scientific evidence paper
Published: 22 November 2007
Cabinet Office paper summarising the wide-ranging evidence behind
strategies to respond to pandemic influenza.
Medicines consultation
Published: 22 November 2007
The consultation on possible changes to medicines and associated
legislation for use during a pandemic suggests ways to maintain people's
access to regular essential medicines in this period and looks at the
amendments which are required to support the operational framework. It asks
when these changes might be brought into force and when they should be
lifted, how far existing safeguards should be relaxed to ensure access and
whether there are other barriers to access that should be considered. The
consultation ends on 26 February 2008 and views are welcomed.
Newfoundland: Province
strengthens preparedness for pandemic
[Nov 16 St John's]--The Provincial Government has taken an important
step forward in its ongoing work to ensure the province is prepared
in the event of an influenza pandemic. Today the Honourable Ross
Wiseman, Minister of Health and Community Services, was joined by
the province’s chief medical officer of health, Dr. Faith Stratton,
as he outlined the tenets of the newly-released document Pandemic
Influenza: Planning Guidelines, Roles and Responsibilities for the
Health Sector.
"The potential threat of a pandemic is of concern worldwide and
while it is impossible to predict the timing of the next pandemic,
our government is working to make certain our health system is
poised to best respond to the needs of our residents should such an
event occur," said Minister Wiseman. "In our most recent Blueprint,
we committed to continued vigilance in ensuring the province’s
readiness for pandemics and other public health emergencies. These
guidelines reflect that commitment and represent an enormous amount
of work that will provide a solid foundation for us to build on our
pandemic preparedness."
Pandemic Influenza: Planning Guidelines, Roles and Responsibilities
for the Health Sector will guide the health sector both at the
provincial and community level to enhance pandemic awareness,
planning and response. The roles and responsibilities of the four
regional health authorities and the Provincial Government are
outlined and aligned with those of the Federal Government. The
overall goal is a comprehensive and integrated approach that will
ease the impacts of a pandemic in the province.
"These guidelines will prove tremendously valuable for our regional
medical officers of health and front-line health care managers,"
said Dr. Stratton. "They will help ensure a consistent and thorough
approach throughout the health system during a pandemic and
consequently, the delivery of the best possible health care."
The planning guidelines were developed in collaboration with the
regional health authorities and involved consultation with several
Provincial Government departments. In addition, the department works
closely with other provinces and territories and the Public Health
Agency of Canada to ensure a common approach to pandemic planning
and response across the country.
"This planning tool is part of a group of measures our government
has implemented to enhance the protection of the public in the event
of a public health emergency," said Minister Wiseman. "In Budget
2006, we invested $4.7 million for enhanced health and emergency
preparedness and today we are taking another important step in
preparing our health care system to respond to an influenza
pandemic."
"The release of these planning guidelines for the health sector
today marks the accomplishment of an important piece in our strategy
of ensuring thorough and effective pandemic and health emergency
preparedness that best protects the people of this province," said
Minister Wiseman. "We will continue to update these guidelines as we
move forward in working with the regional health authorities as they
develop detailed operational plans at the community level."
The document Pandemic Influenza: Planning Guidelines, Roles and
Responsibilities for the Health Sector is available at
www.gov.nl.ca/health.
Indiana: Online pandemic flu
simulation provides opportunity to expand emergency preparedness
solutions
[Nov 16 Indianapolis]--The Indiana State Department of Health
recently launched a pandemic influenza simulation course. The
simulation was an online exercise education tool designed to help
emergency personnel, health departments, hospitals, and mental
health professionals practice responding to critical situations
during the event of an influenza pandemic.
“The Indiana Pandemic Influenza Simulation is a creative continuing
education opportunity on the Indiana Learning Management System
expanding concepts of public health planning and preparedness,” says
Shawn Richards, respiratory epidemiologist at the Indiana State
Department of Health. “It allows individuals to practically apply
decision-making skills for their specific responsibilities and roles
in the event of an influenza pandemic.”
In addition, the simulation helps to develop skills to respond more
efficiently and effectively during a full-scale exercise, drill or
public health emergency.
The web-based simulation allows users to select from 10 functional
roles including public health professional, public information
officer, mental health professional, emergency management agency
staff, medical/hospital preparedness staff, point of distribution,
mental health, screener, security officer and staff supervisor.
Three mock scenarios are also included to allow individuals to
utilize the knowledge they have gained from the simulation.
For more information, go to
www.inlms.com
Lessons from Turkey's bird flu
outbreak
[Nov 15 Istanbul Turkey]--Rapid responses by Turkey's health
authorities and key health personnel were critical in bringing the
2006 bird flu outbreak under control, according to research
published in the online open access journal, BMC Public Health.
Those involved cite poverty and families sharing their homes with
poultry as factors behind the virus' transfer to humans.
During early 2006, 12 avian influenza cases were confirmed in
Turkey, of which eight cases occurred in the Dogubeyazit-Van region.
Ozlem Sarikaya of the University of Marmara, Istanbul and Tugrul
Erbaydar of the University of Yuzuncu Yil, Van, conducted in-depth
interviews with senior health professionals to evaluate attempts to
control the outbreak.
The authors found that, although a crisis committee was created
quickly, healthcare workers felt anxious and ill-prepared due to a
lack of clarity about their responsibilities in emergency disease
plans, and delays in receiving protective clothing. The researchers
also found that the coordination between the human and animal health
services was not sufficient. Despite these difficulties, open
communication between the government and the public, as well as the
health authorities' and health workers' efforts, helped control the
epidemic. Poultry rearing practices, coupled with poverty and poor
access to healthcare, were the primary risk factors for infection.
"Lessons learned from this outbreak should provide an opportunity
for integrating the preparation plans of the health and agricultural
organizations," say Sarikaya and Erbaydar, "and for revising the
surveillance system and enhancing the role of the primary health
care services in controlling epidemic disease." They add that
informed response strategies will play an invaluable role in the
control of a future avian influenza pandemic.
Article available from the journal website at:
http://www.biomedcentral.com/bmcpublichealth
Global: Projected supply
of pandemic influenza vaccine sharply increases
[Oct 25 Geneva Switzerland]--Recent scientific advances and
increased vaccine manufacturing capacity have prompted experts to
increase their projections of how many pandemic influenza vaccine
courses can be made available in the coming years.
Last spring, the World Health Organization (WHO) and vaccine
manufacturers said that about 100 million courses of pandemic influenza
vaccine based on the H5N1 avian influenza strain could be produced
immediately with standard technology. Experts now anticipate that global
production capacity will rise to 4.5 billion pandemic immunization courses
per year in 2010.
"With influenza vaccine production capacity on the rise, we are beginning
to be in a much better position vis-à-vis the threat of an influenza
pandemic," Dr Marie-Paule Kieny, Director of the Initiative for Vaccine
Research at WHO, said today. "However, although this is significant
progress, it is still far from the 6.7 billion immunization courses that
would be needed in a six month period to protect the whole world."
"Accelerated preparedness activities must continue, backed by political
impetus and financial support, to further bridge the still substantial gap
between supply and demand," she said.
This year, manufacturers have been able to step up production capacity of
trivalent (three viral strains) seasonal influenza vaccines to an estimated
565 million doses, from 350 million doses produced in 2006, according to the
International Federation of Pharmaceutical Manufacturers & Associations.
According to experts working in this field, the yearly production capacity
for seasonal influenza vaccine is expected to rise to 1 billion doses in
2010, provided corresponding demand exists.
This would help manufacturers to be able to deliver around 4.5 billion
pandemic influenza vaccine courses because a pandemic vaccine would need
about eight times less antigen, the substance that stimulates an immune
response. Vaccine production capacity is linked to the amount of antigen
that has to be used to make each dose of the vaccine. Scientists have
recently discovered they can reduce the amount of antigen used to produce
pandemic influenza vaccines by using water-in-oil substances that enhance
the immune response.
The progress was reported Friday at the first meeting of a WHO Advisory
Group on pandemic influenza vaccine production and supply.
The Global Action Plan Advisory Group, an independent, international
committee of 10 members, met at WHO headquarters one year after eight new
strategies to increase pandemic influenza vaccine were identified and
published in the WHO Global pandemic influenza action plan to increase
vaccine supply.
At the Advisory Group meeting, other progress on the Global Action Plan
was discussed. WHO reported it is setting up a training hub that would serve
as a source of technology transfer to developing countries.
The Advisory Group also discussed
a new business plan which assessed options for further increasing vaccine
production capacity and reviewed priority next steps. The three most
valuable options include continuing to promote seasonal influenza vaccine
programmes, supporting the industry to sustain production capacity beyond
seasonal demand and enabling some vaccine production facilities to change,
at the onset of a pandemic, from producing inactivated vaccines to live
attenuated vaccines. Due to the higher yields obtained with live attenuated
influenza vaccine technology, facility conversion could, by 2012, bridge the
expected supply-demand gap and produce enough vaccine to protect the global
population within six months of the declaration of a pandemic.
Avian influenza lessons learned
report published
[Oct 25 London England]--In line with our commitment to learn
lessons from all disease outbreaks, Defra has today published a
lessons learned report following the outbreak of H5N1 highly
pathogenic avian influenza in Suffolk in February this year.
The report concludes that the response to the outbreak was effective and
highlights the benefits of the contingency planning work over the last six
years. Disease was contained to one premises and controlled both quickly and
successfully. This view was reflected by stakeholders and operational
partners demonstrating their increased confidence in the Government’s
contingency planning and ability to respond to a disease outbreak.
The report also makes 34 detailed operational recommendations on the
management of an outbreak of avian influenza, or other exotic animal
disease. These recommendations have all been accepted and have already been
adopted in our response to the current Foot and Mouth Disease and Bluetongue
outbreaks.
Commenting on the report, the Deputy Chief Veterinary Officer, Fred Landeg,
said:
“I welcome the publication of this report and congratulate all those
involved for their hard work in containing the outbreak so quickly and
effectively. Even when things have gone well, it is very important to learn
the lessons and improve the way we prepare for the future. This is
especially relevant as we are in the midst of dealing with two outbreaks of
animal disease at the moment. This is a shared responsibility, and I urge
the farming industry to work to develop their own contingency plans to
prepare for possible future outbreaks too.
“Cases of avian influenza, H5N1, over the last few months in the Czech
Republic, Germany and France demonstrate the threat to UK is continuing and
real. We will be at increased risk during the autumn migration period.
Therefore, it is as important as ever that we are properly prepared, and I
would urge all bird keepers to retain high levels of vigilance and
biosecurity.”
Key themes & recommendations include:
- Working ever more closely with delivery partners and the livestock
industry to plan and deliver disease control activities.
- Animal Health working with industry to ensure that plans are in
place at every large commercial poultry premises.
- Animal by-product arrangements to be reviewed and strengthened for
premises similar to the Holton site.
- Communications need to be fast and effective, focused on key
audiences (e.g. through timely use of the GB Poultry Register).
As part of the lessons learned process, Defra and the Food Standards
Agency also jointly commissioned an independent review of the role and
responsibilities of the Meat Hygiene Service in animal disease outbreaks.
This is also being published. This review concluded that the arrangements
had worked well, but that there were lessons to be learned around clarifying
roles and responsibilities for designation of slaughterhouses and
enforcement activities.
Both reports can be found
online
USA: Testimony of Dr. Kimothy Smith, Acting Director of the National
Biosurveillance Integration Center before the Senate Homeland
Security and Governmental Affairs Committee, Subcommittee on
Oversight of Governmental Management, the Federal Workforce, and the
District of Columbia
Forestalling the Coming
Pandemic: Infectious Disease Surveillance Overseas
[Oct 4 Washington DC]--Mr. Chairman, Ranking Member Voinovich, and
Members of the subcommittee, I am Dr. Kimothy Smith, Acting Director
of the National Biosurveillance Integration Center and Chief
Scientist in the Office of Health Affairs at the Department of
Homeland Security (DHS). Before I begin, I would like to thank you
for the opportunity to testify before the subcommittee on this
critical issue of global disease surveillance and your continued
willingness to work with the Department in providing leadership and
commitment to ensure the security of our Nation. I would also like
to thank our Federal partners, including those on the panel today,
and others that support and interact with us as we work everyday to
fulfill our mission.
As you may know, the Office of Health Affairs, within DHS, is leading the
National Biosurveillance Integration Center, or NBIC,
partnership. Establishing NBIC has been, and continues to be, a top priority
for Secretary Chertoff. NBIC brings together biological information from
various Federal partners and open sources to develop an integrated picture
of biological risks. The President has called for a “timely response to
mitigate the consequences of a biological weapons attack.” Our mission was
initially established through Homeland Security Presidential Directives (HSPDs)
9 and 10. It was also recently codified in title XI of P.L. 110-53,
Implementing Recommendations of the 9/11 Commission Act of 2007.
NBIC seeks to provide information to allow early recognition of
biological events of national concern, both natural and man-made, to make a
timely response possible. No other place in government serves to integrate
this information from across the spectrum of public and private, domestic
and international, open or protected sources. The three vital component
parts of NBIC are:
-
A robust information management system capable of handling large
quantities of structured and unstructured information;
-
A corps of highly-trained subject matter experts and analysts; and
-
A clear establishment of a culture of cooperation, trust and mutual
support across the Federal government and other partners.
NBIC has agreements with a number of Federal partners and other relevant
entities. Many of these agreements have been formalized through MOUs, while
others are still being developed. Specifically, we have MOUs with
Departments of the Interior, State, Agriculture, Defense, Health and Human
Services and Transportation, as well as working closely with our DHS
components. We also have formal outreach with the Department of Veterans’
Affairs, FBI, U.S. Postal Service, Environmental Protection Agency and the
National Oceanic and Atmospheric Administration. Additionally, we are
developing relationships with State Intelligence Fusion Centers and with
outside entities such as Georgetown University’s ARGUS Project – who are
represented here today. As we have learned throughout this process, each
agency and organization is quite unique and there are many forms and types
of information out there to identify, capture, analyze and integrate into a
common picture. To succeed, we must leverage all possible information
sources within their limits. The key to the success of NBIC is the trusted
relationships among Federal partners and others who provide access to the
valuable information necessary to meet the needs of decision-makers.
A system of this complex nature, however, is not fully functional without
the subject matter expertise and analysis. Thus, subject matter experts from
the various agencies and organizations must also be leveraged to examine
information, provide informed interpretation, and accomplish consultations,
when necessary, to meet the needs of the appropriate decision makers.
To provide additional value to our partners, DHS has the advantage of its
access to threat information, which, when integrated with surveillance of
health data and disease outbreak trends may provide early warning of a
biological attack. To accomplish this, fused information products and other
patterns and trends developed from biosurveillance sources are provided to
our agency partner, the DHS Office of Intelligence and Analysis, for
incorporation with intelligence analysis products. When appropriate, the
product can be forwarded to the wider Intelligence Community and pertinent
threat analysis information added for return to the Center for further
interagency dissemination. This final process of actionable information
preparation fuses biosurveillance patterns and trends with threat
information. The completed products can then be provided to the National
Operations Center (NOC) for inclusion in the Common Operating Picture
(COP). This distribution closes the loop by providing biosurveillance
situational awareness back to NBIC partner agencies and other organizations.
By integrating and fusing this large amount of available information we
can then begin to develop a base-line against which we can recognize
anomalies and changes of significance. NBIC seeks to identify patterns and
trends, which in combination with threat analysis provide the situational
awareness our partners need to execute their mission.
The NBIC is operating today, providing analysis and developing
biosurveillance assessments, while responding with our Federal partners to
real-world events. However, it should be noted that it is not at Full
Operational Capability (FOC). The projected date for full NBIC operations is
September 2008. The Center currently operates a 24 hour/7 days a week
National Biosurveillance Watch Desk, within the National Operations Center (NOC),
which first stood up in December 2005. Over the last few months, we have
transitioned to having U.S. Public Health Service officers posted at our
Watch Desk, a change that provides a needed, initial “eyes-on” assessment of
incoming information to determine potential importance to health security
and the need for further analysis. Facilities have been acquired and
personnel requirements have been finalized with two-thirds of those
requirements filled to date. Interagency Agreements and Memorandums of
Agreement (MOAs) have also been developed for the integration of subject
matter experts (SMEs) from the Centers for Disease Control and Prevention
(CDC) and the Armed Forces Military Intelligence Center (AFMIC).
We have also recently introduced our National Biosurveillance Integration
System Operational Display System (NODS), an IT system that provides our
Center the visibility into over 300-plus unclassified sources of
biosurveillance information from across multiple sources. This information
is aggregated with various reports that we receive from the departments of
Defense, State, Health and Human Services, Agriculture, and Transportation
and other sources. Our relationship and integration of such valuable
sources, such as ARGUS is firmly established within NODS.
Currently, the acquisition process of our biosurveillance program is
based on monitoring sources of biological information used to develop
information products for dissemination to decision makers and key
stakeholders. Some of these sources include: ARGUS, the Office International
des Epizooties (OIE -The World Organization for Animal Health), and the
World Health Organization (WHO), among others. Our system collects and
stores information, permitting easy querying via web-based interface. Our
early experience has shown that much of this information is not neatly
packaged, but comes mostly unstructured, sometimes as simple “e-mail”
message traffic or reports in multiple formats. As we become aware of new,
useful information streams, we will assess their value and will incorporate
them as appropriate.
We are expanding NODS capabilities to automate the development and
dissemination of reports. Our NBIC reports, to be distributed through the
NOC-COP fall into three categories: real-time notifications, daily and
weekly reports and situational reports. Notifications are short, factual
summaries developed immediately following significant or newsworthy
“bio-events.” Daily and weekly reports, highlight events of potential
significance. Situation reports provide daily updates of ongoing domestic or
international “bio-events.” Additionally, we have instituted a Pilot
Biosurveillance Common Operating Picture (BCOP) that incorporates weekly
Avian Influenza updates.
One important function of NBIC will be the integration of wildlife
biosurveillance information as a potential key early indicator of a possible
disease outbreak. The U.S. Fish and Wildlife Service, USDA and the U.S.
Geological Survey, along with information networks such as the Global Avian
Influenza Network for Surveillance (GAINS), that receives support from my
colleagues at USAID and CDC and the International Species Information
System/Zoological Information Management System (ISIS/ZIMS) community all
provide data that may prove useful as a “very early” indicator of a
significant bio-event.. To this end, we have clear interest in supporting
the ISIS/ZIMS efforts as well as deepening our relationship with our GAINS
colleagues for enhanced information sharing beneficial to the broader
biosurveillance community. NBIC’s ability to fuse data gathered from across
Federal agencies and others will assist in public health risk determinations
in the event sick animals are detected in wildlife. As an example, sampling
of birds for the H5N1 virus is useful to support the Nation’s effort against
pandemic influenza.
Mr. Chairman, and members of the subcommittee, there are numerous
challenges before us to develop an effective biosurveillance capability,
which require a tremendous amount of continued partnership, dialogue and
development of system capacity. However, the consequences of not developing
this capability could be devastating. While continuing to move forward to
meet our initial goals, we are cognizant of maintaining a realistic
assessment of the biosurveillance mission to assure success. There are no
perfect data sets available at the present time that gives a picture of all
bio-events.
Even as we work toward the acquisition and automation of the myriad
information streams, the heart and soul of our program continues to be
people representing our various partners and NBIC staff. Retention of
existing staff and completing interagency agreements for additional
subject-matter experts and analysts are essential to accomplishing the
mission.
The scope and quality of our reporting continues to be our emphasis and
our daily challenge in an effort to serve our customers. Facilitating
distribution of the information products will be in place when NBIS 2.0 is
launched providing web-based, security level specific access. Data from
multiple domains, bringing it together and providing substantive analysis is
complex and difficult. Additionally, there are the challenges of privacy and
propriety of information, information-sharing protocols, and system
security.
At DHS, we continue to work on obtaining the needed systems, information
and subject matter expertise to meet this critical mission of
biosurveillance; one that remains a top-priority of Secretary Chertoff. Our
job is to ensure that the nation has the capability for comprehensive,
integrated biosurveillance situational awareness, early-warning of a
possible attack and a decision support system for outbreak and event
response in the event of a biological incident, whether intentional or
naturally occurring. With your continued support, as well as our interagency
and organizational partners, we can achieve this critical mission. Thank you
for your time and continued leadership on these critical issues. I look
forward to answering your questions.
USA: Testimony of Dr. Til Jolly, DHS Associate Chief Medical Officer
for Medical Readiness before the U.S. House of Representatives
Committee on Homeland Security Subcommittee on Emerging Threats,
Cybersecurity, and Science and Technology
Beyond the Checklist:
Addressing Shortfalls in National Pandemic Influenza Preparedness
[Sep 27 Washington DC]--Mr. Chairman, Ranking Member McCaul and
Members of the Subcommittee:
Thank you for the opportunity to testify before the Subcommittee to
discuss the progress of the National Strategy for Pandemic Influenza and its
Implementation Plan. I am Dr. Til Jolly, Associate Chief Medical Officer
for Medical Readiness, within the Office of Health Affairs at the Department
of Homeland Security (DHS). Before I begin, I would like to take this
opportunity to thank you and Members of the full Committee on behalf of
Secretary Chertoff for your continued willingness to work alongside the
Department to provide leadership in protecting and ensuring the security of
our homeland. I would also like to thank our partners at the Department of
Health and Human Services (HHS) and others with whom we work every day.
