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Avian Influenza Daily Digest
August 19, 2008 14:00 GMT
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Article Summaries ...
Regional Reporting and Surveillance
FAO GLEWS: Cambodia Update
FAO Field Officer, 15/08/08: From 8 to 15 August 2008, the animal health hotline at the National Veterinary Research Institute(NaVRI) received 9 calls from Phnom Penh, Svay Rieng, Kampong Speu, Prey Veng, Kandal and Otdar Meanchey provinces. 5 callers reported...
Regional Reporting and Surveillance
FAO Vietnam Update
8/18/08 FAO Vietnam--reported HPAI in poultry in the last 21 days. The fourth wave of Highly Pathogenic Avian Influenza (HPAI) was reported in Viet Nam from December 2006- January 2007, mainly affecting 12 provinces in Southern Viet Nam. The fifth wave of HPAI was reported from May ? September 2007, mainly affecting 22 provinces in Northern Viet Nam. Eight human cases were reported in 2007, five of which were fatal and three recovered.Tri district, Phu Ngai commune, village No 1, where 287 duck died. The whole flock comprises 1000 birds, unvaccinated, rearing by household.
Regional Reporting and Surveillance
Pakistan: Sale of substandard vaccines: poultry farmers worry about spread of diseases
8/18/08 Business Recorder, contributed by email--The Sindh Livestock Department's inaction towards eliminating the menace of counterfeit, substandard and unregistered vaccines has caused more worries among poultry farmers about the spread of diseases, particularly the lethal form of bird flu. Recently, farmers requested the Minister for Livestock Abdul Haque Bhurt at the second meeting of the Sindh Poultry Board (SPB) to provide them with original vaccines.
Regional Reporting and Surveillance
Myanmar to cooperate with 3 countries in controlling bird flu
8/17/08 Xinhua, contributed by email--Myanmar will cooperate with Bangladesh, Nepal and India in controlling bird flu in Myanmar's border regions starting later this year, a local weekly reported Sunday. The one-year project, which includes information exchange and setting up of more animal disease monitoring stations, involves a total of 1.5 million U.S. dollars' aid from the Food and Agriculture Organization of the United Nations (FAO) and the United States Agency for International Development (USAID), said the Flower News.
Regional Reporting and Surveillance
Indonesia: KOMNAS FBPI CONTINUES BIRD FLU CONTROL PROGRAM
8/13/08 KOMNAS FBPI--The Indonesia National Committee for Avian Influenza Control and Pandemic Preparedness (KOMNAS FBPI) continues its fight against bird flu by focusing on communication and community participation, which have been effective in controlling bird flu spread.
Regional Reporting and Surveillance
Researchers find trends in study of Indonesia's H5N1 cases
8/18/08 CIDRAP--Public health officials from Indonesia recently published an analysis of nearly all of the country's H5N1 avian influenza cases, revealing that death was more likely in those who received antiviral treatment late, were not part of a cluster, and lived in an urban area.
Regional Reporting and Surveillance
South Korea Bird-Flu Free Again
8/18/08 Chosun--Korea has regained its bird-flu free status. The Ministry for Food, Agriculture, Forestry and Fisheries announced Sunday that Korea met the criteria for a bird-flu free zone set out by the world organization for animal health (OIE) as of Friday last week.
Regional Reporting and Surveillance
Kuwait: Two shipments of eggs stopped
8/17/08 Arab Times--Two shipments of eggs were not allowed into Kuwait because the importing companies had reportedly forged the ?country of origin? documents, reports Al-Anba daily quoting reliable sources. The same sources said the eggs are a product of a country which has been blacklisted by Kuwait because of the presence of bird flu in the exporting country. However, when the eggs arrived at a port in Kuwait the documents showed the eggs are a Brazilian product.
Regional Reporting and Surveillance
Hong Kong: No rise in daily live chicken imports
8/19/08 Hong Kong Govt News--The 16,000 daily import ceiling for Mainland live chickens will not be raised before the Mid-Autumn Festival because of the bird flu threat, and the recent daily leftover of live chickens in the wholesale market.
Regional Reporting and Surveillance
Science and Technology
Antibodies still protect 1918 flu survivors: study
8/17/08 Reuters/Maggie Fox--Antibodies from survivors of the 1918 flu pandemic, the worst in human memory, still protect against the highly deadly virus, researchers reported on Sunday.
