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Avian Influenza Daily Digest
September 30, 2008 14:00 GMT
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Article Summaries ...
Regional Reporting and Surveillance
Togo: Health Officials Continue Culling as AI Preventative Measure, Owners Compensated
9/30/08 AFP--An international source reported on 27 September that authorities had culled approximately 5,000 birds in the past 2 days. Reportedly, hundreds of villagers brought their poultry to veterinarians in Agbata square to have them destroyed and were compensated for their losses. Additionally, some officials reportedly culled poultry by going door-to-door and compensating the owners. Health officials indicated that it will be necessary to cull approximately 16,000 birds and disinfect hundreds of houses.
Regional Reporting and Surveillance
FAO Vietnam Update
9/30/08 FAO Vietnam--Currently, 2 provinces ? Ben Tre and Ca Mau have reported HPAI in poultry in the last 21 days.
Regional Reporting and Surveillance
New system to quickly detect flu viruses
9/30/08 The Nation--A researcher team from Chulalongkorn University has come up with a new technique to quickly detect and identify influenza infections in humans. With this technique, doctors can determine the type of virus a patient has contracted within three hours and thus render the correct treatment.
Regional Reporting and Surveillance
Other Emerging Infectious Diseases
WHO: Cholera in Iraq - update
9/29/08 WHO -- On 20 August 2008, the Government of Iraq reported the first cholera cases of the year. As of 28 September 2008, a total of 341 laboratory-confirmed cholera cases, including five deaths, had been verified (case-fatality rate: 1.5%). Nine provinces have already been affected, with Babil accounting for the majority of cases (58%), followed by Baghdad (18%) and Kerbala (9%). Other provinces in which cholera cases have been reported include Anbar, Basra, Diala, Diwanyia, Misan and Najaf.
Other Emerging Infectious Diseases
Science and Technology
Avian influenza: The tip of the iceberg
9/30/08 Thoracic Medicine--[abstract]--For some years now, we have been living with the fear of an impending pandemic of avian influenza (AI). Despite the recognition, in 1996, of the global threat posed by the highly pathogenic H5N1 influenza virus found in farmed geese in Guangdong Province, China, planning for the anticipated epidemic remains woefully inadequate; this is especially true in developing countries such as Saudi Arabia.
AI Research
Novartis MF59®-adjuvanted Vaccine Rapidly Induces Protective Antibody Levels Against Diverse Strains Of Avian Flu
9/30/08 Medical News Today--A new study shows that individuals immunized six years earlier with an MF59 adjuvanted H5N3 (clade 0) vaccine mounted a protective immune response seven days after a single immunization with an H5N1 (clade 1) vaccine containing the Novartis proprietary adjuvant MF59. The immune response was broadly cross reactive and covered all H5N1 clades known to date. These data were presented at the Third European Influenza Conference in Vilamoura, Portugal.
Science and Technology, Vaccines
Avian influenza viruses detected by surveillance of waterfowl in Ireland during 2003?2007
9/30/08 Epidemiology and Infection Cambridge University Press [abstract]--Specimens for the detection of avian influenza virus (AIV) were collected from 1937 waterfowl on the Wexford Sloblands, a major wetland reserve in southeast Ireland, between January 2003 and September 2007. During the same period, 1404 waterfowl were sampled at other locations in Ireland. Specimens were tested either by virus isolation or real-time reverse transcriptase polymerase chain reaction (rtRT?PCR). A total of 32 isolates of AIV, comprising nine subtypes, was obtained from specimens from the Sloblands compared with just one isolate from elsewhere in Ireland. Samples from nine other waterfowl, five of which were from the Sloblands, tested positive for AIV by rtRT?PCR. Ecological factors are likely to have contributed to the higher detection rate of AIV at the Sloblands compared with the rest of Ireland. It was concluded that targeted surveillance at such sites is a cost-effective means of monitoring the circulation of new AIVs in waterfowl, whereas widespread opportunistic sampling is unproductive and wasteful of resources.