To begin, I would like to take a few moments to review some basic facts
about pandemics and their potential impacts on our nation. Pandemic
influenza occurs when a novel strain of influenza virus emerges that has the
ability to infect humans and to cause severe disease, and when efficient and
sustained transmission between humans occurs. This scenario creates unique
challenges. Unlike other incidents, a pandemic is not a singular event, but
is likely to come in waves, each lasting weeks or months, passing through
communities of all sizes across the nation and the world simultaneously.
The complete pandemic cycle may last as long as 18 months. Based on
projections modeled by the Department of Health and Human Services from
prior pandemics, an influenza pandemic could result in 200,000 to 2 million
deaths in the United States, depending on its severity. Further, an
influenza pandemic could have major impacts on society and the economy,
including our nation's critical infrastructure and key resources, as many of
our nation's workforce could be absent for extended periods of time, either
sick themselves or caring for loved ones at home.
The Implementation Plan for the National Strategy for Pandemic Influenza
was released over a year ago by the President's Homeland Security Council to
guide our nation's preparedness and response to an influenza pandemic. DHS
has been actively engaged with its federal, state, local, territorial,
tribal, and private sector partners to prepare our nation and the
international community for an influenza pandemic. As outlined in the
Implementation Plan DHS is responsible for the coordination of the overall
domestic Federal response during an influenza pandemic, including
implementation of policies that facilitate compliance with recommended
social distancing measures, development of a common operating picture for
all Federal departments and agencies, and ensuring the integrity of the
Nation's infrastructure, domestic security and entry and exit screening for
influenza at the borders.
To date DHS has accomplished over 80% of the requirements outlined in the
Implementation Plan. DHS recognizes the key role of HHS in its
responsibilities to lead clinical disease surveillance and rapid detection
during a pandemic, and, under Emergency Support Function (ESF)-8, to plan,
prepare, mitigate and support the coordination of the public health and
medical emergency response activities during a pandemic under ESF-8,
including the deployment and distribution of vaccines and of antivirals and
other life-saving medical countermeasures from the Strategic National
Stockpile. DHS also recognizes the Department of State's role to lead the
coordination of international efforts including U.S. engagement in a broad
range of bilateral and multilateral initiatives that build cooperation and
capacity to fight the spread of avian influenza, to prepare for a possible
pandemic, and to coordinate with our neighbors Canada and Mexico. The
Department of Agriculture (USDA) conducts surveillance for influenza in
domestic animals and animal products, monitoring wildlife in partnership
with the Department of the Interior, and working to ensure an effective
veterinary response to a domestic animal outbreak of highly pathogenic avian
influenza.
In working with our partners DHS has developed and implemented a number
of initiatives and outreach to support continuity of operations planning for
all levels of government and private sector entities. I will highlight a
few noteworthy accomplishments and responsibilities under the Implementation
Plan particular to DHS.
DHS produced and released the
Pandemic Influenza Preparedness, Response, and Recovery Guide for Critical
Infrastructure and Key Resources (Guide). Tailored to
national goals and capabilities, and to the specific needs identified by the
private sector, this business continuity guidance represents an important
first step in working with the owners and operators of critical
infrastructure to prepare for a potentially severe pandemic outbreak. The
Guide has served to support business and other private sector
pandemic planning by complementing and enhancing, not replacing, their
existing continuity planning efforts. With that in mind, the Federal
government developed the Guide to assist businesses whose existing
continuity plans generally do not include strategies to protect human health
during emergencies such as those caused by pandemic influenza or other
diverse natural and manmade disasters.
DHS is currently leading the development of specific guides for each of
the 17 critical infrastructure and key resource sectors. These include
agriculture, food, and water, public health, emergency services,
telecommunications, banking, defense systems, transportation, energy
resources, and others. These guides are being developed utilizing the
security partnership model and in collaboration with our Federal partners.
In coordination with other Federal departments and agencies, DHS is
developing a coordinated government-wide planning forum. An initial
analysis of the response requirements for Federal support has been
completed. From this analysis, a national plan defining the federal concept
for coordinating response and recovery operations during a pandemic has been
developed and will be undergoing interagency review. Utilizing this planning
process, a coordinated federal border management plan has been developed and
is currently in review. This process included state, local, tribal,
territorial, and private sector stakeholder input, along with our Federal
interagency partners.
DHS has conducted or participated in federal and state interagency
pandemic influenza exercises which have focused on varied issues related to
preparedness. These exercises have included:
- FEMA's Determined Accord series for continuity of operations with
federal, state, local, tribal, territorial entities.
- Several Customs and Border Protection exercises – addressing
transportation and border challenges.
- A U.S. Fire Administration tabletop exercise for development of best
practices models and protocols for EMS, 911 Call Centers, Fire Services,
Emergency Managers, Law Enforcement and Public Works. This will allow
for further integration of a unified Federal, state, local and private
sector emergency response capabilities.
- HHS sponsored regional National Governors Association Pandemic
Influenza exercises, CDC funded and provided guidance for state and
local exercises, and DOD pandemic influenza exercises.
- Multiple workshops and forums with the owners and operators of
critical infrastructure and key resources.
Consistent with his role under Homeland Security Presidential Directive (HSPD)
5, Secretary Chertoff pre-designated Vice Admiral Crea, the Vice Commandant
of the US Coast Guard, as the National Principal Federal Official (PFO) for
pandemic influenza and has pre-designated five regional PFOs and 10 deputy
PFOs. Likewise, our partners have pre-designated Infrastructure Liaisons,
Federal Coordinating Officers, Senior Officials for health as well as
Defense Coordinating Officers. VADM Crea and the Regional PFOs have
participated in several training sessions regarding preparedness duties, and
have held two orientation sessions to date. These sessions included updates
from the Department of State, the Department of Agriculture, the Department
of Health and Human Services, the Department of Defense, as well as updates
from various DHS components and staff regarding their work to date.
Additionally, the PFO teams have begun outreach both nationally and in their
regions in advance of a more formalized exercise program which is being
developed by DHS.
On an ongoing basis, DHS participates in interagency working groups to
develop guidance including community mitigation strategies, medical
countermeasures, vaccine prioritization, and risk communication strategies.
These groups bring together a wide range of federal partners to discuss
preparedness issues.
In closing, significant progress that has been made in national
preparedness for pandemic influenza. In fact, September is National
Preparedness Month, which encourages all Americans to prepare for
emergencies and take the necessary actions for all-hazards. Many of these
accomplishments can be incorporated into an all-hazards framework to promote
the national culture of preparedness. DHS looks forward to continuing its
partnership with the federal interagency, state, local, tribal, territorial,
and private sector stakeholders to complete the work of pandemic
preparedness and to further the nation's ability to prepare for, respond to,
and recover from all-hazards.
Thank you again for the opportunity to testify on behalf of the
Department of Homeland Security on these issues of critical importance to
our nation's security and well-being. I would be happy to answer any
questions you might have.
Kansas: State's pandemic flu
preparedness plans selected for national website
[Sep 25 Topeka]-- The Kansas Department of Health and Environment’s
(KDHE) efforts to plan for a flu pandemic were selected to be
included in Pandemic Practices, an online database of promising
practices launched September 24 by two nationally renowned
organizations, the Center for Infectious Disease Research & Policy (CIDRAP)
at the University of Minnesota and the Pew Center on the States
(PCS), a division of The Pew Charitable Trusts.
Compiled as a resource to save communities and states time and
resources, the database enables public health professionals to learn
about KDHE’s efforts. The material can be used to enhance state and
local plans to prepare for pandemic influenza.
KDHE has developed the Community Disease Containment Toolbox, a
document that provides information resources to help local public
health personnel contain the spread of potential pandemic influenza
viruses. The Community Disease Containment Toolbox was developed in
partnership with the Kansas Association of Local Health Departments
(KALHD) and the Kansas Association of Counties (KAC).
“The Community Disease Containment Toolbox is a tremendous example
of what state and local government, including public health
agencies, can do when we pull together and work as a team,” stated
Roderick L. Bremby, Secretary of KDHE.
The toolbox is supported by two additional documents. The KDHE
Analysis and Guidance Plan for Pandemic Influenza Mitigation
provides recommendations for containing pandemic influenza,
utilizing the national pandemic severity index, as well as the
Kansas strategy for a response. The Kansas Pandemic Influenza
Standard Operating Guide outlines procedures for local agencies to
plan and prepare for an influenza pandemic utilizing the resources
provided in the toolbox.
Kansas ’s approach is one of more than 130 practices submitted from
four countries, 22 states and 30 communities nationwide. It was
chosen by peer-reviewers -- 27 public health experts -- for the
online database. The database will allow cities, counties, states,
hospitals, clinics, and community organizations to save time and
resources by adapting promising approaches created by their peers in
three key areas: altering standards of clinical care, communicating
effectively about pandemic flu, and delaying and diminishing the
impact of a pandemic.
Users can easily find practices applicable to their communities. The
database can be searched by state or topic, as well as by area of
special interest, such as materials translated into multiple
languages, materials for vulnerable populations, or toolkits for
schools.
“We’ve worked very hard to develop guidance that will serve Kansas
well in the event of pandemic influenza,” said Dr. Howard Rodenberg,
Director of the KDHE Division of Health and State Health Officer.
“We are extremely excited that other states will now have the
opportunity to benefit from those efforts.”
According to one estimate, pandemic influenza could cause 2,500
deaths, 5,000 hospitalizations, 500,000 outpatient visits, and 1
million people to become ill in Kansas.
Every winter, seasonal flu kills approximately 36,000 Americans and
hospitalizes more than 200,000. Occasionally, a new flu virus
emerges for which people have little or no immunity. Such a virus
will spread worldwide, causing illnesses and deaths far beyond the
impact of seasonal flu, in an event known as a pandemic. A severe
flu pandemic will last longer, sicken more people and cause more
death and disruption than any other health crisis. In addition to
the human toll, a flu pandemic will take a serious financial toll.
One report predicts a range – from a global cost of approximately
$330 billion in a mild pandemic scenario, to $4.4 trillion worldwide
under a 1918-like scenario.
Online at
www.PandemicPractices.org
Public comment welcome on
community measures to prevent deaths during a pandemic
[Sep 13 Salt Lake City UT USA]--The
Utah Department of Health (UDOH) has posted information on its Web
site outlining recommendations that may be implemented during an
influenza pandemic. The issue has been studied and debated by many
over the past year and the UDOH believes these steps will be
important to reduce the number of deaths in Utah.
A study published in the August 8th issue of the Journal of the
American Medical Association looked at public records from the
1918-1919 influenza pandemic. That study demonstrated that school
closures and other community strategies were the most effective in
reducing the possibility of spreading disease between people during
an epidemic.
“Communities that were most successful in warding off deaths during
the 1918 pandemic quickly enacted a number of measures,” according
to Dr. Robert Rolfs, Utah State Epidemiologist.
“These strategies
are particularly important because the intervention most likely to
provide the best protection against pandemic influenza, a vaccine,
will most likely not be available at the beginning of the outbreak,”
adds Dr. Rolfs.
Dr. Rolfs says, “In order for the restrictions to be most effective,
we’ll have to rely on the public’s willingness to make some pretty
substantial changes in day-to-day life. We hope that people will
look at the restrictions, learn about what they’ll need to do during
the next pandemic, and tell us if we need to make any changes for
this plan to work.”
To read and make
comments on the recommendations, please visit
http://pandemicflu.utah.gov/.
Combatting avian flu in
North America - The North American Plan for Avian and Pandemic
Influenza [Aug 21 Montebello QC Canada]--“Canada, Mexico
and the United States face a growing threat posed by the spread of
avian influenza and the potential emergence of a human influenza
pandemic…While the virus has not yet reached North America, the
three countries must be prepared for the day when it—or some other
highly contagious virus—does.” – North American Plan for Avian and
Pandemic Influenza.
The North American Plan for Avian
and Pandemic Influenza was announced by the Presidents of the United
States and Mexico and the Prime Minister of Canada on August 21,
2007 in Montebello, Canada, at the North American Leaders Summit.
The Plan was developed as part of the Security and Prosperity
Partnership of North America (SPP). The SPP is a trilateral effort
launched in March 2005 to increase security and enhance prosperity
in Canada, Mexico and the United States through greater cooperation
and information sharing. The three nations are working together
through the SPP to prepare for a threat that could disrupt our
economies and cause widespread illness and death if it reaches our
shores: highly pathogenic avian influenza—or bird flu—and the
potential emergence of a human influenza pandemic.
Background
The highly pathogenic H5N1 avian
influenza virus, which re-emerged in Asia in late 2003, has infected
birds in more than 55 countries in Europe, the Middle East and
Africa, and has resulted
in the deaths, through illness and culling, of over 250 million
birds across Asia. The virus is now endemic in parts of Southeast
Asia, is present in long-range migratory birds, and is unlikely to
be
eradicated in the short term. Although it has not yet become easily
transmissible among humans, the disease has sickened over 300 people
and resulted in more than 190 deaths.
Although the timing cannot be predicted, history and science suggest
the world will face at least one influenza pandemic this century. A
worldwide outbreak of a new influenza virus could result in a high
death toll, millions of hospitalizations, and hundreds of billions
of dollars in direct and indirect costs to North American economies.
The North American Plan for Avian and Pandemic Influenza
The North American Plan for Avian and Pandemic Influenza outlines a
collaborative North American approach that recognizes that
mitigating the effects of a pandemic requires coordinated action by
all three countries. It outlines how Canada, Mexico and the United
States will work together to prepare for and manage outbreaks of
highly pathogenic avian influenza and pandemic influenza.
At the March 2006 SPP summit in Cancun, Mexico, the leaders of the
three countries committed to developing a comprehensive,
coordinated, science-based approach to prepare for and manage avian
and pandemic influenza. This common approach would be based on the
four pillars of emergency management: prevention and mitigation,
preparedness, response, and recovery.
Canada, Mexico and the United
States also established a senior-level Coordinating Body on Avian
and Pandemic Influenza to facilitate effective planning and
preparedness within North America for a possible outbreak.
Key Objectives of the North American Plan
The North American Plan provides
a framework to accomplish the following:
Detect, contain and control an avian influenza outbreak and prevent
transmission to humans;
Prevent or slow the entry of a new strain of human influenza into
North America;
Minimize illness and deaths; and
Sustain infrastructure and
mitigate the impact to the economy and the functioning of society.
The Plan establishes a framework
for action on priority areas including: trilateral emergency
coordination and communication; joint exercises and training;
response to outbreaks in animals;
surveillance among animals and in humans; laboratory practices;
research; personnel exchange; screening for air, sea and land
travel; and maintaining continuity for critical infrastructure and
key services.
Central to the Plan is a North American approach that undertakes
measures to maintain the flow of people, services, and cargo across
the borders during a severe pandemic while striving to
protect our citizens.
The Plan also complements existing national emergency management
plans, and builds upon the core principles of the International
Partnership on Avian and Pandemic Influenza, the standards and
guidelines of the World Organization for Animal Health, the World
Health Organization (including the revised International Health
Regulations), and the rules and provisions of both the World Trade
Organization and the North American Free Trade Agreement. It
represents a significant contribution to the concerted efforts of
national and multilateral partners worldwide to combat a growing
challenge to animal and human health.
The North American Plan for Avian
and Pandemic Influenza may be found at
www.state.gov/g/avianflu
NIH scientists target
future pandemic strains of H5N1 avian influenza [Aug 9
Bethesda MD USA]--Preparing vaccines and therapeutics that target a
future mutant strain of H5N1 influenza virus sounds like science
fiction, but it may be possible, according to a team of scientists
at the National Institute of Allergy and Infectious Diseases (NIAID),
a component of the National Institutes of Health (NIH), and a
collaborator at Emory University School of Medicine. Success hinges
on anticipating and predicting the crucial mutations that would help
the virus spread easily from person to person.
Led by Gary Nabel, M.D., Ph.D., director of the NIAID’s Dale and
Betty Bumpers Vaccine Research Center (VRC), the team is reporting
in the August 10, 2007 issue of the journal Science that they have
developed a strategy to generate vaccines and therapeutic antibodies
that could target predicted H5N1 mutants before these viruses evolve
naturally. This advance was made possible by creating mutations in
the region of the H5N1 hemagglutinin (HA) protein that directs the
virus to bird or human cells and eliciting antibodies to it.
“What Dr. Nabel and his colleagues have discovered will help to
prepare for a future threat,” says NIH Director Elias A. Zerhouni,
M.D. “While nobody knows if and when H5N1 will jump from birds to
humans, they have come up with a way to anticipate how that jump
might occur and ways to respond to it.”
“Now we can begin, preemptively, to consider the design of potential
new vaccines and therapeutic antibodies to treat people who may
someday be infected with future emerging avian influenza virus
mutants,” says NIAID Director Anthony S. Fauci, M.D. “This research
could possibly help to contain a pandemic early on.”
Making a vaccine against an existing strain of H5N1 or any other
type of influenza virus is relatively routine. Typically, samples of
existing influenza virus strains are isolated and then grown inside
eggs or in cell cultures. The virus is then collected, inactivated,
purified and added to the other components of the vaccine.
A flu shot prompts a person’s immune system to detect pieces of the
inactivated virus present in the vaccine and make neutralizing
antibodies against them. Later, if that same person is naturally
exposed to a flu virus, these same antibodies should help fight the
infection.
Influenza viruses constantly mutate, however, and vaccines are most
effective against the highly specific strains that they are made
from. This makes it difficult to predict how effective a vaccine
made today will be against a virus that emerges tomorrow.
Dr. Nabel and his colleagues started their project by focusing
narrowly on mutations that render H5N1 viruses better able to
recognize and enter human cells. Bird-adapted H5N1 binds bird cell
surface receptors. But these receptors differ slightly from the
receptors on human cells, which in part explains why bird-adapted
H5N1 can infect but not spread easily between humans.
About a year ago, the research team began asking what mutations help
the virus shift its adaptability. They compared the structural
proteins on the surface of bird-adapted H5N1 influenza virus with
those on the surface of the human-adapted strain that caused the
1918 pandemic. They focused specifically on genetic changes to one
portion of the H5 protein — a portion called the receptor binding
domain. They showed that as few as two mutations to this receptor
binding domain could enhance the ability of H5N1 to recognize human
cells.
Additional mutations would likely need to accumulate for H5N1 to
spread more easily from person to person, says Dr. Nabel. The few
mutations he and his colleagues identified are likely just a subset
of those, he emphasizes.
Moreover, they found that these mutations change how the immune
system recognizes the virus. Mouse antibodies that target H5N1 were
up to tenfold less potent against the mutants. Dr. Nabel and his
colleagues used their knowledge of receptor specificity to create
vaccines and isolate new antibodies that might be used
therapeutically against human-adapted mutants.
They vaccinated mice with the material from viruses they altered to
contain the mutant receptors, and they discovered one broadly
reactive antibody that could neutralize both the bird- and
human-adapted forms of an H5N1 virus.
According to Dr. Nabel, their findings should contribute to better
surveillance of naturally occurring avian flu outbreaks by making it
easier to recognize dangerous mutants and identify vaccine
candidates that might provide greater efficacy against such a virus
before it emerges.
“Our findings build on elegant studies of the influenza HA protein
by structural biologists,” notes Dr. Nabel. “Insight into the
structure of the avian flu virus has enabled us to target a critical
region of HA that directs its specificity. Such a structure-based
vaccine design may allow us to respond to this future threat in
advance of an actual outbreak.”
Reference: Z Yang et al.
Immunization by avian H5 influenza hemagglutinin mutants with
altered receptor binding specificity. Science DOI:
10.1126/science.1135165 (2007).
Australia: Victoria
well placed to fight a flu pandemic
[Jul 18 Melbourne
VIC]--Victoria's health system is in the best position yet to combat
a possible influenza pandemic with the announcement of an updated
statewide plan, Health Minister Bronwyn Pike said today.
Ms Pike said the Victorian Health Management Plan for Pandemic
Influenza would be an essential guide for health professionals and
the community to respond to a new pandemic strain of the virus and
to ensure hospitals were well prepared for the demand for services.
"In the event of a major new flu outbreak Victoria's primary health
care services, such as hospitals, GPs, community pharmacies and
community health centres will play an important role in treating
patients and informing the public during all stages of a pandemic,"
Ms Pike said.
"Past instances of avian flu and SARS overseas confirm the threat of
a pandemic is very real and can strike without warning, so it's
important health authorities and the community are prepared.
"Influenza viruses evolve rapidly and there is a risk that the virus
could undergo genetic changes making it able to spread even more
easily from person to person – if these changes occur, the virus
could cause a pandemic," Ms Pike said.
A number of strategies would be used to respond to a pandemic threat
including a concerted effort to contain the virus as long as
possible, until a vaccine is developed to reduce infection. The plan
incorporates a surveillance system to detect any emerging threats,
aims to rapidly identify new virus sub-types and define roles and
responsibilities of health agencies involved.
"The Bracks Government has worked closely with a range of
Commonwealth and local government agencies as well as health,
community and industry professionals to ensure we are well prepared
and the plan will work effectively if there is a major flu
outbreak," Ms Pike said.