AI Research
H9N2 bird flu threat understated in humans says expert
8/15/08 Reuters--The H9N2 bird flu strain, identified as a possible pandemic threat, could be infecting more humans than commonly thought but its mild symptoms mean it often goes undetected, a leading Hong Kong bird flu expert said.
AI Research
Remembrance of viruses past
8/19/08 Nature--[photo] < photo caption: em>Long-lived survivors of the 1918 flu pandemic may hold the key to defeating future outbreaks. Nearly a century after the 1918 influenza pandemic claimed 50 million lives, survivors continue to produce powerful antibodies against the virus, researchers have found.
AI Research
Full Text of Articles follow ...
Regional Reporting and Surveillance
FAO GLEWS: Cambodia Update
FAO Field Officer, 15/08/08: From 8 to 15 August
2008, the animal health hotline at the National
Veterinary Research Institute(NaVRI) received 9
calls from Phnom Penh, Svay Rieng, Kampong
Speu, Prey Veng, Kandal and Otdar Meanchey
provinces. 5 callers reported about sick and dying
poultry in Prey Veng province and the rest asked
about transmission routes and prevention
measures for avian influenza and other poultry
diseases. The team of district veterinarians went
to the villages in Prey Veng province and
concluded after investigation that avian influenza
was not the cause of the illness and death.
Regional Reporting and Surveillance
FAO Vietnam Update
8/18/08 FAO Vietnam--reported HPAI in poultry in the last 21 days.
The fourth wave of Highly Pathogenic Avian Influenza (HPAI) was reported in
Viet Nam from December 2006- January 2007, mainly affecting 12 provinces
in Southern Viet Nam. The fifth wave of HPAI was reported from May ?
September 2007, mainly affecting 22 provinces in Northern Viet Nam. Eight
human cases were reported in 2007, five of which were fatal and three
recovered.Tri district, Phu Ngai commune, village No 1, where 287 duck died. The whole
flock comprises 1000 birds, unvaccinated, rearing by household.
Since 1st August, HPAI has been reported in 5 villages (An Binh Tay, My
Chanh, An Hiep, Vinh Hoa and Phu Ngai communes) of Ba Tri district with the
total dead and compulsory disposed duck are 3.445.
On 14 August, DAH reported HPAI in Ba Tri district, Ben Tre province where
1960 and 905 were sick and dead respectively. The whole flock of 2865 has
been distroyed.
On 5 August, District Veterinary Service in Ba Tri district detected sick duck at
two raisers in An Loi village, An Binh Tay commune with avian influenza
clinical sign.
On 6 August, sick and dead ducks have been found in Cau Vi hamlet, My
Chanh commune. The Regional Animal Health Office No VI confirmed
specimens tested positive with H5N1 virus.
From 8 to 10 August, duck died at 3 household with suspected sign of avian
influenza infection, in Giong Gach village, An Hiep commune.
On 29 July, DAH reported HPAI in Thoi Quan commune, Go Quao district,
Kien Giang province. The disease has been detected in a 50-day-old chicken
flock at a raiser where 300 died among 612.
On 27 July, DAH reported HPAI in Dong Thap province, An Thuan hamlet,
My Hung An B commune, Lap Vo district. The outbreak has been found in a
chicken flock of 36-day-old 1000, of which 110 died initially. The 890
remaining has been destroyed.
However, for at least the next 1-2 years, Vietnam needs to
continue with one mass vaccination campaign in 0ctober and
November to protect poultry over Lunar New Year Festival
(Tet), which usually falls in January or February.
Most years see a spike in the occurrence of the disease
during Tet.
In addition, there should be a requirement for the vaccination
of all commercial poultry, he said.
?The vaccinations should be done on large commercial farms
and then go down to smaller commercial farms. The
requirement is that all birds going to live bird markets have to
be vaccinated. They would require a certificate.?
Regarding vaccination expenditures, FAO experts strongly
supported Vietnam in considering sharing the cost of avian
flu vaccine with producers in order to progressively bring
government support to a level that is sustainable, as funds
from donors may be slashed in the future.
Funding from the main donor ? US Agency for International
Development (USAID) ? remains high, but support from
other donors has already started dropping off, he said.
But, there is a risk that by requiring poultry producers to
share the cost of vaccination, they may be reluctant to
vaccinate, Forman said.