AI Research
Pandemic Preparedness
Updated: US Department of State ?fact sheet? on avian influenza A (H5N1) and pandemic influenza
US Department of State Fact Sheet: Avian influenza A (H5N1) and pandemic influenza The U.S. Government remains concerned about the possibility of an influenza pandemic that will affect Americans abroad. This fact sheet offers advice on measures Americans can take to prepare for and cope with a possible pandemic. It also includes information on the U. S. Government?s efforts to plan for and respond to such an event.
Pandemic Preparedness
CDC Awards $24 Million for Innovative Pandemic Preparedness
9/30/08 HS Today--As fears continue to grow over the emergence of a pandemic strain of influenza in the near future ? mutations of several strains other than H5N1 have given rise to increased worry - a Centers for Disease Control and Prevention (CDC) program has awarded $24 million to 29 state and local public health departments to fund 55 projects to come up with innovative approaches for influenza pandemic preparedness, including several preparedness areas of concern that have been raised by numerous public health officials and planners.
Pandemic Preparedness
Full Text of Articles follow ...
Regional Reporting and Surveillance
Togo: Health Officials Continue Culling as AI Preventative Measure, Owners Compensated
9/30/08 AFP--An international source reported on 27 September that authorities had culled approximately 5,000 birds in the past 2 days. Reportedly, hundreds of villagers brought their poultry to veterinarians in Agbata square to have them destroyed and were compensated for their losses. Additionally, some officials reportedly culled poultry by going door-to-door and compensating the owners. Health officials indicated that it will be necessary to cull approximately 16,000 birds and disinfect hundreds of houses.
AI Research
Avian influenza: The tip of the iceberg
9/30/08 Thoracic Medicine--[abstract]--For some years now, we have been living with the fear of an impending pandemic of avian influenza (AI). Despite the recognition, in 1996, of the global threat posed by the highly pathogenic H5N1 influenza virus found in farmed geese in Guangdong Province, China, planning for the anticipated epidemic remains woefully inadequate; this is especially true in developing countries such as Saudi Arabia.
These deficiencies became obvious in 1997, with the outbreak of AI in the live animal markets in Hong Kong that led to the transmission of infection to 18 humans with close contact with diseased birds; there were six reported deaths. [1] In 2003, with the reemergence of H5N1 (considered the most likely AI virus) in the Republic of Korea and its subsequent spread to Thailand, Vietnam, Hong Kong and China. Many countries started aggressively making preparations to meet the threat. [2] The pressure for real action from governments has increased. Most developed countries have requested increased funding for the search for a more effective vaccine, for stockpiling possibly helpful antiviral drugs, and for intensifying domestic and global surveillance. [3] Most countries, however, continue to be inadequately prepared for such an epidemic, especially with regard to animal surveillance in the farm market and surveillance among migratory birds. Even now, most countries do not have the ability to detect disease among humans in the early stages of an outbreak nor do most hospitals comply with effective infection control measures that could curtail the spread of the virus in the early stages of an epidemic. In Saudi Arabia we are rapidly implementing many of these measures. [4]
The Virus Top
The influenza virus is known to have an unstable character, with the ability to acquire new genetic material from other influenza viruses of similar or different serotypes, thus giving rise to new strains of influenza viruses with different genetic material. That such phenomena occur has been recognized for many years, and it is known to be responsible for the cyclical episodes of transcontinental outbreaks of influenza that have taken place. The best known is the 1918 Spanish influenza outbreak, which claimed more lives than were lost in World War I. [5] Though birds are the main reservoir, other species, including horses, pigs, and humans may easily become infected with the virus. The ability of H5N1 to infect many species rules out the possibility of eradication. Further, as the virus moves from one species to another it will exchange genetic material that will allow for easy mutations and the emergence of a virus with new characteristics. [6]
Transmission to Humans Top
The most common transmission is from birds to humans. Humans exposed to infected poultry will remain in the disease incubation period from 3 to 7 days. Dead poultry seems to be the most infectious; while, handling ill poultry or defeathering, slaughtering, or cooking infected birds is believed to involve less risk. Herein lies the challenge of containing the spread of AI: in many countries back-yard farming remains a common practice and an important source of domestic income. Most disease transmission occurs from domestic animals. [7] A recent report from Azerbaijan describes transmission from wild birds, where humans acquired the infection while slaughtering wild swans; [8] however, the risk of wild birds transmitting the disease to humans is low. The risk of human-to-human transmission is also low and the reports of the appearance of disease among clusters of patients were most likely due to exposure to infected birds as a common source of infection. [9],[10] Until human-to-human transmission is better understood, human bodily fluids such as respiratory secretions, urine, feces, and blood must be considered potentially infectious.