Victoria's Chief Health Officer, Dr John Carnie, said the state is
witnessing lower than average rates of influenza infection with just
73 cases compared to 126 at the same time last year, but insisted
the community played a major role in the containment of the flu.
"Good personal hygiene, including covering your mouth when coughing
and washing your hands regularly, can help reduce the risk of
contracting the flu virus," Dr Carnie said. "Those at special risk –
including persons aged over 65 – are strongly urged to have a yearly
flu vaccination and if cold and flu symptoms persist after a few
days, contact your local GP."
Dr Carnie said Victoria was among leading world research and support
for investigation of influenza at the Victorian Infectious Diseases
Reference Laboratory, while a world-class treatment facility was
available at the Victorian Infectious Diseases Service.
Dr Carnie said the Victorian Health Management Plan for Pandemic
Influenza is available at:
http://www.health.vic.gov.au/pandemicinfluenza/prof_res.htm#general
Australia: Hospital
network frontline weapon in updated pandemic plan [Jul 15
Melbourne VIC]--Victoria’s major metropolitan and regional hospitals
will be used as specialist influenza hospitals in the event of an
influenza pandemic, Health Minister Bronwyn Pike said today.
Launching the updated Victorian Health Management Plan for Pandemic
Influenza today, Ms Pike said a network of 16 major metropolitan and
regional base hospitals would be in the frontline if there was a
pandemic.
“Our hospitals have world-class infectious disease departments, the
clinical expertise and experience in treating all forms of
infectious diseases,” Ms Pike said.
“These hospitals are being provided with the latest equipment,
building modifications and access to medications as part of the
Bracks’ Government’s $4.5 million pandemic flu package announced
last year. They now have enhanced ability to treat and isolate
patients and will be our primary weapon in containing pandemic
influenza cases.”
Ms Pike said developments in research and treatment have informed
the update of the plan which is now consistent with the updated
national arrangements.
“This plan aims to minimise the impact of a possible influenza
pandemic on the Victorian community, healthcare system and economy,”
Ms Pike said. “Putting together plans such as this and making sure
our hospital system is prepared is the best way to counter the
potentially very serious consequences of an influenza pandemic.
“I want to remind Victorians of the dangers of a possible influenza
pandemic, that the risk is always present and we are better prepared
than ever before.”
Ms Pike said the plan updates include:
· The inclusion of detailed operational guidelines for carrying out
mass vaccination sessions during a pandemic including advice on
recording and reporting arrangements;
· More detail on hospital and health service issues including the
list of hospitals under the Designated Hospitals Model;
· The inclusion of a new section on Primary Health Care clarifying
the roles of primary care practitioners in the different phases of a
pandemic;
· A new section on the ethical considerations that will be required
to guide decision making during a pandemic; and
· Clarification of the roles and responsibilities of key response
agencies during a pandemic including community care agencies, DHS,
other government departments, local government, businesses and the
community.
Ms Pike said the plan was an essential guide for health
professionals and the community to respond to an influenza pandemic
and to ensure hospitals were well prepared for the demand for
services.
“Victoria’s primary health care services, such as hospitals, GPs,
community pharmacies and community health centres will play an
important role in treating patients and informing the public during
all stages of a pandemic,” Ms Pike said.
“Past instances of avian flu and SARS overseas confirm the threat of
a pandemic is very real and can strike without warning, so it is
important health authorities and the community are prepared.
“Influenza viruses evolve rapidly and there is a risk that the virus
could undergo genetic changes making it able to spread even more
easily from person to person – if these changes occur, the virus
could cause a pandemic.”
If a pandemic affected 30 per cent of the Victorian population and
there was no pandemic vaccine or treatment available over a six to
eight-week period, it estimated there could be more than 10,000
deaths, 25,000 hospitalisations and more than 710,000 outpatient
visits.
A number of strategies would be used to respond to a pandemic threat
including a concerted effort to contain the virus as long as
possible, until a vaccine is developed to reduce transmission. The
plan incorporates a surveillance system to detect any emerging
threats, aims to rapidly identify new virus sub-types and define
roles and responsibilities of health agencies involved.
“The Government has worked closely with a range of Commonwealth and
local government agencies as well as health, community and industry
professionals to ensure we are well prepared and the plan will work
effectively if there is a major flu outbreak,” Ms Pike said.
Victoria’s Chief Health Officer, Dr John Carnie, said Victorians can
help play a part in reducing the transmission of influenza by simply
washing their hands.
“This is good practice for everyone when it comes to communicable
disease control,” Dr Carnie said. “While Victoria is witnessing
lower than average rates of influenza infection with just 73 cases
compared to 126 at the same time last year, good personal hygiene,
including covering your mouth when coughing and washing your hands
regularly, can help reduce the risk of contracting the flu virus.
“Those at special risk – including persons aged over 65 – are
strongly urged to have a yearly flu vaccination and if cold and flu
symptoms persist after a few days, contact your local GP.”
The Victorian Health Management Plan for Pandemic Influenza is
available at:
http://www.health.vic.gov.au/pandemicinfluenza/prof_res.htm#general
New Zealand: Getting
through together - Ethical values for a pandemic [Jul 4
Wellington]--The National Ethics Advisory Committee – Kāhui Matatika
o te Motu (NEAC) has completed its work on ethical values for a
pandemic.
One of NEAC’s main statutory functions is to advise the Minister of
Health on ethical issues of national significance regarding health
and disability. The Committee believes that minimising harm from any
pandemic, minimising inequalities in the impact of any pandemic, and
getting through any pandemic together are issues of this sort.
Getting Through Together considers ethical issues in a pandemic:
* Section one introduces the statement of ethical values and its
purpose and then describes how this statement could be used.
* Section two outlines two cases, one in an urban community and one
in a hospital, to explore the challenges we may face when planning
for, and responding to, a pandemic.
* Section three describes in a range of settings why we think the
shared values identified in the statement are important.
NEAC hopes that a wide range of people, including health
professionals, planners, policy makers and members of the public and
business community, can use Getting Through Together as they plan
for, and think about, their potential response to a pandemic.
Emphasis is given to using shared values to assist people to care
for themselves, their whānau and their neighbours, and using shared
values to make decisions in situations of overwhelming demand.
Internationally, this work is unique in having had wide public
input. It is the result of a consultation on a discussion document
in 2006. NEAC warmly thanks all those who made valuable
contributions to the creation of this document.
This publication and inserts are
available in PDF format below:
Getting Through Together: Ethical values for a pandemic (PDF, 1.9
MB)
Ethical Values for a Pandemic (quick-reference guide) (PDF, 234 KB)
Guidance on Pandemic Ethics (quick reference guide) (PDF, 220 KB)
Background: The discussion
statement [published July 2006]:
In an influenza pandemic, the
better prepared we are, the better we would cope. One important way
to be prepared is to think through our values – the basic things
that matter to us. Many hard choices would need to be made in a
pandemic. But if these choices are based on shared values, and made
with goodwill and reasonable judgement, support may be expected for
the decisions made.
The National Ethics Advisory Committee (NEAC) has prepared a
statement of ethical values for planning for and responding to a
pandemic. It identifies widely shared ethical values for our
pandemic planning and response. Some are values to govern how we
make decisions. Others are values to govern what decisions are made.
Values that are recognised in Māori tikanga and kawa are identified
alongside other values. The statement is designed to be thought
provoking, accessible to a wide range of people, useful at all
stages of pandemic planning, and useful in a wide range of
situations.
NEAC is seeking feedback to make the statement as reflective of
shared values, and as useful, as possible. NEAC also hopes that this
discussion document will help to raise issues, and to facilitate
public discussion. Feedback is being sought from people and
organisations in the health sector, other sectors involved in
pandemic planning, community groups and others who may be
potentially affected by a pandemic. An initial version of this
statement is included in the current Ministry of Health Influenza
Pandemic Action Plan, and NEAC aims to include a finalised version
of the statement in a subsequent version of this Plan.
Document availability
The discussion document is available in PDF and Word formats.
Ethical Values for Planning for and
Responding to a Pandemic in New Zealand: A Statement for Discussion
(PDF, 422 KB)
Ethical Values for Planning for and
Responding to a Pandemic in New Zealand: A Statement for Discussion
(Word, 560 KB)
Canada: Publication du
plan de lutte contre la grippe pandémique [Jun 28 Halifax
NS]--Le plan provincial de lutte contre la grippe pandémique visera
à réduire le nombre de personnes malades et le nombre de décès
pendant une pandémie possible de grippe.
La première version du Plan de lutte des services de santé de la
Nouvelle-Écosse contre la grippe pandémique, publié aujourd'hui 26
juin, a été élaborée en consultation avec les régies régionales de
la santé et inclut les suggestions et commentaires de divers
organismes partenaires du domaine de la santé.
« Puisque nous savons qu'une pandémie de grippe causerait un stress
important sur nos services de santé, ce plan met l'accent sur le
maintien d'un certain niveau de soins, pour les Néo-Écossais,
pendant une période qui sera sans aucun doute très éprouvante, » a
souligné le ministre de la Santé, Chris d'Entremont. « Toutefois, un
tel événement aurait une incidence non seulement sur les services de
santé, mais aussi sur l'économie et sur la société en général. Nous
devons nous préparer en conséquence. »
Le plan provincial continuera d'être mis à jour à mesure que de
nouveaux renseignements sont disponibles aux niveaux local, national
et international. Le plan décrit les mesures à prendre, organisées
selon les phases d'une pandémie, dans les domaines suivants :
-- communications
-- surveillance
-- mesures de santé publique
-- vaccins
-- médicaments antiviraux
-- services de santé
« Le fait d'être prêt à faire face à une pandémie ne signifie pas
que les gens ne seront pas malades, » a dit le ministre de la
Promotion et de la Protection de la santé, Barry Barnet. « C'est
pourquoi il est si important que les mesures de santé publique
appropriées soient en place. De plus, nous allons suivre les lignes
directrices nationales pour la mise en œuvre de notre stratégie
d'administration de médicaments antiviraux et de vaccins, afin de
s'assurer que les Néo-Écossais sont protégés le mieux possible dans
une situation de pandémie. »
La planification est également en cours dans les domaines de
l'éthique, du stockage et de la gestion des bénévoles au cours d'une
pandémie. Des mises à jour auront lieu de façon continue à mesure
que la planification avancera dans chaque domaine.
Il est prévu que de 15 à 35 pour cent de la population de la
Nouvelle-Écosse sera malade pendant une pandémie de grippe. On
estime que de 1 000 à 3 000 personnes devront être hospitalisées et
que de 300 à 1 000 personnes pourraient mourir.
Chaque année, de 500 à 1 500 Canadiens, principalement des personnes
âgées, meurent d'une pneumonie ou d'autres complications liées à la
grippe ordinaire.
Les ministres ont fait référence à des situations d'urgence
antérieures, par exemple l'ouragan Juan et la tragédie de la Swiss
Air, qui ont aidé la province à comprendre la nécessité de mettre en
place une planification d'urgence flexible, coordonnée et continue.
Une pandémie de grippe est une propagation à l'échelle mondiale d'un
nouveau virus de la grippe qui se transmet facilement.
Pour consulter le plan de lutte contre la grippe pandémique ou pour
obtenir plus d'information sur la grippe pandémique, consultez le
site Web
www.gov.ns.ca/govt/pandemic .
Canada: Province's
pandemic plan released [Jun 28 Halifax NS]--The
province's pandemic plan for the health system will aim to reduce
the amount of sickness and death during a potential influenza
pandemic.
The first version of the Nova Scotia Health System Pandemic
Influenza Plan, made public today, June 26, was developed in
consultation with the district health authorities and incorporates
feedback from various health partner organizations.
"We know that an influenza pandemic would cause great stress on our
health system, so this plan focuses on trying to ensure a level of
care for Nova Scotians during what will be a very stressful time,"
said Health Minister Chris d'Entremont. "An event such as this,
however, would not only stress the health system, but the economy
and society in general. And we need to prepare for that."
The provincial plan will continue to evolve as new information
emerges on the local, national, and international fronts. The plan
describes action, organized by pandemic phase, in areas of:
-- communications
-- surveillance
-- public health measures
-- vaccines
-- antivirals
-- health services
"Being prepared for a pandemic doesn't mean that people won't get
sick," said Health Promotion and Protection Minister Barry Barnet.
"That's why having the right public-health measures in place is so
important. As well, we will follow national guidelines in rolling
out our vaccine and antiviral strategy so that Nova Scotians are
protected as much as possible during a pandemic."
Planning is also underway in the areas of ethics, stockpiling, and
volunteer management during a pandemic. It will continue to be
updated on an ongoing basis as planning progresses in each area.
It is expected that 15 to 35 per cent of Nova Scotia's population
will become ill during a pandemic. About 1,000 to 3,000 Nova
Scotians will require hospitalization, and 300 to 1,000 people could
die.
Every year between 500 and 1,500 Canadians, mostly seniors, will die
from pneumonia and other complications of ordinary seasonal
influenza.
The ministers referenced past emergencies like Hurricane Juan and
Swiss Air, which have helped the province understand the need for
flexible, co-ordinated, and ongoing emergency planning.
The global spread of a new influenza virus that can be easily
transmitted is known as an influenza pandemic.
To access the pandemic plan or for more information on pandemic
influenza, see the website at
www.gov.ns.ca/govt/pandemic
Global: Model for tracking
flu progression could reduce flu pandemic's peril [Jun 18
Cambridge MA USA]--Nearly 40 years ago, MIT Professor Richard Larson
spent a week sick in bed with the worst illness he'd ever had--the
particularly virulent strain of flu that swept the globe in 1968.
"That was the sickest I'd ever been," Larson recalled. "I really
thought that was the end." It took him two or three months to
recover fully from the illness.
Known as the Hong Kong flu, the virus killed 750,000 people
worldwide, the second worst influenza pandemic the world has seen
since the infamous 1918-1919 epidemic of so-called Spanish flu.
Now, many experts fear the world is on the brink of another deadly
flu pandemic. And Larson wants to be sure that people are ready to
deal with it.
To that end, he and his colleagues have developed a mathematical
model to track the progression of a flu outbreak, and their results
show that the death toll of an epidemic could be greatly reduced by
taking steps such as minimizing social contacts and practicing good
hygiene, such as frequent handwashing.
The report, "Simple Models of Influenza Progression within a
Heterogeneous Population," will be published in the May-June issue
of Operations Research, which comes out June 4.
"We can't reduce to zero the chance that any of us will get the next
bad flu. But there is compelling evidence that we can reduce the
chances of our loved ones and ourselves getting the flu by a
significant factor," said Larson, the Mitsui Professor of
Engineering Systems and of civil and environmental engineering.
The H5N1 strain of flu, also known as avian flu, has infected birds
throughout Asia and Europe, with a few known cases among humans. So
far, the disease has not mutated to a form where it can jump easily
between humans, but if that happens, the disease could spread around
the world in days or weeks.
Larson's research team decided to model the progress of such an
epidemic, taking a unique approach. Unlike most existing models,
theirs takes into account people's different levels of social
activity and susceptibility to the flu.
One of the report's key findings is that "social
distancing"--reducing the frequency and intensity of
person-to-person contact--could be an effective way to limit the
spread of the disease.
Influenza is normally spread by person-to-person contact, so people
who have more contact with others have a higher risk of catching the
disease and then spreading it. However, most existing influenza
models assume that all individuals within a population have the same
degree of social contact. They also assume that social behavior does
not change over the course of the epidemic.
Such models "didn't do justice to the complexity of the problem,"
Larson says.
He and his team developed a dynamic mathematical model that assumes
a heterogeneous population with different levels of flu
susceptibility and social contact. They then used the model to
compare different scenarios: one where people maintained their
social interactions as the flu spread, and others where they did
not.
Their results showed that reducing the social contacts of people who
normally have the most interactions could dramatically slow early
growth of the disease. Most of the disease spread is due to a
minority of the population--the people with the most daily human
contacts. Focusing on these individuals and reducing their daily
contacts can change an exponentially exploding disease into one that
dies out over time.
A key feature of the model deals with "R0," a popular parameter of
most other models, which is defined as the average number of new
infections caused by a recently infected person in a population of
susceptible individuals. An R0 greater than 1.0 leads to exponential
increase in the number of cases.
However, because R0 is an average over the entire population, it
does not reflect the fact that only a fraction of the population is
responsible for the majority of new infections. Averages can be
misleading--for example, when a billionaire enters any
establishment, on average everyone there instantly becomes at least
a millionaire.
The researchers believe that splitting R0 into components, one for
each level of activity or propensity to become infected, provides
better policy guidance. In Larson's model, every population
component is assigned different values for R0 , depending on factors
such as that component's frequency of human contact and
susceptibility to infection if exposed to the flu. Each of these
factors can be at least partially controlled, suggesting that our
individual and collective behaviors in response to the flu can
greatly influence the numbers who become infected.
The researchers also found a striking difference in death toll
depending on how early in the epidemic social distancing measures
went into effect. For example, in a hypothetical population of
100,000 susceptible individuals, 12,000 fewer people were infected
if social distancing steps were taken on day 30 of an outbreak
instead of day 33. But intervention on Day 0 is best.
This finding is consistent with historical research reported in
April by two research teams, one led by the National Institute of
Allergy and Infectious Diseases and one from the United Kingdom,
that demonstrated that those communities in 1918 that took
aggressive social distancing actions early usually suffered less
from the "Spanish Flu" than those who waited and debated.
The findings strongly suggest that influenza emergency plans should
include measures to reduce social contact, such as encouraging
people to work from home and avoid large gatherings, Larson said.
This is especially important because it generally takes at least six
months from the time of an outbreak to develop an effective vaccine.
Those who must continue to work, such as doctors and other health
care workers, should be the first to receive any available avian flu
vaccine that might be developed, he said.
Larson says that large institutions like MIT, as well as state and
local governments, should have emergency plans ready to put into
action as soon as the first case of human-to-human H5N1 influenza is
reported.
"We need to be aggressive. We need to be assertive. Don't
dilly-dally, don't have a lot of political debate and
foot-dragging," he said. "If people do take it seriously, the number
of deaths could be greatly reduced. A key is to start taking
aggressive steps well before the flu is at your doorstep."
Larson became interested in modeling influenza after reading a book
about the 1918 outbreak, which killed between 50 and 100 million
people around the world. He had never heard much about the epidemic,
which in the United States claimed more victims than World War I.
"Reading the history of it, I became fascinated," he said. "The
wonderful thing about being in OR (operations research) is you can
go into any problem you think is important and relevant and really
contribute to it."
Larson said he hopes that other operations researchers will take up
influenza research and develop more detailed models.
"Any mathematical model of the disease is bound to be incorrect,"
Larson wrote in the Operations Research paper. "But we are not
seeking multidecimal accuracy, but rather insights on how to limit
the spread of the disease. We firmly believe that fresh eyes from
the OR community can play a significant role in this quest."
Other members of the MIT research team include undergraduate Kelley
Bailey; Stan Finkelstein, senior research scientist in the
Engineering Systems Division; Karima Robert Nigmatulina, graduate
student in the Operations Research Center; Robert Rubin, faculty
member at the Harvard-MIT Division of Health Sciences and
Technology; and Katsunobu Sasanuma, a graduate student in the
Engineering Systems Division and the Operations Research Center.
The research was funded in part by an IBM Faculty Research Award.
USA: During influenza
pandemic, State Health Commissioner to decide if schools should
close [Jun 18 Indianapolis IN]--State health officials
report the state health commissioner will make the decision of when
to close schools during an influenza pandemic. This plan of action
comes after two years of meeting and working with Indiana schools.
“Studies of various U.S. cities during the 1918 influenza pandemic
show that cities that closed schools early in the pandemic had fewer
sick people than cities that closed schools later,” said State
Health Commissioner Judy Monroe, M.D.
Dr. Monroe announced her intention to make the decision on closing
all schools and licensed daycares in the state in a letter sent to
pandemic flu planning partners throughout the state.
In February, the State Department of Health hosted a statewide
tabletop drill with the Indiana Department of Education, focusing on
the role of school closure in slowing the spread of the disease. As
a result, school administrators recognized the need to have state
leadership in making the decision to close schools.
“Schools are already known to be a hotbed of disease transmission.
Diseases are easily spread among children and brought home to other
household members. One study shows that 65% of those infected with
influenza catch it from a child or teenager,” said Dr. Monroe.
The decision to reopen schools is more difficult. The timing is
important, and will be determined by epidemiologists at the State
Department of Health and at the Centers for Disease Control and
Prevention, taking into account what is happening in surrounding
communities.
“During the 1918 pandemic, many communities reopened schools or
lifted restrictions too early and experienced a rapid upsurge in
disease incidence. A few communities waited too long and lifted
restrictions just before the onset of the next wave of the
pandemic,” said Dr. Monroe.
The State Department of Health will continue to refine preparedness
plans and work with state partners to provide the most effective
response during a pandemic. Indiana schools now have plans, policies
and procedures in place to quickly react to pandemics.
Hoosiers can take steps now to prepare themselves and their
families. Health officials advise having a family emergency plan,
including alternative child care plans if schools and licensed
daycares are closed. Good respiratory hygiene habits should be
practiced at all times: washing hands frequently and thoroughly,
covering your mouth and nose when you sneeze or cough, and staying
home from work or school when feeling ill can all prevent the spread
of respiratory diseases.