?And that?s why we want to do this [vaccination cost sharing]
on a trial basis to see at what level the government?s support
will be appropriate.?
Currently, the two major sources of anti-bird flu vaccine for
poultry to Vietnam are from Europe and China.
?The government would need to continue to make sure that
only high quality vaccine is imported to Vietnam,? he urged.
Vietnam has given 800 million injections of anti-bird flu
vaccine to poultry over the past three years, according to the
country?s Department of Animal Health.
?Vietnam is doing a much better job [combating bird flu] than
other countries and I believe that it is because of the strong
government commitment,? Forman said.
However, the disease will continue to be present in Vietnam
for the foreseeable future, according to FAO experts at the
meeting.
In addition to vaccination strategy, long-term measures
should be encouraged, including improvements to biosecurity
of poultry farms and improved regulations on live
bird markets.
Bird flu has killed and led to the slaughter of nearly 60,100
poultry, including some 36,600 waterfowls in Vietnam since
the beginning of this year.
The disease is currently hitting the three provinces of Quang
Ngai in the central region, and Dong Thap and Kien Giang in
the south.
Vietnam?s poultry population increased to 68.09 million in
2007, from 62.6 million in 2006 and 60.01 million in 2005,
according to the Husbandry Department under the Ministry
of Agriculture and Rural Development.
VietNamNet Bridge, 16 August, 2008
FAO recommends cost-sharing to deliver bird flu
vaccinations
The Food and Agriculture Organisation of the United Nations
(FAO) recommended yesterday that Viet Nam consider
moving from a fully publicly-funded bird flu mass-vaccination
campaign, to a public-private funded one to ease the burden
on the State as donations are on the decline, according to
FAO?s senior avian influenza technical consultant Dr Tony
Forman.
"We have to recognise that this disease is going to continue
for a long time. One thing that the Government and FAO are
concerned about is that the strategies we have for controlling
bird flu be sustainable," said the animal health expert on the
sidelines of a two-day meeting to review the Strategy for
Control and Prevention of Highly Pathogenic Avian Influenza
in the Agriculture Sector in Ha Noi.
Cost-sharing was one of strategies being discussed in a bid
to sustain control as donations drop, he said.
Viet Nam has spent around US$20 million a year on bird flu
vaccinations, including about 500 million doses of vaccines
since the disease first broke out in the country in 2003; this
fund comes mostly from donors.
According to Forman, the level of funds from major donors is
still good, the US Agency for International Development
being the largest one, but support from other donors have
already started dropping off.
He explained the problem was that a lot of international
support came from various governments? emergency funding
for Viet Nam. But the country had escaped being one of the
bird flu centres in the world, said Agriculture and Rural
Development Deputy Minister Bui Ba Bong.
Forman said Viet Nam was without question, doing a much
better job in controlling the disease than other countries in
the world thanks to the Government?s strong commitment,
but it was very expensive to undertake control in this way.
Le Thanh Binh, a farmer in Vinh Phuc Province, said if she
had to pay for vaccinations, she would only vaccinate her
family?s small chicken flock in case there was an outbreak in
her area.
Some believe the new mechanism might discourage farmers
from vaccinating their birds, because ironically, the
Government?s success in controlling the disease had led to a
drop in their awareness of the dangers.
The FAO agreed it was a risk and a challenge to encourage
cost sharing. Therefore, they recommended implementing
the mechanism on a trial basis to see what level of support
from the Government would be appropriate, said Forman.
"That is why the Government will continue one mass
vaccination each year [instead of the current two] in October
and November, to ensure that the birds are covered over this
high risk period of Tet (Lunar New Year), in case the funding
fails."
According to the FAO representative in Viet Nam, Andrew
Speedy, public-private cost sharing will not only enable the
Government at the central, provincial and district levels to
have some budgetary reserves for supporting other key
disease prevention and control programmes, but is also
likely to bring about a sense of ownership and stronger
participation in the vaccination policy by all those involved in
the poultry business.
Regional Reporting and Surveillance
Pakistan: Sale of substandard vaccines: poultry farmers worry about spread of diseases
8/18/08 Business Recorder, contributed by email--The Sindh Livestock Department's inaction towards eliminating the menace of counterfeit, substandard and unregistered vaccines has caused more worries among poultry farmers about the spread of diseases, particularly the lethal form of bird flu. Recently, farmers requested the Minister for Livestock Abdul Haque Bhurt at the second meeting of the Sindh Poultry Board (SPB) to provide them with original vaccines.