Clinical Features and Diagnostic Methods Top
Health care workers (HCWs) must strive for early detection of the disease. In the presence of risk factors for human infection with H5N1, adult patients presenting with severe and rapidly progressive community-acquired pneumonia and children presenting with respiratory tract febrile illness and radiological evidence of pneumonia should be evaluated for H5N1. [11],[12] It must be remembered that some patients with AI may present primarily with diarrhea. [13] Most patients presenting with AI are below the age of 40 years, the median age being 18 years. Independent risk factors for human infection with AI were described by Dinh et al . in Vietnamese patients and included the preparation of sick or dead poultry for consumption and having sick poultry in the household at any time within the last 7 days; in addition, the lack of an indoor water source was also identified. [14] Raising or preparing healthy poultry for consumption was not associated with AI infection.
Relevant history also includes laboratory exposure to samples collected from humans with influenza and a history of recent travel to an area where H5N1 is endemic.
Most patients infected with AI develop bone marrow suppression, which manifests as pancytopenia, particularly lymphopenia, neutropenia, and mild to moderate thrombocytopenia. In advanced cases, disseminated intravascular coagulation (DIC) and elevated D-dimer levels with evidence of hemorrhage is described. Elevated serum levels of lactate dehydrogenase and the presence of lymphopenia are associated with poorer outcome, with greater likelihood of complications like multiorgan failure, cardiac and renal dysfunction, pulmonary hemorrhage, and healthcare-related infections, especially ventilator-associated pneumonia. [15],[16],[17],[18],[19]
Specialized laboratories capable of PCR testing and equipped with appropriate primers for the current AI strains are important for early detection of an outbreak. Biosafety level-II laboratories which can detect infection within 4-6 h are needed. [20] Throat swabs are preferred over nasal swabs as samples to be sent for testing because of the lower viral burden in the nose. In cases where the suspicion of AI is high and initial testing is negative, it is important to send serial samples. Urine and fecal samples are of much lower diagnostic value. While rapid assays for detecting influenza antigens are available, they fail to differentiate between human and AI viruses.
Prompt reporting of the presence of suspected or confirmed cases of HP H5N1 is essential. Clinicians must be aware of how to inform appropriate hospital authorities and relevant governmental bodies in order to trigger public health defense mechanisms at the earliest.
Treatment Top
The fatality rate due to infections with HP H5N1 is as high as 62%; fortunately, only 373 cases have been identified as of March 2008. [21] There remains insufficient data on the best care for such patients. There is no standard approach towards management and any guidance available is based on anecdotal experiences. [22] There is evidence that early treatment of definitively documented AI is associated with better outcomes and increased survival rates as compared to late interventions. [23] Early detection, therefore, can be lifesaving.