People should also keep an emergency supplies kit to use for at
least two weeks during a flu pandemic:
* Bottled water – 1 gallon per person per day
* Canned and packaged food
* Clothes
* Essential prescription medications
* Flashlight with extra batteries
* Hand-operated can opener
* Battery-powered or hand-crank radio
* Hygiene items, such as toothbrush, soap, and toilet paper
* First aid kit
USA: Rutgers study shows
avian influenza on people's minds [Jun 16 New Brunswick
NJ]--Researchers at the Food Policy Institute at the Rutgers New
Jersey Agricultural Experiment Station have conducted a nationwide
survey of public knowledge, attitudes, intentions and behaviors
related to the threat of highly pathogenic avian influenza. The
researchers conducted a total of 1200 telephone interviews on the
topic between May 3 and June 5, 2006.
The results suggest that avian influenza is on the national agenda.
Most Americans have heard about it and have talked about it, but
don’t know much about it. Most are aware of the presence of highly
pathogenic H5N1 avian influenza in people, birds, and poultry
globally, but many are unaware that there have been no cases in
humans or animals in the United States.
Despite this, Americans see their current risk of infection with
avian influenza as low and are not particularly worried about it.
They see the current supply of chicken products as relatively safe,
and they continue to eat it. However, most see the risks of
infection from avian influenza as much greater for other people than
for themselves.
“This tendency to believe that others are at greater risk may be a
problem in getting messages across, in influencing perceived
susceptibility, and in persuading people to adopt appropriate
behaviors,” says Sarah C. Condry, the lead author of the study.
The study focused on what American consumers would likely do if
highly pathogenic H5N1 avian influenza were found in poultry in the
United States. According to the United States Department of
Agriculture (USDA), in such a scenario, “The chance of infected
poultry or eggs entering the food chain would be extremely low
because of the rapid onset of symptoms in poultry as well as the
safeguards in place, which include testing of flocks and Federal
inspection programs.”
Moreover, the USDA states,
“Cooking poultry, eggs, and other poultry products to the proper
temperature and preventing cross-contamination between raw and
cooked food is the key to safety.”
However, according to William K. Hallman, director of the Food
Policy Institute, “The results of the study suggest that much of the
American public does not yet have the information they need to make
informed choices about purchasing, preparing, and consuming poultry
products, should avian influenza emerge in the United States.”
Hallman points out that U.S. farming methods for raising poultry
drastically reduce the risk of an outbreak of avian influenza within
our food supply. “Our poultry is typically farmed in tightly
controlled environments,” he said. “The poultry industry is well
aware of the dangers of avian influenza and is working closely with
the USDA to take appropriate precautions to prevent an outbreak.”
Yet, according to the study, only
about two-thirds of Americans seem aware that the majority of
chicken sold in the United States is produced domestically and that
poultry products from countries with reported outbreaks of avian
influenza are banned from import. In addition, while a variety of
clinical symptoms makes it relatively easy to identify domestic
poultry infected with avian influenza, few Americans believe that
live chickens infected with avian influenza are easily
distinguishable from healthy birds.
According to the U.S. Centers for Disease Control and Prevention,
however, a more significant fact is that “there is no evidence that
people have been infected with bird flu by eating safely handled and
properly cooked poultry or eggs.” Yet, less than half of Americans
believe that cooking chicken to the recommended temperature kills
the avian influenza virus and only four-in-ten believe that the
avian influenza virus is not transmissible to humans from eating
fully cooked chicken or eggs.
“The methods for destroying avian influenza during the cooking
process are the same as for destroying salmonella,” said Hallman.
“If poultry contaminated with avian influenza is cooked properly, a
person cannot get sick from eating the finished product.” According
to the USDA, poultry and egg products should be cooked to the
minimum safe internal temperature of 165 °F.
However, even if consumers can be convinced that proper cooking
kills the avian influenza virus, getting them to act on this
information to reduce the risk of infection may be difficult.
Surveys by the Food and Drug Administration suggest that fewer than
60 percent of Americans own a meat thermometer and only 12 percent
always use it when they cook chicken or chicken parts.
Instead, suggests Condry, “Consumers are likely to try to eliminate
the risk entirely by avoiding consumption of poultry altogether.” In
fact, the study found that if highly pathogenic avian influenza were
found in chickens in the United States, nearly 40 percent of
Americans say they would stop eating chicken products altogether.
The study also suggests that even after receiving reassurances that
it is safe to eat chicken, it would take an average of nearly five
months for most Americans to begin eating it again.
The USDA reports that Americans purchase an average of 86 pounds of
chicken a year; nearly 26 billion pounds a year in total. A
substantial drop in domestic consumer demand would result in
significant economic losses.
According to Hallman, the social and nutritional costs would also
likely be significant. “Chicken serves as a popular, low-cost source
of protein for many American families.” Indeed, the USDA estimates
that the per capita consumption of chicken in the United States has
more than doubled since 1970. Loss of confidence in the safety of
poultry would likely result in increases in the prices of
alternative sources of animal protein resulting from higher consumer
demands for substitutes for chicken products. “As a result, the
costs of feeding the average American family would likely rise.”
The authors of the survey were Sarah C. Condry, William K. Hallman,
Miranda Vata, and Cara L. Cuite. The survey project was funded
through a National Integrated Food Safety Initiative grant awarded
by the USDA Cooperative State Research, Education, and Extension
Service and the New Jersey Agricultural Experiment Station at
Rutgers, The State University of New Jersey.
United Kingdom: Avian
influenza - Algorithm Alert Phase 3 updated [May 17 07
London England]--Health Protection Agency WHO Pandemic Alert
Phase 3 Algorithms
Updates and changes
(21 kB): a summary of updates and changes made to the HPA WHO
Phase 3 algorithms
Case Management
A3:
WHO Pandemic Alert Phase 3: Algorithm for
the management of returning travellers and visitors from countries
affected by avian influenza (H5N1) presenting with febrile
respiratory illness
Last reviewed 16 May 2007. The following changes were made:
Azerbaijan, Côte d'Ivoire, Croatia, Djibouti, England, Hungary and
Romania were removed according to OIE reports.
F3:
WHO Pandemic Alert Phase 3: Algorithm for
the management of persons resident in the UK or arriving from areas
not known to have avian influenza H5N1 presenting with febrile
respiratory illness after close contact with sick, dying or dead
birds: recognition, investigation and initial management.
(208 kB) Last reviewed 06 September 2006. The following
change was made: Added “close contact with a confirmed H5N1 infected
animal other than poultry or wild birds (e.g. cat or pig)” in
section “(3) Exposures” according to WHO case definitions (see
reference 2).
Interim HPA guidelines for investigation
and reporting of suspected human cases of avian influenza
Last reviewed 10 January
2006
AI SOP: Health
Protection Agency actions for dealing with human health implications
of avian influenza in poultry and wildfowl
(211 kB) Last reviewed 06 April 2006
E3:
WHO Pandemic Alert Phase 3: Draft
Algorithm for the management of personnel involved in the response
to an occurrence of highly pathogenic avian influenza (H5N1 only) in
wild birds in the UK, presenting with febrile respiratory illness
(165kB) Last reviewed 02 May 2006. The following change was
made: title changed to more accurately reflect situation in which
algorithm should be used.
J3:
WHO Pandemic Alert Phase 3: Draft Algorithm for the management of
personnel involved in the response to an occurrence of confirmed
highly pathogenic avian influenza (H5N1 only) in poultry in the UK,
presenting with febrile respiratory illness
(78kB) Last reviewed 08 February 2007.
Post exposure prophylaxis
Draft algorithms have been prepared for post exposure prophylaxis
(PEP) in response to a possible avian influenza event during WHO
Phase 3.
B3:
WHO Pandemic Alert Phase 3 Draft Algorithm: Post-exposure
prophylaxis (PEP) for contacts of confirmed human cases of avian
influenza (H5N1) in the UK
(155 kB) Last reviewed 19 June 2006. The following changes were
made: action for contact type 4 (travel contact) clarified to
include passive follow up. Actions for contact types 4 and 5
(holiday contact) expanded to include provision of information.
Footnote 4: requirement for duration of travel lasting more than
four hours removed due to practical difficulties in determining
this.
C3:
WHO Pandemic Alert Phase 3 Draft
Algorithm: Post-exposure prophylaxis (PEP) for farm
workers/residents, SVS staff, and cullers involved in confirmed or
suspected outbreaks of highly pathogenic avian influenza suspected
or known to be due to H5N1 in poultry in the UK
(122 kB) Last reviewed 03 February 2007. The changes written
follow up actions in line with the revised policy agreed by ACDP
(Advisory Committee on Dangerous Pathogens).
D3:
WHO Pandemic Alert Phase 3 Draft
Algorithm: Management of human contacts in the event of confirmed
highly pathogenic avian influenza [HPAI] (H5N1) in one or more wild
birds in the UK
(185 kB) Last reviewed 03 May 2006. The following change was
made: clarification provided regarding PPE and PEP for veterinary
workers handling wild birds confirmed to be infected with HPAI
(H5N1) within a 10k Defra wild bird surveillance zone.
Case Reporting
This is the report form for health care professionals
investigating respiratory illness in individuals meeting the avian
influenza infection
case definition.
HPA case report form for suspected human
cases of avian influenza
(93kB) Last reviewed 11 October 2006
The form is also available as a
word document
(241kB) that can be completed and emailed to
Dr Hongxin Zhao.
Laboratory Guidance
Microbiological guidance for taking and
handling specimens for avian influenza testing
Last reviewed 10 January 2006
Advisory Committee on Dangerous Pathogens
(ACDP) laboratory advice
(ACDP website)
Travel Advice
Travel Advice Page
Last reviewed 07 April 2006
Frequently asked questions on travelling
to zones affected by avian influenza (H5N1)
Last reviewed 04 October 2006
United Kingdom: Avian
influenza - Algorithm A3 updated [May 4 07 London
England]--Algorithm for the management of returning travellers and
visitors from countries affected by avian influenza [H5N1]
presenting with febrile respiratory illness: recognition,
investigation and initial management.
http://www.hpa.org.uk/infections/topics_az/influenza/avian/algorithm.htm
Canada: Travel health
advisory - Avian influenza A [H5N1] [May 4 07 Ottawa ON
Canada]--The Public Health Agency of Canada (PHAC) continues to
closely monitor avian influenza A (H5N1) activity in birds and
humans. A particularly severe strain of the H5N1 virus has been
circulating and causing disease among birds in parts of Asia,
Europe, the Middle East and Africa since 2003. Although rare,
infection with this strain has occurred in humans.
People who become infected with H5N1 can become seriously ill,
and in some cases it may cause death. The symptoms resemble those of
human influenza, including fever, cough, aching muscles and sore
throat and may develop into serious respiratory infections, such as
pneumonia. Nearly all human cases of H5N1 have occurred through
direct contact with infected poultry or surfaces and objects
contaminated by their feces.
For more information on avian influenza, including countries
where H5N1 has been confirmed in humans and/or birds, visit the
Public Health Agency of Canada's Avian Influenza web site at:
http://www.phac-aspc.gc.ca/influenza/avian_e.html
Recommendations
For most travellers, the risk of contracting H5N1
is extremely low since H5N1 is an avian disease. Nevertheless, you
can take the following precautions to minimize your risk of
infection:
Avoid unnecessary contact with domestic poultry and wild
birds as well as surfaces contaminated with their feces or
secretions. This includes poultry farms, back yard flocks
as well as markets where live and slaughtered animals such as
chickens and ducks are sold.
Wash your hands! Travellers are routinely
advised to maintain high standards of hygiene, including frequent
and thorough hand washing as disease causing microbes, like viruses
and bacteria, can frequently be found on the hands. Using hot, soapy
water and lathering for at least 20 seconds is the single most
effective way to prevent the spread of infections. Alternatively, if
there is no visible soiling, travellers can use waterless,
alcohol-based antiseptic hand rinses. If there is visible soiling
and soap and water are not available, cleanse hands first with
detergent-containing towelettes to remove visible soil before using
waterless antiseptic hand rinses.
Ensure that all poultry dishes, including eggs, are
thoroughly cooked. Itis always advisable to avoid
undercooked or raw poultry dishes, including eggs and egg products.
In thoroughly cooked poultry juice runs clear and there is
no visible pink meat.
Monitor your health. Travellers who on their
return to Canada develop flu-like symptoms including fever, cough,
aching muscles and a sore throat should seek a medical assessment
with their personal physician. Travellers should inform their
physician, without being asked, that they have been travelling or
living in an area where H5N1 occurs.
In addition to protecting your own health, travelers are
encouraged to refer to the Canadian Food Inspection Agency's (CFIA)
guidelines for information on how to prevent the introduction of
H5N1 into Canada's animal population, as follows:
CFIA Fact Sheet on Avian Influenza.
As a reminder…
The Public Health Agency of Canada routinely
recommends that Canadian international travellers seek the advice of
their personal physician or travel clinic four to six weeks prior to
international travel, regardless of destination, for an individual
risk assessment to determine their individual health risks and their
need for vaccination, preventative medication, and personal
protective measures.
Travellers who become sick or feel unwell on their return to
Canada should seek a medical assessment with their personal
physician. Travellers should inform their physician without being
asked, that they have been travelling or living outside of Canada,
and where they have been.
Additional Information
Information on Avian Influenza from the
Public Health Agency of Canada
External Sources
of Information
USA: Interim guidance
issued for the use of facemasks and respirators in public settings
during an influenza pandemic [May 3 07 Atlanta GA USA]--The Centers
for Disease Control and Prevention (CDC), part of the
Department of Health and Human Services (HHS), today
released interim advice to the public about the use of
facemasks and respirators in certain public
(non-occupational) settings during an influenza pandemic.
There is very little research about the value of masks to
protect people in public settings. These interim
recommendations are based on the best judgment of public
health experts who relied in part on information about the
protective value of masks in healthcare facilities.
The guidance stresses that during an influenza pandemic a
combination of actions will be needed, including hand
washing, minimizing the likelihood of exposure by distancing
people who are infected or likely to be infected with
influenza away from others and treating them with antiviral
medications, having people who are caring for ill family
members voluntarily stay home, and encouraging people to
avoid crowded places and large gatherings. When used in
conjunction with such preventive steps, masks and
respirators may help prevent some spread of influenza.
“Pandemic influenza remains a very real threat. We continue
to look for ways to protect people and reduce the spread of
disease,” Secretary Mike Leavitt said. “The guidance issued
today is a good step forward in the broader, multifaceted
federal effort to prepare the nation for an influenza
pandemic.”
“During an influenza pandemic, we know that no single action
will provide complete protection,” said Dr. Julie Gerberding,
CDC director. “We also know that many people may choose to
use masks for an extra margin of protection even if there is
no proof of their effectiveness. If people are not able to
avoid crowded places, large gatherings or are caring for
people who are ill, using a facemask or a respirator
correctly and consistently could help protect people and
reduce the spread of pandemic influenza.”
Gerberding noted that while studies are underway in an
effort to learn more about whether masks and respirators can
provide protection from influenza and how people would use
such things, the guidance was designed to be a “best
estimate” based on what is currently known. It is designed
to help guide people’s decisions regarding the use of masks.
In the guidance recommends that:
People should consider wearing a facemask during an
influenza pandemic if …
They are sick with the flu and think they might have close
contact with other people (within about 6 feet). They live
with someone who has the flu symptoms (and therefore might
be in the early stages of infection) or will be spending
time in a crowded public place and thus may be in close
contact with infected people. During a pandemic, people
should limit the amount of time they spend in crowded places
and consider wearing a facemask while they are there.
They are well and do not expect to be in close contact with
a sick person but need to be in a crowded place. Again,
people should limit the amount of time they spend in crowded
places and wear a facemask while they are there.
People should consider wearing a respirator during an
influenza pandemic if…
They are well and will be, or expect to be, in close contact
(within about 6 feet) with people who are known or thought
to be sick with pandemic flu. People should limit the amount
of time they are in close contact with these people and wear
a respirator during this time. These recommendations apply
if people are taking care of a sick person at home (and if a
respirator is unavailable, use of a mask should be
considered).
Dr. Michael Bell, associate director for infection control
at CDC’s Division of Healthcare Quality Promotion, noted
that facemasks and respirators have different qualities and
offer different types and levels of protection. According to
Bell, the primary factor that should be considered by a well
person before deciding whether to wear a facemask or a
respirator for personal protection during a pandemic is
whether close contact is expected with someone who has
pandemic influenza.
“Facemasks are not designed to protect people from breathing
in very small particles, such as viruses,” said Bell.
“Rather, facemasks help stop potentially infectious droplets
from being spread by the person wearing them. They also keep
splashes or sprays from coughs and sneezes from reaching the
mouth and nose of the person wearing the facemask.
Respirators are designed to protect people from breathing in
very small particles, which might contain viruses. Thus, if
you’re caring for someone who is ill with pandemic flu,
proper use of a well-fitted respirator may be a reasonable
choice.”
Bell stressed that neither a facemask nor a respirator will
provide complete protection from a virus. To reduce the
chances of becoming infected during a pandemic, people will
need to practice a combination of simple actions, including:
washing hands often with soap and water, staying away from
other people when they are ill, and avoiding crowds and
gatherings as much as possible.
Pandemic Influenza
A flu pandemic is a global outbreak caused by a new flu
virus that spreads around the world. The virus will spread
easily from person to person, mostly by close contact
(within about 6 feet) with individuals who are infected, and
mostly through coughing and sneezing. Because the virus will
be new to people, everyone will be at risk of getting it.
Much of the transmission will most likely occur in
non-healthcare settings, such as schools, public gatherings,
mass transit, and households. The severity of the infection
from an influenza virus in a pandemic is not knowable in
advance. Severity could range from a level comparable to
seasonal influenza to the level that occurred in the
pandemic of 1918.
What is a facemask?
Facemasks are loose-fitting, disposable masks that cover the
nose and mouth. These include products labeled as surgical,
dental, medical procedure, isolation, and laser masks.
Facemasks help stop droplets from being spread by the person
wearing them. They also keep splashes or sprays from
reaching the mouth and nose of the person wearing the
facemask. They are not designed to protect the person
wearing it against breathing in very small particles.
Facemasks should be used once and then thrown away in the
trash.
What is a respirator?
A respirator (e.g., an N95 or higher filtering facepiece
respirator approved by the National Institute for
Occupational Safety and Health) is designed to protect
people from breathing in very small particles, which might
contain viruses. Most of the time, N95 respirators are used
in construction and other jobs that involve dust and small
particles. Health care workers, such as nurses and doctors,
also use respirators when taking care of patients with
diseases that can be spread through the air.
“N95” means the filter on the respirator screens out 95
percent of the particles (0.3 microns and larger) that could
pass through (and higher numbers mean a higher percentage of
particles are screened). The filter and the tightness of fit
together determine overall effectiveness of a respirator. To
be most effective, these types of respirators need to fit
tightly to the face so that the air is breathed through the
filter material. “Fit testing” is the usual method for
assuring proper fit in workplaces where respirators are
used. Respirators are not designed to form a tight fit on
people with small faces (e.g., children) or facial hair. Men
who have beards need to shave before using. N95 and higher
respirators are less comfortable to wear than facemasks
because they are more difficult to breathe through. If
people have a heart or lung disease or other health
condition, they may have trouble breathing through
respirators and should talk with their doctor before using a
respirator.
Like surgical masks, most N95 respirators should be worn
only once and then thrown away in the trash. Reusable
respirators are available, but special precautions need to
be followed when using them. For more information about
respirators, see NIOSH Safety and Health Topic: Respirators
(www.cdc.gov/niosh/npptl/topics/respirators/).
For more information on the proper use and removal of masks
and respirators, or to learn more about these (including
pictures) and other issues relating to pandemic influenza,
http://www.pandemicflu.gov/vaccine/mask.html.
This guidance is now part of other community preventive
measures available at
www.pandemicflu.gov/plan/community/commitigation.html.
Members of the public with questions about masks,
respirators and pandemic influenza can also call the CDC
information line, 1-800-CDC-INFO.
Ireland: National pandemic influenza plan 2007
[Jan 16 07 Belfast Ireland]--The Department of Health and Children
and the Health Service Executive (HSE) today (15th January 2007)
published the National Pandemic Influenza Plan and Pandemic
Influenza Preparedness for Ireland - Advice of the Pandemic
Influenza Expert Group.
A pandemic influenza is a worldwide flu epidemic. The risk of
pandemic influenza is serious. Experts believe that future pandemics
are inevitable, but agree that it is difficult to predict the
timing, source and impact of the next pandemic. Planning is critical
in order to limit the effects of a potential pandemic.
Mary Harney T.D, Minister for Health and Children, welcomed the
publication of these documents and complimented all involved in
their preparation. The Minister said “I wish to take this
opportunity to acknowledge the progress made over the past year in
preparing for a possible flu pandemic and this work will continue to
be a priority in 2007”.
National Pandemic Influenza Plan
The National Pandemic Influenza Plan is based on World
Health Organization (WHO) recommendations for national pandemic
plans and reflects the advice of the Pandemic Influenza Expert
Group.