The ministry assured them that action would be taken against vaccine sellers who break the law. Farmers have now again complained that the original vaccines for poultry chicks are rarely available in the market. They say the provincial Livestock Department has paid no heed to this issue.
Farmers were to hold an important meeting on this issue with the Minister for Livestock but it did not materialise as the minister abruptly rescheduled the date and time for the meeting. Other than this, no contact has been made from the department, they complain. They say this "is a genuine issue, which is going to hit the industry in long run, [it] should be tactfully addressed before it reaches uncontrollable stages."
High costs of production has forced 45 percent of poultry farms countrywide to completely close down, they say, adding that government should give small loans to farmers enabling them to shore up their declining businesses. They demand that the government ban the export of maize, saying that its unavailability in the local market has increased their costs of production. They suggested that the government should only allow the export of maize when local demand has been fulfilled.
The poultry farmers concerns rose after the country started maize exports for the first time in its history, with the prospects of bumper crop this year. It is expected that the country is likely to receive 3.7 million tons of the commodity crop as compared to some three million tons last year, witnessing a 23 percent growth roughly. The crop is believed to be higher by 0.7 million tons as compared to 2.8 million consumption.
Reportedly, exporters are getting big offers from Indonesia, Malaysia, Gulf countries, Singapore and other places. Maize is an important ingredient in poultry feed and human diets. Poultry farmers say that the unabated export of maize will create an acute shortage in the domestic market. Recently, Pakistan imported maize from India to meet local demand. On a better note however, they add that recent monsoon rains have not affected poultry farms and production.
Regional Reporting and Surveillance
Myanmar to cooperate with 3 countries in controlling bird flu
8/17/08 Xinhua, contributed by email--Myanmar will cooperate with Bangladesh, Nepal and India in controlling bird flu in Myanmar's border regions starting later this year, a local weekly reported Sunday.
The one-year project, which includes information exchange and setting up of more animal disease monitoring stations, involves a total of 1.5 million U.S. dollars' aid from the Food and Agriculture Organization of the United Nations (FAO) and the United States Agency for International Development (USAID), said the Flower News.
Of the aid, the USAID accounted for 1 million dollars.
Meanwhile, Myanmar is also cooperating with the FAO in prevention against highly pathogenic avian influenza under a three- year project, according to official report.
The three-year project (2008-2011) involves a financial aid of 1.315 million U.S. dollars pledged by the World Bank.
In April this year, the World Animal Health Organization (OIE) declared Myanmar as a bird-flu-free country three months after the country was proved that there was no residual bird flu virus remained over the period since January.
According to then OIE statement, the latest spread of the H5N1 virus from Kengtung to Mongphyat in Shan state in November last year, which infected a seven-year-old girl later in December, has been under control since late January this year, attributing the infection to carrying from abroad.
There were numerous outbreaks of the avian influenza in Myanmar covering 25 townships of six states and divisions over the past two years since February 2006 until the last in December 2007.
All of the occurrences were blamed for infecting from abroad especially that the virus was carried into the country by migratory birds from the cold regions in the world infecting local birds, according to the LBVD.
Myanmar reported outbreak of the avian influenza in the country for the first time in some poultry farms in Mandalay and Sagaing divisions in early 2006, followed by those in Yangon division in early 2007, in Mon state's Thanbyuzayat and western Bago division' s Letpadan in July and in eastern Bago division's Thanatpin and in Yangon division's Hmawby in October the same year.
Despite the declaration as a bird-flu-free country, the Myanmar livestock authorities continued to call on the country's people to exercise a long-term precaution against the deadly H5N1 bird flu.
Regional Reporting and Surveillance
Indonesia: KOMNAS FBPI CONTINUES BIRD FLU CONTROL PROGRAM
8/13/08 KOMNAS FBPI--The Indonesia National Committee for Avian Influenza Control and Pandemic Preparedness (KOMNAS FBPI) continues its fight against bird flu by focusing on communication and community participation, which have been effective in controlling bird flu spread.
"We are still consistent with our main strategy--the communication and community involvement, and build partnership with all community groups to fight the virus," says Bayu Krisnamurthi, Chief Executive of the Indonesia National Committee for Avian Influenza Control and Pandemic Preparedness (KOMNAS FBPI).