The options for pharmacotherapy remain limited; the choice is between neuraminidase inhibitors, of which most experience has been with oseltamivir, and the adamantanes, which are inhibitors of the ion channel activity of the M2 membrane protein of influenza A viruses, such as amantadine. Currently, oseltamivir remains the drug of choice because of evidence of reduced mortality when oseltamivir is initiated in the early stages of the disease. In the mouse model, a survival benefit has been demonstrated with a combination therapy of oseltamivir and amantadine over monotherapy. [24] Therefore, in areas with amantadine-sensitive H5N1, it seems reasonable to consider combination therapy in patients with progressive disease. [25]
The emergence of resistant AI virus has been detected when the virus has the N294S resistance gene which encodes for a lower susceptibility to oseltamivir. AI viruses with this specific mutation have been identified in infected human cases in Egypt, Turkey, and Indonesia. For patients who are infected with this virus, it is important to be aware of the option of using oseltamivir at a higher dose and for a longer duration (e.g., 150 mg twice daily for 10 days for adults) in those who present late or who fail to improve while on the standard dose for the drug (i.e., 75 mg twice daily for 5 days for adults). [11] Resistance to amantadine is also being reported with increasing frequency. [26]
In addition to antiviral drugs, supportive care is critical and includes fluid management, correction of hypoxemia, and prevention and management of healthcare-associated infections. The use of corticosteroids is not routine practice but it may be used in septic shock or in renal insufficiency. [22]
Prophylaxis Top
The WHO guidelines recommend prophylaxis for those who have been exposed to HP H5N1 AI. Mathematical models simulating emerging outbreaks in rural Asia predict that an influenza pandemic can be prevented through the provision of targeted, mass chemoprophylaxis, along with implementation of isolation policies. [27] However, we should keep in mind that casual use of the very few proven antiviral agents that are available, whether as part of a planned mass prophylaxis program or as recommendations by individual physicians, may aid the development of drug resistance. Either way, these agents will become useless during a pandemic. This definitely poses tough decisions for health care policymakers. [28]
Immunization Top
As with all viruses of rapidly changing antigenicity, the hope for developing an effective AI vaccine is a major challenge. [29] One part of the WHO Global Influenza Program is the development of representative H5N1 candidate vaccine viruses. Since it is not known which specific H5N1 virus will become the pandemic virus, efforts are in place to prepare for the most likely viruses, including both clade 1 and clade 2 influenza viruses. [30]
H5N1 Outbreak in the Kingdom of Saudi Arabia Top
The first cases of AI in the Kingdom were reported from a farm in Al Kharj District on April 2, 2007, when 1500 birds died. This occurrence was reported to the Saudi Ministry of Agriculture (MOA) [31] [Figure 1]. There was an intensive public health infection control response to this event. PCR testing on the dead birds quickly confirmed the presence of HP H5N1. The remainder of the flock (50,000 birds) was promptly culled.
The farm was disinfected and designated as an 'infected area.' Human contacts were closely followed for possible acquisition of disease. Despite these measures, the outbreak spread to the nearby poultry farms in Drumaa, Almazahmiah, Alhayathem, and several others [Figure 2]. [32] It is speculated that the birds were initially infected by migratory wild birds. [33]
Efforts to control such outbreaks require intense collaboration between many governmental and non-governmental agencies. In the Kingdom of Saudi Arabia the consequences of an outbreak during the hajj will have a global impact as the Kingdom hosts over 2.5 million pilgrims a year from all over the world. [4],[34] The MOA has detailed the emergency measures and a prevention plan for HP AI in the Kingdom of Saudi Arabia. These measures include several critical steps to prevent the introduction of HP H5N1 into poultry farms: e.g., banning the importation of poultry and poultry products and food from countries with endemic AI; isolating those who return from endemic areas to work on poultry farms for at least 10 days; isolating poultry farms and storage areas from exposure to migratory and wild birds; and, lastly but importantly, educating workers and owners of poultry farms on appropriate preventive measures and early reporting of ill or dying poultry to the MOA. [35] Strict policies on destruction of infected and exposed birds, as well as farm decontamination, are clearly detailed in the plan. In addition, the designation of an area within a 5-km radius of an infected farm as a 'restricted area' is a critical factor in successful disease control; this is necessary in order to survey the area for newly infected birds. Within the restricted area, all birds dying due to any reason are to be dealt with as if they have died from AI. Additional measures include banning the exit of any heavy machinery or birds from the restricted area for a period of 6 months from the date of identification of the last diseased bird. Only after 6 months of consistently documented absence of newly identified cases can the farm and the surrounding area be opened up for full access. [35]
At the Ministry of Health (MOH) level, many educational programs are now in place to educate HCWs on the importance of standard and extended precautions, isolation policies and procedures, and hand hygiene. Such efforts are vital in this phase of the pandemic, when no human cases have yet been identified. Even though these measures will be helpful, successful compliance and adherence to these policies calls for a change in HCWs' behavior and this has its own unique barriers to implementation, a discussion of which is beyond the scope of this review.
The MOH has identified a number of protocols to be followed in the event of human cases being suspected or identified. These include standard operating procedures for individuals under investigation for HP H5N1, case definitions, data collection forms, emergency contact numbers, public health measures, and educational material for HCWs and the public. All efforts have been in collaboration with the concerned governmental bodies in order to standardize these approaches.