The purpose of the National Pandemic Influenza Plan is to
limit the effects of a potential pandemic and to:
- inform the public about pandemic influenza
- explain what the Government and the health services are doing to
prepare for a possible pandemic
- give information on what members of the public need to do if there
is a pandemic.
Written jointly by the Department of Health and Children and the
Health Service Executive, the plan concentrates on the health
response to pandemic influenza but also provides some advice on the
planning which must take place across all sectors of society. The
pandemic plan is based on eight core elements of response:
communications strategy, telephone hotline, public responsibilities,
surveillance, antiviral drugs, pandemic vaccine, reorganisation of
health services, and essential supplies.
The following estimates were adopted for planning purposes:
- a cumulative clinical attack rate of between 25% and 50% of the
population;
- a hospitalisation rate of between 0.55% and 3.70%;
- a case fatality rate of between 0.37% and 2.50% (equivalent to the
1957 and1918 pandemics respectively).
“The measures identified in this National Plan are designed
to reduce the impact of a pandemic. If a pandemic arises each of us
has a role to play in ensuring that it is managed”, said Professor
Brendan Drumm, CEO of the HSE.
Pandemic Influenza Preparedness for Ireland- Advice of the
Pandemic Influenza Expert Group
Advice from the Pandemic Influenza Expert Group was also
published today which provides vital and authoritative information
on pandemic influenza.
The advice outlines clinical guidance and provides public health
advice to health professionals and others involved in pandemic
influenza preparedness and response. Its contents are consistent
with the revised WHO Global Influenza Preparedness Plan. It is being
issued as a consultative document. Following a three month
consultation period which will end in April 2007, a final version
will be published.
The chair of the Pandemic Influenza Expert Group, Professor
William Hall said:
“I encourage all interested parties to provide feedback to the
expert group. It is our intention that the final document will
contain the best and most informed advice possible.”
The publication can be
downloaded in english and irish HERE
CDC influenza pandemic operation plan [OPLAN]
[Dec 20 06 Atlanta GA USA]--This
CDC Influenza Pandemic OPLAN is an INTERNAL document that provides
guidance for CDC operations as directed by the Director, Centers for
Disease Control and Prevention.
This plan is made available to outside agencies for the sole
purpose of providing an understanding of the internal processes
within CDC. This document in no way prescribes guidance for any
entity other than CDC agencies.
This plan shall not be construed to alter any law, executive
order, rule, regulation, treaty, or international agreement.
Noncompliance with this plan shall not be interpreted to create a
substantive or procedural basis to challenge agency action or
inaction.
Download the Entire OPLAN:
PDF version of entire CDC Influenza
Pandamic Operation Plan (OPLAN)
(14.81
MB/350 pages)
Download Individual Sections of the OPLAN:
All downloads in Adobe PDF
format:
Revised Canadian Pandemic
Influenza Plan for the Health Sector released [Posted
07:18 Dec 10 Ottawa ON Canada]--The revised Canadian Pandemic
Influenza Plan for the Health Sector was released today along with a
summary booklet entitled Highlights from the Canadian Pandemic
Influenza Plan for the Health Sector.
The updated Plan was released today at the annual meeting of
federal, provincial and territorial health ministers in Moncton, New
Brunswick.
The Plan – developed collaboratively by federal, provincial and
territorial governments with input from health experts and officials
– provides guidelines and recommendations to assist governments and
organizations in planning their own responses.
Updated regularly since it was first published in 2004, the current
version now includes new guidelines on influenza surveillance and
public health measures. The Plan will continue to be updated with
new information.
Both documents are available on
the Public Health Agency of Canada website at
http://www.phac-aspc.gc.ca.
For more information about pandemic influenza, visit
http://www.influenza.gc.ca
Guidance relating to
suspected human cases of avian influenza returning to the UK
[Dec 5 London England]--Health Protection Agency WHO
Pandemic Alert Phase 3 Algorithms
Updates and changes
(25 kB): a summary of updates and changes made to the HPA WHO
Phase 3 algorithms
Case Management
A3:
WHO Pandemic Alert Phase
3: Algorithm for the management of returning travellers and visitors
from countries affected by avian influenza (H5N1) presenting with
febrile respiratory illness
Last reviewed
04 December 2006. The following changes were made: Korea (Republic
of) was added into, and Serbia and Montenegro and Ukraine were
removed from the algorithm according to OIE reports.
F3:
WHO Pandemic Alert Phase
3: Algorithm for the management of persons resident in the UK or
arriving from areas not known to have avian influenza H5N1
presenting with febrile respiratory illness after close contact with
sick, dying or dead birds: recognition, investigation and initial
management.
(208 kB) Last reviewed 06 September 2006. The following
change was made: Added “close contact with a confirmed H5N1 infected
animal other than poultry or wild birds (e.g. cat or pig)” in
section “(3) Exposures” according to WHO case definitions (see
reference 2).
Interim HPA guidelines for
investigation and reporting of suspected human cases of avian
influenza
Last reviewed 10 January 2006
AI SOP: Health
Protection Agency actions for dealing with human health implications
of avian influenza in poultry and wildfowl
(211 kB) Last reviewed 06 April 2006
E3:
WHO Pandemic Alert Phase
3: Draft Algorithm for the management of personnel involved in the
response to an occurrence of highly pathogenic avian influenza (H5N1
only) in wild birds in the UK, presenting with febrile respiratory
illness
(165kB) Last reviewed 02 May 2006. The following change was
made: title changed to more accurately reflect situation in which
algorithm should be used.
Post exposure prophylaxis
Draft algorithms have been prepared for
post exposure prophylaxis (PEP) in response to a possible avian
influenza event during WHO Phase 3.
B3:
WHO Pandemic Alert Phase 3 Draft Algorithm: Post-exposure
prophylaxis (PEP) for contacts of confirmed human cases of avian
influenza (H5N1) in the UK
(155 kB) Last reviewed 19 June 2006. The following changes were
made: action for contact type 4 (travel contact) clarified to
include passive follow up. Actions for contact types 4 and 5
(holiday contact) expanded to include provision of information.
Footnote 4: requirement for duration of travel lasting more than
four hours removed due to practical difficulties in determining
this.
C3:
WHO Pandemic Alert Phase 3
Draft Algorithm: Post-exposure prophylaxis (PEP) for farm
workers/residents, SVS staff, and cullers involved in confirmed or
suspected outbreaks of highly pathogenic avian influenza suspected
or known to be due to H5N1 in poultry in the UK
(178 kB) Last reviewed 19 September 2006. The following change
was made: ‘exposure to infected poultry/environment’ added to
actions necessary for contact types 1 and 2. Footnote 1 altered to
read " …in the 48 hours prior to onset of clinical signs in
poultry".
D3:
WHO Pandemic Alert Phase 3
Draft Algorithm: Management of human contacts in the event of
confirmed highly pathogenic avian influenza [HPAI] (H5N1) in one or
more wild birds in the UK
(185 kB) Last reviewed 03 May 2006. The following change was
made: clarification provided regarding PPE and PEP for veterinary
workers handling wild birds confirmed to be infected with HPAI
(H5N1) within a 10k Defra wild bird surveillance zone.
Case Reporting
This is the report form for health care
professionals investigating respiratory illness in individuals
meeting the avian influenza infection
case definition.
HPA case report form for
suspected human cases of avian influenza
(93kB) Last reviewed 11 October 2006
The form is also available as a
word document
(241kB) that can be completed and emailed to
Dr Hongxin Zhao.
Laboratory Guidance
Microbiological guidance
for taking and handling specimens for avian influenza testing
Last reviewed 10 January 2006
Advisory Committee on
Dangerous Pathogens (ACDP) laboratory advice
(ACDP website)
Travel Advice
Travel Advice Page
Last reviewed 07 April 2006
Frequently asked questions
on travelling to zones affected by avian influenza (H5N1)
Last
reviewed 04 October 2006
Australian Capital
Territory Health Management Plan for Pandemic Influenza
[Nov 13 Canberra ACT Australia]--ACT Health invites members of the
Capital Region community to comment on the draft ACT Health
Management Plan for Pandemic Influenza (The Plan).
Download: Pandemic
Plan consultation draft
(PDF File - 431k)
The Plan outlines how the health sector is preparing and draws
together what the residents of the ACT may need to know about that
planning effort for a possible future outbreak of pandemic
influenza. It also explains how people can protect themselves and
others from infection, with much local information.
Download: Pandemic
Plan consultation details
(Microsoft Word Document - 54k)
Information on bird flu
cases poorly recorded, scientists say [Nov 1 Washington
DC USA]--The highly pathogenic H5N1 avian influenza has been
detected in at least 55 countries in Asia, Europe, and Africa. This
often fatal disease is of pressing concern because it can be
transmitted from birds to humans, although such transmissions have
been rare so far.
Unfortunately,
according to a Roundtable article in the November 2006 BioScience,
the journal of the American Institute of Biological Sciences (AIBS),
critical information about incidence of the disease in wild
birds--even the species of the infected bird--is often recorded
inaccurately or not recorded at all.
The deficiencies
in data collection, the authors write, "can lead to unwarranted
assumptions and conclusions that in turn affect public perceptions,
practical control and management measures, and the disposition of
resources."
Bird flu is typically studied by veterinarians and virologists. The
article's authors, Maï Yasué, Chris J. Feare, Leon Bennun, and
Wolfgang Fiedler, made use of the Aiwatch (avian influenza watch)
e-mail forum to gather information for their article from sources
worldwide.
They describe
several instances in which the species of an infected wild bird was
incorrectly or inadequately recorded--sometimes just as "wild duck,"
for example--and others in which the bird's sex and age were
misidentified.
Likewise,
reported details of the location and time of discovery of an
infected bird often lack specificity, yet they are crucial for a
good understanding of the virus's spread. Information about capture
and sampling methods and other species in the vicinity of an
infected bird has also often been inadequately described.
The authors end
their article with a plea for greater involvement by ornithologists
and ecologists in H5N1 research and monitoring.
Control measures fail to
stop spread of new H5N1 virus [Oct 31 Memphis TN USA]--A
new variant of the bird flu virus H5N1 emerged in late 2005 and
replaced most of the previous variants across a large part of
southern China, despite an ongoing program to vaccinate poultry,
according to researchers at the University of Hong Kong in
collaboration with scientists at St. Jude Children’s Research
Hospital.
The new virus, called Fujian-like (FL), appears to be responsible
for the increased occurrence of H5N1 poultry infections since
October 2005, as well as recent human cases in China, the
researchers said. FL has now also been transmitted to Hong Kong,
Laos, Malaysia, and Thailand, resulting in a new bird flu outbreak
wave in Southeast Asia that has caused human infections as well,
according to the Hong Kong/St. Jude team.
The investigators also warned that it is possible that this new H5N1
variant will spread further through Asia and into Europe, as it
evolves to form other sublineages that vary from place to place.
This evolution into different sublineages also occurred during the
previous two waves of H5N1 transmission that occurred during the
past several years, according to the investigators. A report on
these findings appears in the November online edition of the
Proceedings of the National Academy of Sciences (PNAS).
The findings are significant because experts believe that H5N1 is
the most likely virus to trigger a human influenza pandemic
(worldwide epidemic). Moreover, the increasing number of
transmissions from birds to humans in the past year supports this
opinion, said Robert G. Webster, Ph.D., a co-author of the PNAS
paper. Webster is a member of the Infectious Diseases department and
holder of the Rose Marie Thomas Chair at St. Jude.
Based on their study of vaccinated poultry the Hong Kong/St. Jude
team suggested that the vaccination itself might have facilitated
emergence of this new variant.
This emergence and rapid distribution of FL, despite the vaccination
program that was started in September 2005, also suggests that the
current H5N1 control measures are still inadequate, Webster said.
Moreover, since November 2005, some of the 22 H5N1 human infections
reported from 14 provinces in China were from infected residents of
metropolitan areas such as Shangai, Wuhan and Guangzhou, which are
remote from poultry farms.
“We don’t know yet whether the people in those metropolitan areas
were infected locally by contact with poultry or by contact with
other humans,” Webster said, “but we suspect from the studies they
are being infected by contact with poultry.”
The researchers found the virus in samples taken from infected
chickens in 11 of the last 12 months of the present study, compared
with only four months during 2004-05. This indicates an increase in
the incidence of H5N1 infection in 2005-2006 compared with previous
years, which suggests that H5N1 viruses have not been effectively
contained.
The investigators also conducted genetic studies of 390 H5N1 viruses
isolated from poultry in the current study (30 percent of the total
found in southern China) and found that 68 percent were of the FL
sublineage.
The emergence of FL-like viruses and their success in replacing
other H5N1 variants in such a short time demonstrates how difficult
it is to control H5N1 in China, Webster said.
The other authors of this paper are Gavin Smith, X. H. Fan, J. Wang,
K. S. Li, K. Qin, J.X. Zhang, D. Vijaykrishna, C.L. Cheung, K.
Huang, Marik Peiris, Honglin Chen and Yi Guan (University of Hong
Kong), and J.M. Rayner (formerly of St. Jude).
This work was supported in part by the Li Ka Shing Foundation, the
National Institute of Allergy and Infectious Diseases and ALSAC.
Media seminar on flu
pandemic preparedness and avian influenza [Oct 25
Brussels Belgium]--On 17 October 2006, the European Commission’s
Directorate-General for Health and Consumer Protection organised a
media seminar bringing together a number of leading experts from the
European Commission, the European Centre for Disease Prevention and
Control, the pharmaceutical industry and the World Health
Organisation, with journalists from across the EU Member States. The
aim of the seminar was to provide participants with a deeper
understanding of pandemic preparedness planning and the steps being
taken by the European Commission and the international community to
tackle and prevent avian influenza in wild birds and poultry. The
seminar also sought to clarify technical aspects such as the
difference between flu and human seasonal flu; the different aspects
of transmission and the relative properties of vaccines and
anti-virals. Please find below further information, presentations
and information on the speakers
http://ec.europa.eu/food/press/index_en.htm
Study identifies North
American wild bird species that could transmit bird flu
[Oct 23 Athens GA USA]--University of Georgia researchers have found
that the common wood duck and laughing gull are very susceptible to
highly pathogenic H5N1 avian influenza viruses and have the
potential to transmit them.
Their finding, published in the November issue of the journal
Emerging Infectious Diseases, demonstrates that different species of
North American birds would respond very differently if infected with
these viruses. David Stallknecht, associate professor in the
department of population health at the UGA College of Veterinary
Medicine and co-author of the study, said knowing which species are
likely to be affected by highly pathogenic H5N1 viruses is a vital
component of efforts to quickly detect the disease should it arrive
in North America.
"If you're looking for highly pathogenic H5N1 in wild birds, it
would really pay to investigate any wood duck deaths because they
seem to be highly susceptible, as are laughing gulls," said
Stallknecht, a member of the UGA Biomedical and Health Sciences
Institute. "It was also very interesting that in some species that
you normally think of as influenza reservoirs – the mallard, for
instance – the duration and extent of viral shedding is relatively
low. This may be good news since it suggests that highly pathogenic
H5N1 may have a difficult time surviving in North American wild
birds even if it did arrive here."
Working under controlled conditions in an airtight biosecurity lab
at the USDA Agricultural Research Service's Southeast Poultry
Research Laboratory, the researchers determined how much of the
virus was shed in the feces and through the respiratory system of
several species of wild birds. The work was jointly funded by the
United States Poultry and Egg Association, the Morris Animal
Foundation and the USDA.
"We chose birds that, because of their behavior or habitat
utilization, are most likely to transmit the virus or bring the
virus here to North America," said lead author and doctoral student
Dr. Justin Brown.
The species studied were: Mallards, which are often infected with
commonly circulating, low-pathogenic avian influenza viruses in
North America and Eurasia; Northern pintails and blue-winged teal,
which migrate long distances between continents; redheads, a diving
species; and wood ducks, which breed in Northern and Southern areas
of the United States. The laughing gull is a common coastal species
ranging from the Southern Atlantic to the Gulf Coast.
Stallknecht explained that in low-pathogenic avian influenza, most
of the virus is shed in the feces of birds. The virus then spreads
as other birds drink from contaminated water. The study found that
in highly pathogenic H5N1 avian influenza, however, the birds shed
most of the virus through their respiratory tract.
Stallknecht said that with this knowledge, scientists can more
effectively detect the virus in live birds by swabbing the birds'
mouths and throats.
"Doing avian influenza surveillance is pretty tricky because there
are a lot of species differences and there are also seasonal
differences," he said. "So you've got to pick the right species at
the right time and you've got to collect the right samples."
In a related study scheduled to be published in December issue of
the journal Avian Diseases, the researchers have quantified how long
the virus persists in water samples. They found that highly
pathogenic H5N1 avian influenza viruses don't persist as long as
common low-pathogenicity strains. In some cases, persistence times
were reduced by more than 70%. This could affect transmission and
supports the idea that these viruses may not have much of chance of
becoming established in North America.
Stallknecht said the finding is encouraging, but cautions that it's
difficult to put it into context without results from a study his
team is currently working on that will assess the minimum amount of
virus it takes to infect a bird.
This month the researchers also received the first $875,000 of a
planned three-year grant totaling $2.6 million from the Centers for
Disease Control and Prevention. The grant will be used for an
ambitious project that will take a broad look at the possibility of
human contact with avian influenza viruses.
In the first phase of the project, the researchers will examine the
prevalence, persistence and distribution of the viruses in various
environments. In the next phase, they'll work with state public
health departments to determine the groups of people who – by virtue
of their occupation or recreational activities – are likely to come
into contact with the viruses. The researchers will then assess the
ability of low-pathogenic avian influenza viruses to infect mammals
so that the risk of human contact can be put into perspective.
"With this information, public health officials will be able to
better understand the human health risks associated with both
low-pathogenic and highly pathogenic avian influenza viruses in both
domestic and wild bird populations," Stallknecht said. "Many of
these potential risks are not very well understood or even defined,
and it is possible that they could be very effectively controlled
with simple preventive measures."
Effective booster shot a
bit of good news against bird flu [Oct 12 Toronto ON
Canada]--An initial priming shot given in advance of a booster shot
may be an effective way to protect people against bird flu,
researchers say in a presentation at the annual meeting of the
Infectious Diseases Society of America.
The findings help address a major question facing public health
officials: How to protect against a possible pandemic caused by a
virus whose precise viral make-up won't be known until it has
already become a threat?
The team from the University of Rochester Medical Center is
addressing the question by taking advantage of a small group of
people in Rochester who were among the first Americans to be
vaccinated against bird flu when the disease first became a human
threat in Hong Kong back in 1997 and 1998.
Shortly after the Hong Kong threat, the National Institute of
Allergy and Infectious Diseases funded a study in Rochester of an
experimental vaccine designed against that form of bird flu. Last
year scientists turned to the same group of volunteers, who
represent a unique pool of knowledge about bird flu, in a study to
determine the effects of giving a booster shot years after a person
was originally immunized.
Officials were able to track down 37 people who agreed to take part.
Each had received two shots as part of the vaccine study in 1998
against the form of the virus that had emerged in Hong Kong. Earlier
this year each was again vaccinated with another shot targeting a
different form of bird flu, the variant that swept through Vietnam
in 2004 and 2005. Their immune response to the second shot was
compared to the response in people who received shots for the first
time in 2005. More than twice as many people who also received the
shot in 1998 developed a protective antibody response against bird
flu compared to people who had never been immunized against bird flu
previously.
"We studied a relatively small group, so that certainly, this issue
needs to be studied more thoroughly in a larger group of people,"
said John J. Treanor, M.D., professor of medicine and director of
Rochester's Vaccine and Treatment Evaluation Unit. If the findings
hold up, then it might open up a number of options beneficial for
planning. One might consider giving a priming shot to members of the
community who would be a central part of the response if a pandemic
were to occur, such as health care workers. You'd have people who
were prepared as much as possible in advance."
The work is being presented at IDSA by research fellow Nega Ali
Goji, M.D., who did the study with Treanor
The work addresses one of the features of bird flu that makes a
potential pandemic so hard to fight: Like human flu viruses, bird
flu mutates constantly, and by the time a vaccine has been produced
to protect against one form of bird flu, it's very possible that
another form, requiring a different vaccine, will have emerged that
can move from person to person.
The results of the new study are similar to what doctors already
know about giving "regular" flu shots. Every year millions of adults
get an updated flu shot every year – one shot is enough, because
their immune systems "remember" previous forms of the flu and help
make the new shot each year effective. But small children who have
never seen the flu before typically need two shots, a primer and a
booster. The results from the new study indicate that, like small
children who receive a regular flu shot, adults who have never
encountered bird flu would benefit from a booster shot.
The two vaccines used in the study target viruses belonging to
different "clades" or viral families. Both are H5N1 bird flu
viruses, but the Hong Kong strain from 1997 belongs to clade 3,
while the Vietnam strain from 2004 belongs to clade 1. Goji and
Treanor found that the shot targeting clade 3 helps the body
maximize the immunization against a virus in a different clade,
clade 1. In other words, using the vaccines that are available now
might help improve the response to the vaccines developed for a
future strain of bird flu.