The National Committee has supported several activities organized by UNICEF in partnership with local administrations. In July, a community mobilization activity involved 10,000 children in Cirebon, West Java. The "Tanggap Flu Burung" campaign promotion was held by the "Bike ? to ? work" group and ecologist organization Octopus in Batam on August 10 2008. On August 14 2008, thousands of boys and girls scout will declare their support to "Tanggap Flu Burung" (Aware of Bird Flu) campaign in Sukabumi, West Java.
Up to today, the number of bird flu cases are 136 confirmed with 111 deaths (2 from 136 confirmed case releases on media have not yet confirmed by Ministry of Health).
From January to July 2008, there are 19 confirmed cases with 16 deaths. This number decreases compare to the same period last year with recorded confirmed cases 27 with 23 deaths. The Case Fatality Rate in 2007 stands at 88.1% and 2008 is 84.2%.
People are urged to learn more about bird flu and to reduce their risk of contracting the virus by adopting clean and healthy behaviors:
1. Don't touch sick or dead chickens. If you have had contact with sick or dead chickens, promptly wash your hands with soap and report the incident to your village head.
2. Wash your hands and cooking appliances with soap before cooking. Cook chicken and eggs well.
3. Separate poultry from humans. And also separate new poultry from existing poultry flocks for 2 weeks.
4. Go to a Public Health Center or Hospital immediately if you have flu and fever symptoms after having contact with poultry/chicken. Do not wait more than two days, especially if there are many poultry around your house or you had contact with poultry.
5. Wear gloves and cover your nose and mouth when handling poultry
6. Do not eat poultry that are sick or have died.
7. Cull, burn and bury sick or dead poultry.
8. Do not let children play with poultry.
Regional Reporting and Surveillance
Researchers find trends in study of Indonesia's H5N1 cases
8/18/08 CIDRAP--Public health officials from Indonesia recently published an analysis of nearly all of the country's H5N1 avian influenza cases, revealing that death was more likely in those who received antiviral treatment late, were not part of a cluster, and lived in an urban area.
The study, published online Aug 15 in The Lancet, was authored by officials from Indonesia's Directorate General of Disease Control and Environmental Health, the country's health ministry, as well as authorities from laboratories and health organizations. It includes data from public health investigations and, when available, patients' clinical information.
The evaluation covered all confirmed human cases between Jun 22, 2005, when Indonesia recorded its first H5N1 infection, to Feb 1, 2008. Included were 127 patients, 103 (81%) of whom died.
The case-fatality rate (CFR) rose from 65% in 2005 to 86.8% in 2007. However, Indonesian officials say the rate has declined so far in 2008. According to a report that appeared Aug 15 on the Web site of the health ministry's avian influenza committee, the CFR from January through July was 84.2%, based on the 19 cases and 16 deaths recognized by the nation (as of this writing, the World Health Organization has recognized 18 cases with 15 deaths).
Only 2 of Indonesia's 127 infected patients were not hospitalized. One had a mild infection and received outpatient care, and one refused treatment and died at home.
Emerging patterns
A review of 108 clinical histories showed that symptoms during the first 2 days after onset were nonspecific in most cases. Thirty-two (30%) patients had fever and cough, and nine (8%) had fever and dyspnea.
Of the 125 patients who were hospitalized, 104 were diagnosed with pneumonia immediately or shortly after admission.
Eighty-eight (69%) of the case-patients were treated with oseltamivir, and the median time between symptom onset and treatment was 7 days (range 0 to 21). Patients who received the drug early were more likely to survive; those starting treatment more than 5 days after onset were more likely to die.
The authors report there were 11 case clusters that involved 28 patients. Infected patients who were not part of clusters were more likely to die, but researchers did not find any differences between cluster patients and noncluster patients in terms of when they presented to a healthcare facility, whether they received oseltamivir, or how soon they received the drug.
Patients with secondary cases were more likely to survive than primary case-patients, and they received antiviral treatment about 3 days earlier than primary case-patients. The investigators acknowledge that secondary cases may have involved other early interventions as well. They also report that patients who had indirect exposure to the virus were more likely to die.
Death and survival patterns among patients in clusters deserve further study, the authors state. Though close-knit families may be exposed to a common viral source, the role of genetic susceptibility and H5N1 virulence may also play important roles, they note. "Further studies should therefore be done on clusters to elucidate the definitive causes of reduced case fatality."