Fortunately, during the outbreak in the Kingdom of Saudi Arabia, none of the human contacts of infected birds were identified as having AI. As we remain in the early phases of the pandemic, we should bear in mind that once the virus acquires the genetic material that allows for more efficient human-to-human transmission the number human infections will rise and we can expect an explosive pandemic.
Conclusion Top
Even as we hope that AI will remain a serious problem involving only birds, it is crucial to prepare for a possible major outbreak of human disease, especially since we have historical evidence that influenza pandemics do recur, typically several times each century. [36] This observation has catalyzed the development of global preparedness plans by the WHO in which all nations become integral parts. All governments would be well advised to develop and be ready to execute emergency plans in the event of what appears to be an inevitable pandemic. [37],[38]
References Top
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9. Kandun IN, Wibisono H, Sedyaningsih ER, Yusharmen, Hadisoedarsuno W, Purba W, et al . Three Indonesian clusters of H5N1 virus infection in 2005. N Engl J Med 2006;355:2186-94. Back to cited text no. 9
10. Ungchusak K, Auewarakul P, Dowell SF, Kitphati R, Auwanit W, Puthavathana P, et al . Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med 2005;352:333-40. Back to cited text no. 10 [PUBMED] [FULLTEXT]
11. Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus, Abdel-Ghafar AN, Chotpitayasunondh T, Gao Z, Hayden FG, Nguyen DH, et al . Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med 2008;358:261-73. Back to cited text no. 11 [PUBMED] [FULLTEXT]
12. Nicoll A. Children, avian influenza H5N1 and preparing for the next pandemic. Arch Dis Child 2008;93:433-8. Back to cited text no. 12 [PUBMED] [FULLTEXT]
13. de Jong MD, Bach VC, Phan TQ, Vo MH, Tran TT, Nguyen BH, et al . Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med 2005;352:686-91. Back to cited text no. 13 [PUBMED] [FULLTEXT]
14. Dinh PN, Long HT, Tien NT, Hien NT, Mai le TQ, Phong le H, et al . Risk factors for human infection with avian influenza A H5N1, Vietnam, 2004. Emerg Infect Dis 2006;12:1841-7. Back to cited text no. 14 [PUBMED] [FULLTEXT]
15. Peiris JS, Yu WC, Leung CW, Cheung CY, Ng WF, Nicholls JM, et al . Re-emergence of fatal human influenza A subtype H5N1 disease. Lancet 2004;363:617-9. Back to cited text no. 15 [PUBMED] [FULLTEXT]
16. Beigel JH, Farrar J, Han AM, Hayden FG, Hyer R, de Jong MD, et al . Avian influenza A (H5N1) infection in humans. N Engl J Med 2005;353:1374-85. Back to cited text no. 16 [PUBMED] [FULLTEXT]
17. Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, Chunsuthiwat S, Sawanpanyalert P, Kijphati R, et al . Human disease from influenza A (H5N1), Thailand, 2004. Emerg Infect Dis 2005;11:201-9. Back to cited text no. 17 [PUBMED] [FULLTEXT]
18. Peiris JS, Guan Y, Yuen KY. Severe acute respiratory syndrome. Nat Med 2004;10:S88-97. Back to cited text no. 18 [PUBMED] [FULLTEXT]
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20. Wu C, Cheng X, He J, Lv X, Wang J, Deng R, et al . A multiplex real-time RT-PCR for detection and identification of influenza virus types A and B and subtypes H5 and N1. J Virol Methods 2008;148:81-8. Back to cited text no. 20 [PUBMED] [FULLTEXT]
21. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO. 2008. [cited on 2008 March 18]. Available from: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_03_18/en/index.html. Back to cited text no. 21
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23. Sedyaningsih ER, Isfandari S, Setiawaty V, Rifati L, Harun S, Purba W, et al . Epidemiology of cases of H5N1 virus infection in Indonesia, July 2005-June 2006. J Infect Dis 2007;196:522-7. Back to cited text no. 23 [PUBMED] [FULLTEXT]
24. Ilyushina NA, Hoffmann E, Salomon R, Webster RG, Govorkova EA. Amantadine-oseltamivir combination therapy for H5N1 influenza virus infection in mice. Antivir Ther 2007;12:363-70. Back to cited text no. 24 [PUBMED]