The work was possible thanks to the availability of volunteers in
Rochester who took part in the nation's first U.S. human bird flu
study, back in 1998, at the University of Rochester Medical Center.
At the University's VTEU, thanks to funding from NIAID, more than
450 people have taken part in studies of bird flu vaccine, more than
nearly any city in the world.
Updates on pandemic flu
vaccine trials to be presented at 44th annual IDSA meeting
[Oct 12 Toronto ON Canada]--Preliminary results from clinical trials
testing two different pandemic flu vaccine approaches--one a
prime-boost strategy using different subtypes of H5N1 vaccines, the
other an H5N1 vaccine delivered into the skin (intradermal) rather
than the muscle--will be presented at the 44th Annual Meeting of the
Infectious Diseases Society of America being held in Toronto Oct.
12-15. The presentations are scheduled for a late-breaker session on
Friday afternoon, Oct. 13th (see
http://www.idsociety.org).
Funding for the trials comes from the National Institute of Allergy
and Infectious Diseases (NIAID), one of the National Institutes of
Health. Reporters may call the NIAID News Office at 301-402-1663 to
speak with NIAID Director Anthony S. Fauci, M.D., who is available
to comment and provide perspective on these preliminary findings.
Preliminary Results Suggest Priming Boosts Immune Responses to
Variant H5N1 Vaccine
Presentation time: Late-Breaker Session, Friday, Oct. 13, 2006, 5:00
p.m. Presenter: Nega Ali Goji, M.D., University of Rochester Medical
Center, Rochester, NY
If a pandemic influenza strain was identified, it would likely take
several months to make a vaccine against it, and stimulating
protective immunity with the vaccine would likely require more than
one dose. Giving people two doses of H5N1 influenza vaccine as a
pandemic is evolving would be logistically difficult, however, so
researchers have been urgently investigating alternative strategies.
One such alternative is to prime people ahead of time with a related
vaccine so that only a single dose of vaccine is required when the
pandemic emerges. A team of researchers led by University of
Rochester Medical Center investigators Nega Ali Goji, M.D., and John
J. Treanor, M.D., recently tested this hypothesis. They compared the
immune response to a single 90-microgram dose of one variant of
avian flu vaccine in two groups of adults: those who had received a
different variant of H5N1 avian flu virus vaccine some eight years
earlier and those without pre-exposure to any H5N1 virus or
vaccines.
In late 1997-98, soon after the first case of direct bird-to-human
transmission of an H5N1 flu virus occurred in Hong Kong, NIAID
funded the production of an experimental vaccine made from the Hong
Kong virus and tested it in a small clinical trial conducted at the
University of Rochester in healthy adults (see reference).
Thirty-seven individuals who received two doses of the Hong Kong
H5N1 vaccine in that trial served as the "primed" population in the
current study.
The booster dose in the current study--an experimental inactivated
H5N1 virus vaccine produced for NIAID by sanofi pasteur, the
vaccines business of the sanofi-aventis Group of Paris--is based on
an H5N1 flu virus from Vietnam. The Hong Kong virus is related to
the Vietnam virus but belongs to clade 3, which refers to its branch
on an evolutionary tree of the H5N1 viruses in Asia, while the
Vietnam virus belongs to clade 1.
In their trial, the Rochester team found that more than twice as
many of the individuals who had received the priming dose of clade 3
H5N1 vaccine responded with substantial antibody levels to a single
dose of clade 1 H5N1 vaccine than did those with no prior H5N1
exposure. Dr. Treanor says that these early but promising data
indicate that priming with an antigenic variant vaccine before a
pandemic occurs may be one strategy used to help control a pandemic.
"These preliminary findings need to be confirmed in larger studies,
but they offer the intriguing possibility that pre-pandemic priming
with existing H5N1 vaccines may boost the immune response to a
different H5N1 vaccine tailor-made years later to thwart an emerging
human influenza pandemic," says Dr. Fauci.
Third Dose of Intramdermal H5N1 Vaccine Well-Tolerated but does Not
Improve the Immune Response
Presentation Time: Late-Breaker Session, Friday, Oct. 13, 2006, 5:15
p.m.
Presenter: Shital M. Patel, M.D., Baylor College of Medicine,
Houston, TX
Previous studies have suggested that lower dosages of seasonal flu
vaccine given intradermally may work as well as higher dosages of
the same vaccine given intramuscularly, enabling public health
officials to "stretch" available doses of vaccine in a time of
shortage. To test this principle with an H5N1 pandemic flu vaccine,
NIAID initiated a vaccine trial to compare immune responses
generated by an H5N1 vaccine given by the intradermal or the
intramuscular route. The H5N1 vaccine formulations were produced for
NIAID by sanofi pasteur.
Wendy Keitel, M.D., Shital M. Patel, M.D., and their Baylor College
of Medicine colleagues conducted the trial. Results of their initial
two-dose study among 100 participants indicated that antibody
responses among volunteers given 3 or 9 micrograms of vaccine
intradermally were similar to the antibody responses seen among
volunteers given 15 micrograms intramuscularly: 4 percent, 5
percent, and 12 percent of volunteers, respectively, had a
significant increase in antibody levels after two doses. Those given
45 micrograms by the intramuscular route, however, showed a
significantly higher response rate: 56 percent of volunteers in this
group responded.
In the current study, the Baylor team enrolled 77 healthy adults
between the ages of 18 and 40 who had previously received two doses
of the same vaccine one month apart and gave them a third dose of
vaccine 6 months later to see if it boosted their antibody response.
The participants, again divided into four groups, received either 3
or 9 micrograms intradermally or 15 or 45 micrograms
intramuscularly. The dosages of vaccine were limited by the
formulations available.
According to Dr. Patel, a quarter or less of the participants in the
study groups given the vaccine intradermally or intramuscularly at
15 micrograms had a significant antibody response after the third
dose, while nearly two-thirds of the volunteers in the group that
received 45 micrograms intramuscularly had a similar response. For
each dosage by either route of administration, the results show that
giving a third dose of the vaccine 6 months later increased antibody
titers to levels similar to those achieved after the first two
doses.
"This small pilot study demonstrates that multiple doses of an
inactivated H5N1 vaccine given by either the intradermal or the
intramuscular route are safe and well tolerated," says Dr. Fauci.
"It also provides a strong rationale for testing higher dosages of
H5N1 vaccine given intradermally." Plans are under way to directly
compare the immune responses generated by vaccinating either into
the skin or into the muscle with an H5N1 vaccine containing higher
levels of the same amount of antigen.
NSW human
influenza pandemic plan [Oct 4 Sydney NSW Australia]
http://www.health.nsw.gov.au/pandemic/docs/nswplan.pdf
Live H5N1 avian flu virus
vax show protection in animal studies [Sep 12
Gaithersburg MD USA]--When tested in mice and ferrets, experimental
vaccines based on live, weakened versions of different strains of
the H5N1 avian influenza virus were well-tolerated and protected the
animals from a deadly infection with naturally occurring H5N1 flu
viruses. The findings, which appear in the September 12 issue of
PLoS Medicine, are also encouraging, the researchers say, because
they demonstrate the ability to create a vaccine based on one
particular strain of the H5N1 flu virus that could potentially
protect against different emerging H5N1 flu strains.
Senior investigator Kanta Subbarao, M.D., M.P.H., and co-chief Brian
Murphy, M.D., both of the Laboratory of Infectious Diseases at the
National Institute of Allergy and Infectious Diseases (NIAID), part
of the National Institutes of Health (NIH), led the research. The
study was the result of a cooperative research and development
agreement between NIAID and MedImmune Inc., of Gaithersburg, Md.
“This is an excellent example of the NIH and industry working
together to find scientific solutions to potential public health
problems,” notes NIH Director Elias A. Zerhouni, M.D. “Developing a
vaccine that could protect against a potential influenza pandemic is
a top priority for all of us.”
“If an influenza pandemic were imminent or under way, we would need
a vaccine that could stimulate immunity quickly, preferably with a
single dose,” says NIAID Director Anthony S. Fauci., M.D. “The
encouraging findings of this study suggest that vaccines based on
live but weakened versions of the H5N1 avian influenza virus may
quickly stimulate protective immunity. We are further exploring this
live, attenuated vaccine strategy as one of several tools that we
hope to have available in the event of an influenza pandemic.”
As of September 8, 2006, there have been 244 confirmed human cases
of H5N1 infection and more than half of those were fatal, according
to the World Health Organization (WHO). Public health officials
worry that the H5N1 virus will evolve to become easily transmissible
among people, potentially sparking an influenza pandemic, because
humans have no pre-existing immunity to the H5N1 viruses.
The NIAID and MedImmune research team created three vaccines by
combining modified proteins derived from virulent H5N1 flu viruses
with proteins from an artificially weakened (attenuated) flu strain.
The virulent H5N1 viruses were isolated from human cases in Hong
Kong in 1997 and 2003, and Vietnam in 2004. The attenuated flu
vaccine strain, which also serves as the basis for MedImmune’s
FluMist® influenza vaccine, was lab-grown in progressively colder
temperatures (“cold-adapted”) to prevent the resulting vaccine
viruses from spreading beyond the relatively cool upper respiratory
tract. Large quantities of the resulting cold-adapted viruses were
grown in chicken eggs.
The safety of the vaccine viruses was evaluated in chickens and
mice. In chickens, the H5N1 vaccine viruses were not lethal, while
each of the three strains of the “wild-type” (naturally occurring)
H5N1 viruses were. Similarly, the vaccine viruses were not lethal in
mice, but the 1997 and 2004 strains of the wild-type H5N1 viruses
were. The 2003 strain of the H5N1 wild-type virus was not tested in
mice because the researchers found that the virus was lethal in
those animals only at very high doses. Because the wild-type H5N1
viruses have been shown to replicate in animal lungs and brains, the
researchers tested the ability of the 1997 and 2004 strains of the
vaccine viruses to replicate in mice and ferrets as an additional
safety measure In mice, the vaccine viruses replicated in the
respiratory tract but did not spread to the animals’ brains. In
ferrets, the H5N1 vaccine viruses did not replicate in the lungs or
the brain.
To evaluate the protective ability of the vaccines, the researchers
gave the mice a single dose of vaccine virus via nose drops. All of
these mice survived infection with the 1997 and 2004 H5N1 wild-type
viruses, including two more recent strains of the H5N1 virus found
circulating in Vietnam and Indonesia in 2005. Further, mice that
received a second dose of vaccine 28 days after the initial
inoculation demonstrated a stronger and more rapid immune response
and almost complete protection from respiratory infection when
exposed to the naturally occurring H5N1 viruses. Ferrets exhibited
similar results when given two doses of the vaccine viruses.
“It is impossible to predict how the H5N1 virus will evolve or which
strain, if any, will cause an influenza pandemic. To be prepared, we
need to select a vaccine capable of inducing an effective human
immune response against a range of H5N1 viruses that may emerge in
the future. This study shows that such cross-protection can be
achieved in small animals,” says Dr. Subbarao. “The next step is to
evaluate in people the safety and immune response induced by these
vaccines to see if they produce cross-reactive antibodies that are
likely to protect against different H5N1 viruses.”
In June 2006, NIAID and MedImmune launched a Phase 1 study to
evaluate the safety and immunogenicity of a live, attenuated H5N1
vaccine based on the 2004 H5N1 virus strain. The study, which is
being performed in an isolation unit at Johns Hopkins Bloomberg
School of Public Health Center for Immunization Research in
Baltimore, is evaluating the safety and immunogenicity of the
vaccine in approximately 20 healthy individuals between the ages of
18 and 49. Results from that study are not yet available.
The concept of using cold-adapted flu viruses to create flu
vaccines, as detailed in the study in PLoS Medicine, was developed
by scientists at NIAID and the University of Michigan School of
Public Health (http://www3.niaid.nih.gov/news/focuson/flu/research/prevention/flumist.htm).
|
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Global: H5N1 avian influenza: Timeline
of major events
[Apr 15 Geneva Switzerland]
Early events:
1996
Highly pathogenic H5N1 virus is isolated from
a farmed goose in Guangdong Province, China.
1997
Outbreaks of highly pathogenic H5N1 are
reported in poultry at farms and live animal markets in Hong Kong.
Human infections with avian influenza H5N1 are
reported in Hong Kong. Altogether, 18 cases (6 fatal) are reported in the
first known instance of human infection with this virus.
Feb 2003
Two human cases of avian influenza H5N1
infection (one fatal) are confirmed in a Hong Kong family with a recent
travel history to Fujian Province, China. A third family member died of
severe respiratory disease while in mainland China, but no samples were
taken.
Subsequent Events
25 Nov 2003
A fatal human case of avian influenza H5N1
infection occurs in China in a 24-year-old man from Beijing and is
attributed to SARS. This case is retrospectively confirmed in August of
2006 (as the 20th human case in China).
12 Dec 2003
Republic of Korea first reports H5N1 in
poultry. Outbreaks continue through September 2004
Dec 2003 - Jan 2004
Two tigers and two leopards, fed on fresh
chicken carcasses, die unexpectedly at a zoo in Thailand. Subsequent
investigation identifies a H5N1 virus similar to that circulating in
poultry. This is the first report of influenza causing disease and death in
big cats.
8 Jan 2004
Viet Nam first reports H5N1 in poultry.
Outbreaks continue to be reported on a regular basis.
11 Jan 2004
Viet Nam identifies H5N1 as the cause of human
cases of severe respiratory disease with high fatality. Sporadic human cases
are reported through mid-March.
12 Jan 2004
Japan first reports H5N1 in poultry, outbreaks
continue in commercial poultry through March 2004.
19 Jan 2004
Hong Kong reports H5N1 in a dead wild bird
(first report in birds since poultry outbreak in 1997)
23 Jan 2004
Thailand first reports H5N1 in poultry. By the
end of January, 32 provinces (throughout the north and several in the south)
report outbreaks in many types of poultry, including fighting cocks, and
outbreaks continue to be reported
throughout the year. The virus appears closely related to the isolates from
human cases in Viet Nam. Thailand prohibits
vaccination of poultry.
Thailand reports two laboratory-confirmed
cases of human infection with H5N1. Sporadic human cases are reported
through mid-March.
24 Jan 2004
Cambodia first reports H5N1 in poultry.
27 Jan 2004
Lao PDR first reports H5N1 in poultry.
1 Feb 2004
Investigation of a family cluster of H5N1
cases, which occurred in Viet Nam in early January, cannot rule out the
possibility of limited human-to-human transmission.
2 Feb 2004
Indonesia first reports H5N1 in poultry in 11
provinces. Outbreaks continue to be reported. Vaccination is allowed.
4 Feb 2004
China first reports H5N1 in poultry. During
February-March, 16 mainland provinces are affected, and approx. 9 million
poultry culled. Government subsidized vaccination initiated.
20 Feb 2004
A report from Thailand confirms that a
domestic cat was infected with H5N1 after eating an infected pigeon.
18 Mar 2004
Case studies of 10 patients in Viet Nam point
to close contact with infected poultry as the probable source of infection
in most cases, but conclude that, in two family clusters, limited
human-to-human transmission within the family cannot be ruled out.
Jun/Jul 2004
China reports recurrence of H5N1 in poultry.
Outbreaks continue to be reported in Indonesia, Viet Nam and Thailand.
8 Jul 2004
Research identifies the dominant Z genotype in
poultry, considers possible role of wild birds in spread, and concludes that
H5N1 has found a new ecological niche in poultry, but is not yet fully
adapted to this host.
13 Jul 2004
Research shows that H5N1 has become
progressively more lethal for mammals
and can kill wild waterfowl, long considered a disease-free natural
reservoir.
Jul 2004
A case report is published indicating atypical
human H5N1 infection in Thailand (from March 2004), with fever and diarrhoea
but no respiratory symptoms. The report suggests that the
clinical spectrum of disease may be broader than previously thought.
12 Aug 2004
Viet Nam reports 3 new human cases, all fatal
(first cases since February). Dates of hospital admission are from 19 July
to 8
August.
19 Aug 2004
Malaysia (peninsular) first reports H5N1 in
poultry. Outbreaks and positive avian surveillance samples continue to be
reported through September 2004.
20 Aug 2004
Chinese researchers report preliminary
findings of H5N1 infection in pigs. No evidence suggests that pig infections
are widespread, and the finding appears to
have limited epidemiological significance.
2 Sep 2004
Research shows that domestic cats
experimentally infected with H5N1 develop severe disease and can spread
infection to other cats. Prior to this research, domestic cats were
considered resistant to disease from all influenza A viruses.
7 Sep 2004
A 4th fatal human case is reported in Viet
Nam.
9 Sep 2004
Thailand confirms its third fatal case of
human infection.
28 Sep 2004
Thailand confirms 2 further human cases.
4 Oct 2004
Thailand confirms its 4th human case.
18 Oct 2004
Two healthy Hawk-Eagles smuggled from Thailand
are seized at Brussels
International Airport. HPAI H5N1 is isolated.
20 Oct 2004
A second outbreak of HPAI H5N1 in zoo tigers
in Thailand occurs. It is attributed to tigers having been fed fresh chicken
carcasses and whole chickens. Altogether, 147 tigers out of a population of
441 die or are euthanized. No virus is detected in birds in zoo or local
area.
25 Oct 2004
Thailand confirms its 5th human case.
29 Oct 2004
Research confirms that domestic ducks can act
as silent reservoirs, excreting
large quantities of highly pathogenic virus yet showing few if any signs of
illness.
3 Nov 2004
Hong Kong SAR reports H5N1 in a dead wild bird
(last report January 2004).
Dec 2004
Poultry outbreaks continue in Indonesia,
Thailand, and Viet Nam and possibly also in Cambodia and Lao PDR.
Reported outbreaks continue more or less
continuously in Indonesia through August 2006, in Thailand through November
2005, and in Viet Nam though December 2005.
30 Dec 2004
Viet Nam confirms a new human case.
6 Jan 2005
Viet Nam confirms two further human cases.
14 Jan 2005
Hong Kong reports H5N1 in one wild bird as
part of routine surveillance.
Total number of human cases in Viet Nam rises
to six. Sporadic cases continue
to be reported over the coming months, making Viet Nam the hardest hit
country.
27 Jan 2005
Research concludes that a girl in Thailand
probably passed the virus to at least her mother in September 2004, causing
fatal disease. This is the first published account of probable secondary
human transmission, resulting in severe disease, of any avian influenza
virus.
2 Feb 2005
Cambodia confirms its first human case, which
is fatal.
17 Feb 2005
Research retrospectively identifies at least one fatal atypical case in Viet
Nam (from Feb 2004), presenting with diarrhoea and encephalitis, but
normal chest X-rays.
29 Mar 2005
Cambodia confirms its 2nd human case, also
fatal.
12 Apr 2005
Cambodia confirms its 3rd human case, also
fatal.
30 Apr 2005
Wild birds begin dying at Qinghai Lake in
central China, where hundreds of
thousands of migratory birds congregate. Altogether, 6,345 birds from
different species die in the coming weeks. This is the first reported
instance of any HPAI causing mass die-offs in wild birds.
4 May 2005
Cambodia confirms its 4th human case, also
fatal.
8 Jun 2005
China reports poultry outbreak in Xinjiang
Autonomous Region. Reports continue from several provinces, through
February 2006.
26 Jun 2005
Japan reports LPAI H5N2 in poultry, which
continues to be detected through April 2006. Source remains unconfirmed,
though one rumour suggests the strain
was introduced via improperly prepared vaccine.
30 Jun 2005
A WHO investigative team finds no evidence that H5N1 has increased its
transmissibility in humans in Viet Nam.
6 Jul 2005
Research on viruses isolated from dead birds in Qinghai Lake suggests the
outbreak was caused by a new H5N1 variant that may be more lethal to wild
birds and experimentally infected mice.
7 Jul 2005
The Philippines reports LPAI (likely an H9) in
poultry.
14 Jul 2005
Research on viruses isolated from dead birds
in Qinghai Lake demonstrates
transmission of the virus among migratory geese and suggests that the virus
may be carried along winter
migratory routes.
15 Jul 2005
H5N1 is detected in three captive Owston’s
palm civets that died in late June in a Vietnamese wildlife preserve. This
is the first reported infection of this
species with the virus. The civets were not fed chicken and the source of
infection remains unknown.
21 Jul 2005
Indonesia confirms its first human case. Infection in two other family
members is considered likely, but cannot be laboratory confirmed. Subsequent
investigation is unable to determine the source of infection. Virus has been
circulating in poultry in Indonesia since February 2004.
23 Jul 2005
Russia reports first outbreaks of H5N1, in
poultry in the Novosibirsk region. Dead migratory birds are reported in the
vicinity of outbreaks. From 23 July- 22 December 2005, a total of 62 sites
in 10
regions are confirmed as HPAI H5N1-positive.
29 Jul 2005
Kazakhstan reports first H5N1 in poultry in
areas adjacent to Siberia. Dead
migratory birds are reported in the vicinity of outbreaks.
2 Aug 2005
Indonesia reports H5N1 in poultry and pigs
during surveillance in the region where the recent human cases lived
(Tangerang district, Banten province,
West Java).
10 Aug 2005
China reports additional outbreaks in several
provinces through February 2006. Vaccination is initiated in affected
regions using an H5N2 monovalent
inactivated vaccine.