A need for new strategies
Most patients were hospitalized too late and received oseltamivir too late, the group says. "Training and equipping of all H5N1 referral hospitals across Indonesia, together with increasing the number of referral hospitals, is in progress to address this issue."
The authors emphasize that early identification is often difficult, but more information from agricultural officials about local poultry outbreaks could help healthcare workers increase their index of suspicion for H5N1 infections.
Other measures that could help reduce the country's CFR from H5N1 infections include rapid diagnostic tests for field use and better case-management training for healthcare workers, they write.
Experts call for more rigorous data
In a commentary accompanying the Lancet report, two British researchers say more uniform and complete data are needed to shed more clarity on trends emerging from Indonesia's cases?which account for a third of cases worldwide. The researchers are Sheila Bird, a biostatistician at Medical Research Council's biostatistics unit in Cambridge, and Jeremy Farrar, who directs the Oxford University clinical research unit at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.
"Basic clinico-epidemiological data are an essential adjunct to virological surveillance," they write. For example, exposures to the H5N1 should be clearly specified, including dates, they say, adding that lack of full data raises questions about such issues as whether the time frame between H5N1 disease onset and hospital admission has decreased over time.
"Indonesia, with the most extensive experience of human H5N1 patients, has a crucial clinical, epidemiological, and scientific role to play in the world's response to this potentially devastating infection," write Bird and Farrar.
The time to bolster national surveillance for human H5N1 cases is now, and disagreement over virus sample sharing should not hamper the flow of epidemiologic data, they add. "The world also needs to find a more equitable way to ensure that all share in the benefits of such important research. Indonesia could give the lead here."
Kandun IN, Tresnaningsih E, Purba WH, et al. Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series. Lancet 2008 (published online Aug 15 [Abstract]
Bird SM, Farrar J. Minimum dataset needed for confirmed human H5N1 cases. Lancet 2008 (published online Aug 15
See also:
Aug 13 Indonesian bird flu committee statement
http://www.komnasfbpi.go.id/berita_eng.php?id=58
Jul 17 CIDRAP News story "Reports examine high H5N1 death rate in Indonesia"
Regional Reporting and Surveillance
South Korea Bird-Flu Free Again
8/18/08 Chosun--Korea has regained its bird-flu free status. The Ministry for Food, Agriculture, Forestry and Fisheries announced Sunday that Korea met the criteria for a bird-flu free zone set out by the world organization for animal health (OIE) as of Friday last week.
According to OIE guidelines, a country can be declared bird-flu free if the disease does not break out again three months after quarantine measures were implemented and if preventative inspection finds no signs of the disease.
The last case of bird flu in Korea was detected in Gyeongsan, North Gyeongsang Province, and Yangsan, South Gyeongsang Province, and the cull of poultry took place on May 15. A thorough examination of duck farms nationwide from May 19 to June 30 showed that the country was clean of bird flu.
Regional Reporting and Surveillance
Kuwait: Two shipments of eggs stopped
8/17/08 Arab Times--Two shipments of eggs were not allowed into Kuwait because the importing companies had reportedly forged the ?country of origin? documents, reports Al-Anba daily quoting reliable sources. The same sources said the eggs are a product of a country which has been blacklisted by Kuwait because of the presence of bird flu in the exporting country. However, when the eggs arrived at a port in Kuwait the documents showed the eggs are a Brazilian product.
However, when the Brazilian authorities were contacted they confirmed the eggs are not of Brazilian origin. However, the Ministry of Commerce and Industry is said to have refused to take action against the importers because the eggs did not reach the Kuwaiti market.
AI Research
Antibodies still protect 1918 flu survivors: study
8/17/08 Reuters/Maggie Fox--Antibodies from survivors of the 1918 flu pandemic, the worst in human memory, still protect against the highly deadly virus, researchers reported on Sunday.
The findings by a team of influenza and immune system experts suggest new and better ways to fight viruses -- especially new pandemic strains that emerge and spread before a vaccine can be formulated.
These survivors, now aged 91 to 101, all lived through the pandemic as children.
Their immune systems still carry a memory of that virus and can produce proteins called antibodies that kill the 1918 flu strain with surprising efficiency, the researchers report in the journal Nature.
"It was very surprising that these subjects would still have cells floating in their blood so long afterward," said Dr. James Crowe of Vanderbilt University in Tennessee, who helped lead the study.
The antibodies also protected mice from the 1918 virus, which swept around the world at the end of World War One killing between 50 million and 100 million people, Crowe's team reports in the journal Nature.
"The antibodies that we isolated are remarkable antibodies. They grab onto the virus very tightly and they virtually never fall off," Crowe said in a telephone interview.
"That allows them to kill the 1918 virus with extreme potency, meaning it takes a very small amount of antibody."
The human body has two systems for fighting off bacterial and viral invaders. One system uses so-called T-cells while the other employs B-cells, made in the bone marrow, which in turn make antibodies to both flag and directly attack the targets.
RESURRECTED VIRUS
Dr. Christopher Basler and colleagues at the Mount Sinai School of Medicine in New York tested the 1918 survivors and found that in most of them, the B-cells made antibodies highly attuned to the 1918 flu strain.
Dr. Terrence Tumpey at the U.S. Centers for Disease Control and Prevention had worked on a team that resurrected the 1918 virus taken from buried victims of the epidemic and tested this virus in mice. Mice given the antibodies from the elderly survivors lived, while those given placebos died.
Crowe said it will now be important to test other people who have had influenza to see if their immune responses are as strong. "The thought is the first influenza that you see during life is the one that you have the best immunity to," he said.
"If we can learn the rules about how these antibodies work we may be able to design antibodies to lots of other viruses."
The 1918 flu was an H1N1 strain that apparently came straight from birds. "This study tells us that human beings can make long lasting immune responses to bird influenza," Crowe said.
Crowe said his team is working to get antibodies from people vaccinated with experimental shots for the H5N1 avian influenza now circulating in Asia, Europe, the Middle East and Africa. H5N1 mostly affects birds but it has infected 385 people since 2003, killing 243.
Experts fear that, like the H1N1 virus did in 1918, H5N1 will mutate into a form that passes easily among people and spark another pandemic. No one knows if the vaccines being made now would protect against whatever form of H5N1 might emerge.
Crowe said antibodies from survivors might make a good interim treatment while a vaccine is formulated, manufactured and distributed -- a process that would take months.
AI Research
H9N2 bird flu threat understated in humans says expert
8/15/08 Reuters--The H9N2 bird flu strain, identified as a possible pandemic threat, could be infecting more humans than commonly thought but its mild symptoms mean it often goes undetected, a leading Hong Kong bird flu expert said.
"It's quite possible ... H9N2 is infecting humans quite a lot, much (more) than we appreciate merely because it is beyond the radar," Malik Peiris, a Hong Kong-based microbiologist, told Reuters.
"In humans, it is very mild, so most of the time it's probably not even recognised or biologically tested," said Peiris, who has co-authored several papers on the strain in recent years.
So far, only a handful of human H9N2 cases have been documented worldwide, including four children in Hong Kong in 2003 who suffered from mild fevers and coughs -- as well as a batch in China's Guangdong province, where people often live in close proximity to poultry, Peiris said.
The Hong Kong cases were only picked up by chance given the city's rigorous influenza testing regime, Peiris said.
"It's quite a silent virus, it's not highly pathogenic ... and sometimes it causes some morbidity in poultry but by and large it is just there and it's unnoticed," Peiris said of the H9N2 strain.
The strain occurs mostly in birds, although it has also affected pigs and other animals in Europe and Asia.
Most influenza experts agree that a pandemic -- a deadly global epidemic -- of some kind of flu is inevitable.
No one can predict what kind but the chief suspect is the H5N1 bird flu virus, which has infected 385 people and killed 243 of them since 2003.
However, flu experts at the University of Maryland, St. Jude's Children's Research hospital in Memphis and elsewhere recently wrote in the Public Library of Science journal PLoS ONE that the H9N2 strain posed a "significant threat for humans".
They found that just a few mutations could turn it into a virus that people catch and transmit easily.
Peiris said that while the H9N2 strain might be more transmissible, its effects would be far less devastating than a possible H5N1 pandemic.
"There are other viruses out there besides H5N1 that could be the next pandemic," Peiris said. "But I suspect (H9N2) will not be so severe in its outcome."
Peiris pointed out that the last three major pandemics vastly differed in their severity, with the 1918 Spanish flu pandemic killing an estimated 50 million people worldwide, whereas the "Hong Kong" flu in 1968 killed around one million.