Mongolia reports deaths in 89 migratory birds at two lakes in Northern
Mongolia.
H5N1 is subsequently identified in 4 of the birds.
16 Sep 2005
Indonesia confirms its 2nd human case.
22 Sep 2005
Indonesia confirms its 3rd human case.
29 Sep 2005
Indonesia confirms its 4th human case.
Research describes the clinical features of H5N1 infection and reviews
recommendations for the management of cases.
Oct 2005
Research on the evolution of human and animal viruses circulating in Asia in
2005 suggests that several amino acids located near the receptor-binding
site are undergoing change, some of which may affect antigenicity or
transmissibility.
6 Oct 2005
Highly pathogenic H5N1 is first reported in
poultry in Turkey.
Research describes reconstruction of the lethal 1918 pandemic virus,
concludes that this virus was entirely avian, and finds some similarities
with H5N1.
7 Oct 2005
Highly pathogenic H5N1 is first reported in
poultry in Romania. Reports continue
through July 2006.
10 Oct 2005
Indonesia confirms its 5th human case.
20 Oct 2005
Taiwan, China reports the detection of highly
pathogenic H5N1 in a cargo of exotic songbirds smuggled from mainland
China.
Thailand confirms its 18th human case (the
first human case in Thailand since October 2004.
21 Oct 2005
Croatia first reports H5N1 in wild birds
(migratory swans). H5N1 continues to be reported in wild birds on routine
surveillance, through April 2006.
23 Oct 2005
The United Kingdom reports highly pathogenic
H5N1 in an imported parrot, held in quarantine, that died 3 days earlier.
24 Oct 2005
Thailand confirms its 19th human case, and Indonesia confirms its 6th and
7th
human cases.
9 Nov 2005
Viet Nam confirms its 65th human case (its
first human case since July 2005).
11 Nov 2005
Kuwait detects highly pathogenic H5N1 in a
single migratory flamingo, marking the first report of this disease in the
Gulf
region.
17 Nov 2005
China confirms its first two human cases, from
Hunan and Anhui provinces (does
not include the case in 2003, confirmed retrospectively).
24 Nov 2005
China confirms its third human case, from
Anhui province. Sporadic cases
continue to be reported in the coming weeks.
2 Dec 2005
Ukraine reports its first H5N1 outbreak in
domestic birds in Crimea. Outbreaks
continue to be reported through February 2006.
26 Dec 2005
Turkey reports a new outbreak in poultry in
the eastern province of Igdir. Through April 2006, additional outbreaks are
reported in primarily backyard poultry in 11 of the country’s 81 provinces.
Wild birds are also reported to be infected. Control measures include
culling of
poultry in Iraqi Kurdistan and all backyard poultry in Iran within 10 km of
the Turkish border. Vaccination is prohibited.
Jan 2006
Qinghai Lake-like H5N1 viruses are reportedly
isolated from cats in Northern Iraq.
By the end of 2005, Indonesia has confirmed a total of 20 cases in humans.
5 Jan 2006
Turkey confirms its first two human cases. Sporadic cases continue to be
reported in the coming weeks, but rapidly end. Viruses are similar to those
currently circulating in birds.
20 Jan 2006
Hong Kong reports H5N1 in a dead wild bird
(first report since January 2005), and
H5N1 reports in wild birds (and in 2 chickens) continue through March 2006.
These viruses all belong to H5N1 genotype V, which has previously been
recorded in southern China, Japan and
South Korea.
30 Jan 2006
Iraq confirms its first human case, in a
15-year-old girl in Sulaimaniyah (onset date 9 January 2006).
1 Feb 2006
Iraq reports its first outbreak of H5N1, in
backyard flocks in same village where human case detected.
3 Feb 2006
Bulgaria first reports H5N1 in wild birds
(swans).
8 Feb 2006
Nigeria first reports H5N1 in poultry. This is
the first report of the virus in Africa. Outbreaks in poultry and
ornamental birds are reported through March 2006.
9 Feb 2006
Greece first reports H5N1 in wild birds
(swans). Additional reports in wild birds through March 2006.
11 Feb 2006
Italy first reports H5N1 in wild birds.
12 Feb 2006
Slovenia first reports H5N1 in a wild bird
(swan). A total of 48 dead wild birds are
reported through March 2006.
13 Feb 2006
Iran first reports H5N1 in wild birds (swans)
found dead on routine surveillance.
Russia reports H5N1 outbreaks (at large
commercial farms) in the Caucasus region, near the border with Azerbaijan.
Further outbreaks are reported in backyard poultry, pigeons, and wild birds
in Tyva Republic, Altaj, Tomsk, Omsk and Novosibirsk regions through July
2006. (first outbreak reported since October 2005)
China confirms its 12th human case and 8th fatality. Some human cases have
occurred in areas with no reported outbreaks in
poultry.
Indonesia confirms its 25th human case and 18th fatality.
14 Feb 2006
Germany first reports H5N1 in wild birds
(swans). Reports of H5N1 in wild birds on routine surveillance continue
through April 2006.
17 Feb 2006
Egypt reports its first H5N1 in domestic
poultry (since 1965). Outbreaks continue
to be reported through December 2006.
France first reports H5N1 in a wild duck (followed by additional reports in
other
wild birds).
Iraq confirms its second human case.
18 Feb 2006
India first reports H5N1 in domestic poultry.
Reported outbreaks continue through April 2006.
Austria first reports H5N1 in wild birds (swans). Austria continues to find
H5N1 in some wild birds on routine
surveillance, until April 2006.
19 Feb 2006
Malaysia reports H5N1 in a flock of free-range
poultry (last reported September
2004). Outbreaks reported through March 2006.
20 Feb 2006
Bosnia-Herzegovina and Slovakia each first
report H5N1 in wild birds (migratory swans).
21 Feb 2006
Hungary first reports H5N1 in wild birds
(swans).
Studies of H5N1 viruses show that multiple genetically and antigenically
distinct sublineages of the virus are now established in poultry in parts of
Asia.
Poultry-to-poultry transmission is thought to
sustain endemicity of the virus in this region. H5N1 virus is isolated from
apparently healthy migratory birds in southern China, suggesting that
migratory birds can carry the virus over long distances.
23 Mar 2006
West Bank/Gaza Strip first reports H5N1 in
poultry. Outbreaks reported through April 2006.
24 Feb 2006
Azerbaijan first reports H5N1 in migratory
birds. H5N1 is later also confirmed in poultry.
Georgia first reports H5N1in wild birds (swans).
25 Feb 2006
France first reports H5N1 in a single turkey
farm, marking the first appearance of this disease in domestic poultry in
the
EU. Had previously been identified in wild birds in France.
27 Feb 2006
Niger first reports H5N1 in domestic poultry
(area near border with affected states of northern Nigeria)
Pakistan first reports H5N1 in poultry. Outbreaks are reported through July
2006.
28 Feb 2006
Germany reports H5N1 infection in a dead
domestic cat on the Isle of Ruegen.
Two more cats on the Island are found to be infected in March. Cats are
thought to have been exposed by eating infected
birds.
1 Mar 2006
Serbia-Montenegro first reports H5N1 in wild
birds (swans).
Switzerland first reports H5N1 in a dead wild bird. Additional wild birds
are reported positive in March and April from various locations throughout
the country on routine surveillance.
6 Mar 2006
Poland first reports H5N1 in wild birds
(swans). Reports continue through May 2006.
7 Mar 2006
Albania first reports H5N1 in poultry
(chickens).
Austria reports H5N1 in 3 domestic cats in an animal shelter.
9 Mar 2006
Germany reports H5N1 infection in a stone
marten on the Isle of Ruegen,
marking the first documented infection of
this species with an avian influenza virus.
Myanmar reports H5N1 in poultry (first since
1996).
11 Mar 2006
Cameroon first reports H5N1 in domestic ducks.
13 Mar 2006
Serbia-Montenegro first reports H5N1 in
poultry (1 rooster). Had been previously reported in wild birds.
Iraq has its third human case, in a
3-year--old boy (case retrospectively confirmed in September, 2006)
14 Mar 2006
Denmark first reports H5N1 in a wild bird.
Reports in wild birds continue through May of 2006.
Azerbaijan confirms its first human cases (onset dates from mid-February
2006).
15 Mar 2006
Afghanistan first reports H5N1 in poultry and
a crow.
16 Mar 2006
Israel first reports H5N1 in poultry.
Sweden first reports H5N1 in 36 dead wild birds tested in February and March
(no increase in overall wild bird
mortality)
17 Mar 2006
Khazakstan reports H5N1 in wild birds (first
since August 2005)
Sweden first reports HPAI H5 (no N type given) in poultry in a game bird
holding within the surveillance zone set up in
response to detection of H5N1 in wild birds.
20 Mar 2006
Egypt confirms its first human case in a 30-year-old woman from Qalubiya
(onset early March 2006).
23 Mar 2006
Cambodia reports its first outbreak in poultry
since December 2004. Outbreaks
continue to be reported through fall 2006.
Jordan first reports H5N1 in poultry.
Two research groups publish findings that may help explain why the H5N1
virus
does not easily infect humans or – like normal seasonal influenza – spread
readily by coughing or sneezing. Whereas human influenza viruses attach
themselves to molecules in cells lining the nose and throat, avian viruses
prefer to bind to molecules located deep in the lungs. Such findings are
consistent with
the clinical picture of H5N1 infection, in which most patients present with
symptoms of infection in the lower respiratory tract, with rapid progression
to
pneumonia.
27 Mar 2006
Czech Republic first reports H5N1 in a wild
bird (swan). Reports in wild swans continue through May 2006.
Sweden detects H5N1 in a wild mink in southern
Sweden in an area where wild birds cases have been detected.
3 Apr 2006
Burkina Faso first reports H5N1 in poultry (guineafowl).
5 Apr 2006
Germany first reports H5N1 in poultry, in
turkeys on a single farm (previously reported in wild birds).
6 Apr 2006
United Kingdom first reports H5N1 in a single
wild bird (swan).
Cambodia confirms its 6th human case in a 12-year-old boy from Prey Vang
(onset date 29 March 2006) (first human case in Cambodia since April 2005).
12 Apr 2006
Indonesia confirms its 31st human case
in a 23-year-old man from West Java
(onset date 20 March 2006).
13 Apr 2006
Egypt confirms its 12th human case in a 18-year-old woman from Minufiyah
(onset date 5 April 2006).
17 Apr 2006
Sudan first reports H5N1 in poultry (both
intensive and backyard systems). Additional outbreaks reported through
October 2006.
19 Apr 2006
China reports H5N1 in wild aquatic and other
birds in Qinghai and Tibet regions.
Côte d’Ivoire first reports H5N1 in poultry and a wild bird. Outbreaks
continue to be reported through July
2006.
China confirms its 17th human case in an 21-year-old man from Hubei (onset
date 1 April 2006).
Indonesia confirms its 32nd human case in a 24-year-old man from Banten
(onset date 29 March 2006).
24 Apr 2006
Djibouti reports its first case
of H5N1 in poultry.
27 Apr 2006
China confirms its 18th human case in an 8-year-old girl from Sichuan (onset
date 16 April 2006).
4 May 2006
Mongolia reports H5N1 in dead wild birds on
routine surveillance through June
2006 (last report August 2005).
Egypt confirms its 13th human case in a 27-year-old woman from Cairo (onset
date 15 April 2006).
8 May 2006
Indonesia confirms its 33rd human case in a 30-year-old man from Jakarta
(onset date 17 April 2006)
9 May 2006
Ukraine first reports HPAI H5 in wild birds
(previously reported in poultry)
12 May 2006
Djibouti confirms its first human case in a 2-year-old girl from Arta (onset
date 23 April 2006).
18 May 2006
Denmark reports its first outbreak of H5N1
HPAI in domestic poultry (was
previously reported in wild birds). An outbreak of H5N2 LPAI was also
reported during this period.
Egypt confirms its 14th human case in a 75-year-
-old woman from Al Minya (onset date 11 May 2006).
Indonesia reports the largest family cluster in any country to date, with 7
confirmed cases (the 34th through 39th and the 42nd) from 4 households in
the
Karo district of North Sumatra.
The index case (unconfirmed) develops symptoms
on 24 Apr, the last case dies on 22 May.
Cases include the index case's 2 sons, (aged
15 and 17 years), her 10-year-old nephew, her 2 brothers (aged 25 and 32
years), her 28-year-old sister, and this sister's 18-month-old daughter.
Disease does not spread beyond the extended
family. Limited human to human transmission can not be ruled out.
Viruses do not show any significant genetic mutations or reassortment.
Indonesia also confirms its 40th human case,
in a 38-year-old woman from East Java [onset 2 May 2006].
19 May 2006
Indonesia confirms its 41st human case in a 12-year-old boy from East
Jakarta
(onset date 7 May 2006).
29 May 2006
Indonesia confirms its 43rd - 48th human cases in an 18-year-old man from
East
Java (onset date 6 May 2006), a 10-yearold girl and her 18-year-old brother
from West Java (both with onset date 16 May 2006), a 39-year-old man from
Jakarta (onset date 9 May 2006), a 43-year-old man from Jakarta (onset date
6 May 2006), and a 15-year-old girl from West Sumatra (onset date 17 May
2006). All 6 cases are unrelated to the family cluster in Karo, North
Sumatra.
4 Jun 2006
China reports its first cases in poultry since
February 2006. Outbreaks reported
from various provinces through October 2006.
6 Jun 2006
Indonesia confirms its 49th human case in a 15-year-old boy from West Java
(onset date 26 May 2006).
9 Jun 2006
Hungary reports its first H5N1 in poultry
(previously reported in wild birds).
15 Jun 2006
Ukraine reports H5N1 in poultry (first report
since February 2006), first reported in wild birds in May 2006.
Indonesia confirms its 50th human case in a 7-year-old girl from Banten
(onset date 26 May 2006).
16 Jun 2006
China confirms its 19th human case, in a 31-year-old man from Guandong
(onset date 3 June 2006).
20 Jun 2006
Indonesia confirms its 51st human case in a 13-year-old boy from Jakarta
(onset
date 9 June 2006).
30 Jun 2006
The first analysis of epidemiological data on all 205 laboratory-confirmed
H5N1 cases officially reported to WHO from Dec 2003 to 30 Apr 2006 is
published by WHO.
4 Jul 2006
Indonesia confirms its 52nd human case in a 5-year-old boy from East Java
(onset
date 8 June 2006).
7 Jul 2006
Spain first reports H5N1 in a single wild
shore bird (grebe) in northern region.
14 Jul 2006
Indonesia confirms its 53rd human case in a 3-year-old girl from Jakarta
(onset
date 23 June 2006).
20 Jul 2006
Indonesia confirms its 54th human case in a 44-year-old man from Jakarta
(onset date 24 June 2006).
26 Jul 2006
Thailand reports two H5N1 outbreaks in poultry
(in Phichit and Nakhon Phanom provinces). These are the first reported in
more than 8 months. Poultry vaccination remains prohibited.
Thailand confirms its 23rd human case in a 17-year-old boy from Phichit in
northern Thailand (onset date 15 July 2006) (the first human case in
Thailand in 2006).
27 Jul 2006
Lao PDR reports H5N1 in poultry (first
reported since January 2004)
3 Aug 2006
H5N1 is detected in a captive zoo swan in
Germany (previously reported in both wild and domestic birds)
30 Aug 2006
Viet Nam reports H5N1 in unvaccinated duck
flocks and market ducks on routine surveillance. Ducks did not show clinical
signs. (First report since December 2005)
7 Aug 2006
Thailand confirms its 24th human case in a 27-year-old man from Uthai Thani
in central Thailand (onset date 24 July 2006).
8 Aug 2006
China retrospectively confirms its 20th human case in a 24-year-old man from
Beijing (onset date 25 November 2003) who died. This case becomes the first
confirmed case of HPAI H5N1 infection in the present outbreak. The case was
initially attributed to SARS.
Indonesia confirms its 55th human case in a 16-year-old boy from West Java
(onset date 26 July 2006), and becomes the country with the most human
deaths (n=43) from H5N1 HPAI infection,
surpassing Viet Nam.
A system for unified H5N1 nomenclature, developed by the WHO/OIE/FAO
Evolution Working Group, is posted on the WHO website and the OFFLU website
www.offlu.net.
9 Aug 2006
Indonesia confirms its 56th human case in an 17-year-old girl from Jakarta
(onset
date 28 July 2006).
14 Aug 2006
Indonesia confirms its 57th human case in an 17-year-old boy from West Java
(Cikelet/Garut Cluster) (onset date 26 July 2006).
14 Aug 2006
The USA detects LPAI H5N1 in wild mute swans
in Michigan.
China confirms its 21st human case in a 62-year-old man from the Uygur
Autonomous Region in north-western China (onset date 19 June 2006).
17 Aug 2006
Indonesia confirms its 58th human case in an 9-year-old girl from West Java
(Cikelet/Garut Cluster) (onset date 1 August 2006).
21 Aug 2006
Indonesia confirms its 59th human case in an 35-year-old woman from West
Java
(Cikelet/Garut Cluster) (onset date 8 August 2006). In this cluster, there
was no evidence of human to human transmission, poultry deaths were possibly
linked with live chickens
returning to village from live animal market, and there were possible
additional
human cases that were not confirmed.
23 Aug 2006
Indonesia confirms its 60th human case in an 6-year-old girl from West Java
(onset date 6 August 2006).
2 Sep 2006
The USA detects LPAI H5N1 in wild ducks in Pennsylvania and Maryland.
8 Sep 2006
Indonesia confirms its 61st human case in an 14-year-old girl from South
Sulawesi (onset date 18 June 2006).
Due to revisions to the WHO case definition,
two cases are retrospectively
confirmed in Indonesia: The 62nd in an 8-year-old girl from Banten (onset
date 24 June 2005) and the 63rd in a 45-year-old man from central Java
(onset date 25 November 2005).
14 Sep 2006
Indonesia confirms its 64th human case in a 5-year-old boy from West Java
(onset date 4 March 2006)and (through follow up testing) its 65th human case
in a
27-year-old male from West Sumatra (onset date 28 May 2006) (brother of
15-year-old girl; was possible human to human transmission).
25 Sep 2006
Indonesia confirms its 66th human case in an
11-year-old boy from East Java
(onset date 16 September 2006)and its 67th human case in a 9-year-old boy
from Jakarta (onset date 13 September 2006).
27 Sep 2006
Indonesia confirms its 68th human case in a 20-year-old man from West Java
(onset date 17 September 2006).
27 Sep 2006
Thailand confirms its 25th human case, in a 59-year-old man from Nong Bua
Lam Phu Province in Northeastern Thailand
(onset date 14 July 2006).
3 Oct 2006
Indonesia confirms its 69th human case in a 21-year-old woman from East Java
(onset date 19 September 2006) (the sister of the 66th case).
11 Oct 2006
Egypt confirms its 15th human case, in a 39-year-old woman from Gharbiya
(onset date 30 September 2006) (the first human case since May 2006).
16 Oct 2006
Indonesia confirms its 70th human case in a
67-year-old woman from West Java
(onset date 3 October 2006), its 71st human case in a 11-year-old boy from
Jakarta (onset date 2 October 2006), and its 72nd human case in a
27-year-old woman from Central Java (onset date 8 October 2006).
30 Oct 2006
A surveillance study of H5N1 isolates from
poultry in southern China confirms
that subtypes continue to emerge and their relative prevalence continues to
change.
13 Nov 2006
Indonesia confirms its 73rd human case in a 35-year-old woman from Banten
(onset date 7 November 2006) and its 74th human case, in a 30 month old boy
from West Java (onset date 10 November 2006).
22 Nov 2006
Republic of Korea reports H5N1 in poultry
(first since September 2004). Outbreaks continue to be reported.
10 Dec 2006
China confirms its 22nd human case in a 37-year-old man from Anhui (onset
date 10 December 2006) (retrospectively confirmed on 10 January 2007).
14 Dec 2006
In an effort to contain the disease, live
animal markets in Beijing, China are permanently closed.
19 Dec 2006
Viet Nam reports H5N1 in unvaccinated poultry
(first report since August 2006).
Outbreaks become widespread in the southern part of the country.
27 Dec 2006
Egypt confirms its 16th, 17th, and 18th human cases in an extended family in
Gharbiyah (onset dates 9-15 December 2006). The isolated viruses had a
genetic mutation, linked in laboratory testing to moderately reduced
susceptibility to oseltamivir. WHO does not change
treatment recommendations.
8 Jan 2007
Indonesia confirms its 75th human case, in a 14-year-old boy from West
Jakarta
(onset date 31 December 2006).
9 Jan 2007
Indonesia confirms its 76th human case, in a
37-year-old woman from Banten
(onset date 1 January 2007).
12 Jan 2007
Indonesia confirms its 77th human case, in a
22-year-old woman from Banten
(onset date 3 January 2007).
13 Jan 2007
Japan reports H5N1 in poultry (first since
March 2004).
15 Jan 2007
Hong Kong reports H5N1 in dead wild birds (first since January 2006).
Indonesia confirms its 78th human case, in a 27-year-old woman from South
Jakarta (onset date 6 January 2007) and its 79th human case, in a
18-year-old boy from Banten (onset date 10 January 2007) (son of the 76th
case).