There are hundreds of strains of avian influenza virus but only four -- H5N1, H7N3, H7N7, and H9N2 - are known to have caused human infections, according to the World Health Organization.
AI Research
Remembrance of viruses past
8/19/08 Nature--[photo] < photo caption: em>Long-lived survivors of the 1918 flu pandemic may hold the key to defeating future outbreaks. Nearly a century after the 1918 influenza pandemic claimed 50 million lives, survivors continue to produce powerful antibodies against the virus, researchers have found.
These antibodies have now been isolated from their nonagenarian hosts and could be exploited to defend against future outbreaks. In work published this week in Nature1, researchers report that five of the antibodies were able to rescue mice that had been infected with the 1918 flu virus.
Antibodies attach themselves to viral proteins and, ideally, neutralize the virus. But antibodies vary widely in the specific proteins or regions within a protein that they bind. Researchers can take advantage of this to learn more about weaknesses in the virus: the regions targeted by an antibody could also make a good target for a vaccine or drug.
Despite this, no one had yet characterized the antibodies in survivors of the 1918 pandemic. Eric Altschuler, now a doctor of physical medicine and rehabilitation at the University of Medicine and Dentistry of New Jersey, was inspired to do so after watching a television show one night while on call as a medical resident. (?It was a slow night,? he says.) The show was a short-lived series called 'Medical Investigation', and featured fictional scientists who track down the causes of mysterious disease clusters.
In the episode he watched that night, scientists respond to an outbreak of a lethal virus that curiously spares an elderly butler who had survived the 1918 flu pandemic. The investigators realize the culprit is a flu virus similar to the 1918 strain, and give an ailing heroine a transfusion of blood from the butler just in time to save her life. "It?s TV," says Altschuler, "so everything worked out in about an hour." His own efforts to replicate the programme?s result in mice ? admittedly with considerably more detailed analysis along the way ? would take about four years.
Long-life antibodies
With little immunological training of his own, Altschuler recruited a research team including microbiologist Christopher Basler of Mount Sinai School of Medicine in New York, who had worked on the reconstruction of the 1918 flu virus, and immunologist James Crowe of Vanderbilt University in Nashville, Tennessee. The team gathered blood samples from 32 people aged 91 to 101 years.
Many of the participants remembered having a sick relative during the pandemic. ?It was a horrible time and unfortunately many people can recall that,? says Altschuler. ?We met people who had multiple relatives die on the same day.?
The researchers found that 94% of the participants produced antibodies that neutralized the 1918 virus. In contrast, only one out of ten people born after the pandemic produced such antibodies.
Scientists had expected the influenza antibodies to be long-lived. ?But it?s never been demonstrated in this capacity,? says Michael Gale, an immunologist at the University of Washington in Seattle who was not affiliated with the study. ?This is a true demonstration that neutralizing antibodies can persist for many decades.?
The researchers went on to infect mice with the reconstructed 1918 flu virus and then treated them with the antibodies. Like the heroine from the television show, mice that received the antibodies survived the infection. Those that did not invariably succumbed.
Altschuler's team also isolated antibody-producing cells, generating five cell cultures that each produced a single type of antibody and could be grown in the lab. When they studied the sequence of the genes that encoded these antibodies, the scientists found they had accumulated many mutations - suggesting that the cells had made further adaptations to similar viruses after 1918, says Gale.
The results suggest that the antibodies could be used therapeutically should an outbreak of a similar virus occur. What?s more, one of the antibodies reacted not only with the 1918 flu strain, but with several other strains as well. "It?s probably binding to something that?s really important for the flu virus ? possibly so important that the virus can?t change it to avoid immunity," says immunologist Patrick Wilson of the University of Chicago. "As a target for drug development, that would be ideal."
*
References
1. Yu, X. et al. Nature doi:10.1038nature07231 (2008).
Regional Reporting and Surveillance
Hong Kong: No rise in daily live chicken imports
8/19/08 Hong Kong Govt News--The 16,000 daily import ceiling for Mainland live chickens will not be raised before the Mid-Autumn Festival because of the bird flu threat, and the recent daily leftover of live chickens in the wholesale market.
The Food & Health Bureau today said the present level of live chicken imports is adequate to meet demand during the festival.
So far in August there has been on average 28,000 live chickens available at markets daily. The number of leftover chickens in the wholesale market is about 4,000 daily.
The bureau will ensure a steady supply of chilled and frozen chickens.