16 Jan 2007
Thailand reports H5N1 in poultry during
routine intensive surveillance (first since July 2006). Vaccination remains
prohibited.
17 Jan 2007
Viet Nam reports continued
H5N1infection in farmed and village poultry
22 Jan 2007
Egypt confirms its 19th human case, in a 27-year-old woman from Beni Sweif
(onset date 9 January 2007).
22 Jan 2007
Indonesia confirms its 80th human case, in a
32-year-old woman from West Java
(onset date 8 January 2007).
24 Jan 2007
Hungary reports H5N1 in poultry (first since
June 2006).
25 Jan 2007
Indonesia confirms its 81st human case, in a 6-year-old girl from Central
Java
(onset date 8 January 2007).
26 Jan 2007
Russia reports H5N1 in poultry (first report
since July 2006).
27 Jan 2007
The United Kingdom reports H5N1 on a
commercial turkey farm (first ever report in poultry, reported in wild birds
in April 2006). Only a single outbreak occurs.
28 Jan 2007
In an effort to curb virus spread, Indonesia
institutes a poultry ban for the entire island of Java, and bans backyard
poultry in 9 provinces.
31 Jan 2007
Nigeria confirms its first human case, in a 22-year-old woman from Lagos
(onset date 8 January 2007).
1 Feb 2007
Pakistan reports H5N1 in poultry (first since
July 2006).
6 Feb 2007
Egypt confirms its 20th human case, in a 17-year-old girl from Fayoum (onset
date 25 January 2007).
9 Feb 2007
The second WHO analysis of epidemiological data on WHO-confirmed human cases
of avian influenza A (H5N1) infection, 25 November 2003 – 24 November 2006
is published by WHO.
9 Feb 2007
Turkey reports H5N1 in backyard poultry (first
report since April 2006).
15 Feb 2007
Egypt confirms its 21st human case, in a 37-year-old woman from Fayoum
(onset date 10 February 2007).
19 Feb 2007
Egypt confirms its 22nd human case, in a
5-year-old boy from Sharkia (onset date 14 February 2007).
20 Feb 2007
Ongoing H5N1 outbreaks in poultry in several
states of Nigeria are reported by
FAO.
19 Feb 2007
Lao PDR reports H5N1 in poultry (first
reported since July 2006).
22 Feb 2007
Afghanistan reports H5N1 in backyard poultry
and farms (first report since March 2006).
26 Feb 2007
Kuwait reports H5N1 in poultry in backyards,
on farms, and in a zoo (first
report in birds since November 2005. First ever report in poultry).
Lao PDR confirms its first human case, in a 15-year-old girl from Vientiane
(onset date 10 February 2007).
28 Feb 2007
Myanmar reports H5N1 in poultry (first report
since April 2006).
Egypt confirms its 23rd human case, in a 4-year-old girl from Dakahlea
(onset date 25 February 2007).
China confirms its 23rd human case, in a 44-year-old woman from Fujian
(onset date 18 February 2007).
6 Mar 2007
China reports H5N1 in poultry (first report
since September 2006).
12 Mar 2007
Egypt confirms its 24th human case, in a 4-year-old boy from Dakahlea (onset
date 7 March 2007).
16 Mar 2007
Lao PDR confirms its second human case, in a 42-year-old woman from
Vientiane Province (onset date 26
February 2007).
19 Mar 2007
Egypt confirms its 25th human case, in a
10-year-old girl from Aswan (onset date 13 March 2007).
20 Mar 2007
Egypt confirms its 26th human case, in a 2-year-old boy from Aswan (onset
date 15 March 2007).
China confirms avian influenza H9N2 infection in a 9-month-old girl with
mild
signs of disease.
26 Mar 2007
Egypt confirms its 27th human case, in a
3-year-old girl from Aswan (onset date 22 March 2007). No epidemiological
link is
evident among the three recent cases from Aswan.
27 Mar 2007
During high level talks in Jakarta, Indonesia announces that it will resume
sharing H5N1 AI virus with the international community.
28 Mar 2007
Egypt confirms its 28th human case, in a
6-year-old girl from Qena, and its 29th human case, in a 5-year-old boy from
Menia. (both had onset date 26 March 2007)
29 Mar 2007
China confirms its 24th human case, in a 16-year-old boy from Anhui (onset
date 17 March 2007).
30 Mar 2007
Bangladesh reports H5N1 in poultry (first ever
in Bangladesh).
2 Apr 2007
Saudi Arabia reports H5N1 in poultry (first
ever in Saudi Arabia)
Egypt confirms its 30th human case, in a 4-year-old boy from Qena (brother
of the 28th case), its 31st human case, in a 7-year-old boy from Sohag (both
with onset date 26 March 2007), and its 32nd human
case, in a 4-year-old girl from Qalyoubia (onset date 29 March 2007).
According to the Ministry of Health in Indonesia, cases of H5N1 infection in
humans continue to occur.
10 Apr 2007
Cambodia confirms its 7th human case, in a
13-year-old girl from Kampong
Cham (onset date 2 April 2007) (first human case since March 2006).
Egypt confirms its 33rd human case, in a 2-year-old girl from Menia (onset
date 3 April 2007) and its 34th human case in a 15-year-old girl from Cairo
(onset date 30 March 2007).
12 Apr 2007
Cambodia reports H5N1 in village poultry
(first report in poultry since August 2006).
3 May 2007
Ghana reports H5N1 in poultry (first ever in
Ghana).
16 May 2007
WHO retrospectively confirms 15 human cases and 13 deaths in Indonesia,
bringing the total confirmed human cases to 96, with 76 deaths. Cases had
onset dates between 25 January and 3 May 2007, and had been initially
confirmed by the Indonesian Ministry of Health.
23 May 2007
A resolution on international sharing of
influenza viruses is reached at the WHO World Health Assembly in Geneva.
24 May 2007
Viet Nam reports multiple outbreaks in
unvaccinated poultry (primarily ducks) from several provinces
throughout the country.
Bangladesh reports multiple outbreaks in poultry from additional provinces
throughout the country.
Indonesia confirms its 97th human case, in a
5-year-old girl from Central Java
(onset date 8 May 2007).
25 May 2007
The United Kingdom Health Protection Agency reports at least 4 human
infections with low pathogenic avian
influenza H7N2. The cases are associated with reported H7N2 infections in
poultry.
30 May 2007
China confirms its 25th human case, in a 19-year-old soldier stationed in
Fujian province (onset date 9 May 2007).
31 May 2007
Indonesia confirms its 98th human case, in a 45-year-old man from Central
Java
(onset date 17 May 2007).
2 Jun 2007
Malaysia reports its first outbreak in poultry
since March, 2006 (in village
chickens).
6 Jun 2007
Indonesia confirms its 99th human case, in a
16- year-old girl from Central Java
(onset date 21 May 2007).
11 June 2007
Egypt confirms its 35th human case, in a 10-year-old girl from Qena (onset
date 1 June 2007).
12 Jun 2007
Egypt confirms its 36th human case, in a 4-year-old girl from Qena (onset
date 7 June 2007) (no epidemiological link between these two most recent
Egyptian cases).
15 Jun 2007
Indonesia confirms its 100th human case, in a 27- year-old man from Riau
(onset date 3 June 2007).
22 Jun 2007
Czech Republic reports its first outbreak ever
in poultry (in commercial turkeys).
Togo reports its first outbreak ever in
poultry (in commercial chickens).
25 June 2007
Egypt confirms its 37th human case, in a
4-year-old boy from Qena (onset date 20 June 2007).
Indonesia confirms its 101st human case, in a 3-year-old girl from Riau
(onset date 18 June 2007).
26 Jun 2007
Germany reports H5N1 in wild birds found dead
(first reports since detected in
commercial poultry in April 2006).
29 Jun 2007
Czech Republic reports H5N1 in a dead mute swan (first in wild birds since
May
2006).
Viet Nam confirms it first human cases since November, 2005, in a
29-year-old man from Vinh Phuc (onset date 10 May
2007) and a 19-year-old man from Thai Nguyen (onset date 20 May 2007). No
epidemiological link between these two cases has been identified. There have
been 95 human cases in Viet Nam since 2003.
5 Jul 2007
France reports H5N1 in wild swans found dead
(first report since detected in
commercial turkeys in February 2006).
6 Jul 2007
Germany reports H5N1 in a dead domestic goose
11 Jul 2007
Indonesia confirms its 102nd human case, in a 6-year-old girl from Banten
(onset date 23 June 2007).
15 Jul 2007
Bangladesh Ministry of Agriculture reports
continued H5N1 outbreaks in commercial and backyard poultry.
25 Jul 2007
Egypt confirms its 38th human case, in a 25-year-old woman from Damietta
(onset date 20 July 2007).
26 Jul 2007
India reports H5N1 in backyard poultry (first
report since April 2006).
14 Aug 2007
Indonesia confirms its 103rd human case, in a 29-year-old woman from Bali
(onset date 3 August 2007).
15 Aug 2007
A study describing the epidemiology of 54 human cases of H5N1 infection in
Indonesia is published. Conclusions included that 76% of cases were
associated with poultry contact, and the source of infection was not
identified in 24% of cases.
16 Aug 2007
Indonesia confirms its 104th human case, in a 17-year-old woman from Banten
(onset date 9 August 2007).
23 Aug 2007
Indonesia confirms its 105th human case, in a 28-year-old woman from Bali
(onset date 14 August 2007).
30 Aug 2007
The WHO criteria for accepting confirmed cases of A(H5) infection are
amended.
31 Aug 2007
Based on amended acceptance criteria, Viet Nam retrospectively confirms its
96th through 100th cases, in a 28-year-old woman from Ha Nam (onset date 3
June 2007), a 29-year-old man (onset date 30 May 2007) and a 15-year-old boy
(onset
date 27 July 2007) from Thanh Hoa, and a 20-year-old man (onset date 2 June
2007) and a 22-year-old woman (onset date 20 July 2007) from Ha Tay.
07 Sept 2007
Russia reports H5N1 in poultry (first report
since January 2007).
10 Sept 2007
Indonesia confirms its 106th human case, in a
33-year-old man from Riau (onset date 25 August 2007).
15 Sept 2007
China reports H5N1 in commercial ducks in
Guandong (first report since May 2007).
2 Oct 2007
Indonesia confirms its 107th human case, in a
21-year-old man from Jakarta (onset date 18 September 2007).
8 Oct 2007
Indonesia confirms its 108th human case, in a
44-year-old woman from Riau (onset date 1 October 2007).
11 Oct 2007
Viet Nam reports H5N1 in unvaccinated ducks in
Tra Vinh (first report since
August 2007).
12 Oct 2007
Indonesia confirms its 109th human case, in a
12-year-old boy from Banten (onset date 30 September 2007).
15 Oct 2007
According to FAO26, H5N1 has caused recent
outbreaks in poultry in 19 districts in Bangladesh and 4 districts in
Indonesia, and in commercial poultry in
Ogun, Nigeria (in September).
24 Oct 2007
Myanmar reports H5N1 in commercial poultry in
Bago (first report since August
2007).
25 Oct 2007
Indonesia confirms its 110th human case, in a
5-year-old girl from Banten (onset date 14 October 2007).
31 Oct 2007
Viet Nam reports H5N1 in unvaccinated poultry
in 3 additional provinces.
Indonesia confirms its 111th human case, in a 3-year-old boy from Banten.
Both this case and the 110th case became ill on
14 October, but no epidemiological link between them has been identified.
5 Nov 2007
Indonesia confirms its 112th human case, in a
30-year-old woman from Banten (onset date 23 October 2007).
12 Nov 2007
Indonesia confirms its 113th human case, in a 31-year-old man from Riau
(onset date 31 October 2007).
13 Nov 2007
UK reports H5N1 in a flock of free-range
turkeys in England (first since January
2007).
19 Nov 2007
Saudi Arabia reports H5N1 in commercial
chickens in four areas of Ar Riyad.
22 Nov 2007
Pakistan reports H5N1 in commercial, poultry
in the North West Frontier (first
outbreak in poultry since July 2007).
23 Nov 2007
Myanmar reports H5N1 in backyard poultry in a
new province (Shan state)
27 Nov 2007
Romania reports H5N1in backyard poultry in
Tulcea (first outbreak in poultry since May 2006).
3 Dec 2007
Poland reports H5N1 in young turkeys in
Mazowieckie (first outbreak ever in poultry, last H5N1 reported in a wild
swan in May 2006).
Egypt retrospectively reports 579 outbreaks of H5N1 in birds from 23 March
2006 through 24 November 2007.
4 Dec 2007
China confirms its 26th human case, in a 24-year-old man from Jiangsu (onset
date 24 November 2007).
5 Dec 2007
Benin reports highly pathogenic avian
influenza (not confirmed as H5N1) in
poultry in Cotonou and Adjara (first HPAI outbreak ever reported in Benin).
Later reported as H5N1by FAO.
9 Dec 2007
China confirms its 27th human case, in a
52-year-old man from Jiangsu (onset date 3 December 2007), who is the father
of
the 26th case.
12 Dec 2007
Russia reports H5N1 in poultry in Rostovskaya
(first outbreak in poultry since September 2007).
Pakistan reports additional H5N1 outbreaks in commercial poultry in North
West Frontier and Punjab provinces.
Poland reports H5N1 in birds in a second
province (Warminsko-Mazurskie).
Indonesia confirms its 114th human case, in a 28-year-old woman from Banten
(onset date 1 December 2007).
13 Dec 2007
Indonesia confirms its 115th human case, in a 47-year-old man from Banten
(onset date 2 December 2007).
14 Dec 2007
Myanmar confirms its first human case, in a
7-year-old girl from Shan State (onset date 21 November 2007).
15 Dec 2007
Pakistan informs WHO of 8 people in the North
West Frontier Province that have
tested positive for H5N1 in the national reference laboratory. These are the
first suspected human cases ever reported in
Pakistan. The presence of virus was confirmed in samples from one of these
patients, a 25-year-old man from Peshawar (onset date 21 November).
17 Dec 2007
According to FAO, H5N1has continued to cause
outbreaks in poultry in areas of Indonesia (Bali, Java, Sulawesi, Sumatra)
and Viet Nam (Tra Vinh, Cao Bang, Quang Tri) in November and December.
26 Dec 2007
Indonesia confirms its 116th human case, in a
24-year-old woman from Jakarta (onset date 14 December 2007).
Egypt confirms its 39th human case, in a 25-year-old woman from Beni Sweif
(onset date 23 December 2007). This is the first case confirmed by Egypt
since
July 2007.
28 Dec 2007
Viet Nam confirms its 101st human case in a
4-year-old boy from Son La (onset
date 7 December 2007).
The last case confirmed by Viet Nam had an
onset of
July 2007.
Egypt confirms its 40th human case in a 50-year-old woman from Domiatt
(onset date 24 December 2007) and its 41st human case in a 22-year-old woman
from Menofia (onset date 26 December 2007).
29 Dec 2007
Myanmar reports ongoing outbreaks of H5N1 in
backyard poultry in Shan state.
31 Dec 2007
Benin reports H5N1 in poultry in two new
provinces (Dangbo and Porto Novo)
3 Jan 2008
Israel reports H5N1 in birds in a petting zoo
in Haifa (first outbreak since March
2006)
2 Jan 2008
Egypt confirms its 42nd human case in a
25-year-old woman from Dakahlia (onset date 26 December) and its 43rd human
case in a 36-year-old woman from
Menofia (onset date 26 December 2007).
4 Jan 2008
China reports H5N1 in poultry in Xinjiang
(first outbreak reported in this
province since September 2006)
7 Jan 2008
Viet Nam reports H5N1 in poultry in 4
provinces (Tra Vinh, Cao Bang, Thai
Nguyen, and Quang Tri).
11 Jan 2008
Indonesia confirms its 117th human case, in a 16-year-old girl from West
Java
(onset date 30 December 2008)
15 Jan 2008
India reports H5N1 in backyard and commercial
poultry in West Bengal State (first since July 2007).
Egypt reports widespread H5N1 outbreaks in
backyard and commercial poultry (including in vaccinated poultry) in 17
governorates during December and early January.
Indonesia confirms its 118th human case, in a 32-year-old woman from Banten
(onset date 3 January 2008)
16 Jan 2008
Iran reports H5N1 in backyard poultry in
Mazandaran (first since February 2006).
21 Jan 2008
Ukraine reports H5N1 in poultry in Crimea
(first since June 06).
Indonesia confirms its 119th human case, in an 8-year-old boy from Banten
(onset date 7 January 2008).
22 Jan 2008
Germany reports ongoing outbreaks of H5N1 in
backyard birds in Brandenburg.
Turkey reports H5N1 in backyard poultry in
Zonguldak (first report since
February 2007).
23 Jan 2008
Thailand reports H5 in poultry in Nakhon Sawan
and Phichit (first reports
since March 2007).
Indonesia confirms its 120th human case, in a 30-year-old man from Banten
(onset date 13 January 2008).
24 Jan 2008
Viet Nam confirms its 102nd human case in a
34-year-old man from Tuyen Quang
(onset date 10 January 2008).
29 Jan 2008
China reports H5N1 in poultry in the Tibet
Autonomous Region (first report in this province since March 2007).
Indonesia confirms its 121st human case in a 31-year-old woman from Jakarta
(onset date 18 January 2008), its 122nd
human case in a 9-year-old boy from West Java (onset date 16 January 2008),
123rd human case in a 32-year-old man from Banten (onset date 17 January
2008), and its 124th human case in a 23-year-old woman from Jakarta (onset
date 19 January 2008).
2 Feb 2008
Pakistan reports outbreaks of H5N1 on
commercial farms in Sindh (Karachi)(first reports since November 2007).
5 Feb 2008
China retrospectively reports H5N1 in two wild birds in Tuen Mun Park, Hong
Kong SAR (detected in November and December 2007).
Indonesia confirms its 125th human case in a 29-year-old woman from Banten
(onset date 22 January 2008), and its
126th human case in a 38-year-old woman from Jakarta (onset date 24
January 2008).
6 Feb 2008
United Kingdom continues to report sporadic
deaths due to H5N1 in mute swans in southern England (detected in November
and December 2007).
11 Feb 2008
According to FAO, Indonesia continues to
experience outbreaks of H5N1 in
poultry.
12 Feb 2008
Indonesia confirms its 127th human case in a 15-year-old girl from Jakarta
(onset date 2 February 2008)
13 Feb 2008
Laos reports H5N1 in poultry in Luang Namtha
(first report since February,
2007)
15 Feb 2008
Viet Nam confirms its 103rd human case, in a
40-year-old man from Hai Duong
(onset date 2 February 2008).
17 Feb 2008
Saudi Arabia reports H5N1 in poultry in Ar
Riyad, outbreaks dated from Oct 07 through Jan 08.
18 Feb 2008
Nigeria reports H5N1 in poultry in Anambra
(first report since March 2006).
20 Feb 2008
Pakistan reports new H5N1 outbreaks in poultry
in North West Frontier province.
China confirms its 28th human case, in a 22-year-old man from Hunan (onset
date 16 January 2008).
21 Feb 2008
Indonesia confirms its 128th human case in a 16-year-old man from Central
Java (onset date 3 February 2008), and its 129th human case in a 3-year-old
boy
from Jakarta (onset date 3 February 2008).
Viet Nam confirms its 104th human case in a 27-year-old man from Ninh Binh
(onset date 3 February 2008)
22 Feb 2008
China confirms its 29th human case, in a 41-year-old man from Guanxi
Autonomous Region (onset date 12 February 2008).
25 Feb 2008
Viet Nam continues to report outbreaks of H5N1
in poultry from several
provinces.
China reports H5N1 in poultry in a new province, Guizhou (first report from
this province since January 2006).
26 Feb 2008
Turkey reports H5N1 in poultry in a new
province, Sinop.
Pakistan reports new H5N1 outbreaks in poultry in Sindh province.
China confirms its 30th human case, in a 44-year-old woman from Guangdong
(onset date 16 February).
Viet Nam confirms its 105th human case, in a 23-year-old-woman from Phu Tho
(onset date 14 February).
28 Feb 2008
Egypt confirms its 44th human case in a 4-year-old girl from Minea (onset
date 21 February).
4 Mar 2008
Egypt confirms its 45th human case in a 26-year-old woman from Fayoum (onset
date 24 February).
5 Mar 2008
Egypt confirms its 46th human case in a 11-year-old boy from Minea
(hospitalisation date 26 February).
9 Mar 2008
According to the Ministry of Fisheries and
Livestock in Bangladesh, 47 districts have now had confirmed outbreaks of H5
infection in birds.
According to the Department of Animal Husbandry, Dairying, and Fisheries in
India, additional H5 infection in birds has been confirmed in West Bengal.
10 Mar 2008
Pakistan reports new H5N1 outbreaks in poultry
in North West Frontier Province.
11 Mar 2008
Egypt confirms its 47th human case in a 8-year-old boy from Fayoum
(hospitalisation date 3 March 2008).
16 Mar 2008
China reports H5N1 in poultry at a live animal
market in Guangdong
Viet Nam confirms its 106th human case, in an 11-year-old boy from Ha Nam
(onset date 4 March).
18 Mar 2008
Turkey reports H5N1 in backyard poultry in
Edirne
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