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27. Alexander ME, Bowman CS, Feng Z, Gardam M, Moghadas SM, R ?st G, et al . Emergence of drug resistance: Implications for antiviral control of pandemic influenza. Proc Biol Sci 2007;274:1675-84. Back to cited text no. 27
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29. Watanabe T, Watanabe S, Kim JH, Hatta M, Kawaoka Y. Novel approach to the development of effective H5N1 influenza A virus vaccines: Use of M2 cytoplasmic tail mutants. J Virol 2008;82:2486-92. Back to cited text no. 29 [PUBMED] [FULLTEXT]
30. Poland GA. Vaccines against avian influenza: A race against time. N Engl J Med 2006;354:1411-3. Back to cited text no. 30 [PUBMED] [FULLTEXT]
31. Infection of 1500 birds with avian influenza in Alkharj. 2007 [cited on 2008 Feb 26]. Available from: http://www.agrwat.gov.sa/public/P_WEBCONT?p_sys_code=874. Back to cited text no. 31
32. Announcement of New Infections with Avian Influenza. 2007 [cited on 2008 Feb 20]. Available from: http://www.agrwat.gov.sa/public/P_WEBCONT?p_sys_code=875. Back to cited text no. 32
33. Saad MD, Ahmed LS, Gamal-Eldein MA, Fouda MK, Khalil F, Yingst SL, et al . Possible avian influenza (H5N1) from migratory bird, Egypt. Emerg Infect Dis 2007;13:1120-1. Back to cited text no. 33 [PUBMED]
34. Balkhy HH, Memish ZA, Bafaqeer S, Almuneef MA. Influenza a common viral infection among Hajj pilgrims: Time for routine surveillance and vaccination. J Travel Med 2004;11:82-6. Back to cited text no. 34 [PUBMED] [FULLTEXT]
35. Preventive Measures and Contingency Plan for the Highly Pathogenic Avian Influenza. Avian influenza 2005 [cited on 2008 Feb 26]; Available from: http://www.agrwat.gov.sa/files/620147.htm. Back to cited text no. 35
36. Cumulative number of Confirmed Human Cases of Avian (h5N1) Reported to WHO. 2008 Available from: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_02_22. Back to cited text no. 36
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Other Emerging Infectious Diseases
WHO: Cholera in Iraq - update
9/29/08 WHO -- On 20 August 2008, the Government of Iraq reported the first cholera cases of the year. As of 28 September 2008, a total of 341 laboratory-confirmed cholera cases, including five deaths, had been verified (case-fatality rate: 1.5%). Nine provinces have already been affected, with Babil accounting for the majority of cases (58%), followed by Baghdad (18%) and Kerbala (9%). Other provinces in which cholera cases have been reported include Anbar, Basra, Diala, Diwanyia, Misan and Najaf.
In addition to the confirmed cholera cases, there are a further 31 suspected cases currently under investigation and seven fatal cases of acute watery diarrhoea with symptoms similar to those of cholera.
Although the outbreak this year appears to be less intense then that of 2007, further waves are still possible. It is therefore too early to consider this epidemic to be under control. In addition, long-term inadequacies in the area of water and sanitation remain of immediate concern and cholera outbreaks will recur in Iraq until access to safe water and proper sanitation is ensured for all people.
In response to a request from the Ministry of Health, WHO is providing technical support. The WHO regional expert for water and sanitation has arrived in Baghdad and a joint WHO-UNICEF assessment mission to Babil and Misan will take place as soon as the security situation allows.
WHO does not recommend any restrictions to travel or trade to or from affected areas as a means to control the spread of cholera. However, neighbouring countries are encouraged to reinforce their active surveillance and preparedness systems. Mass chemoprophylaxis is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.
Use of the current internationally available prequalified oral cholera vaccine is not recommended once an outbreak has started due to its 2-dose regimen and the time required to reach protective efficacy as well as the high costs and the heavy logistics associated with its use. The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the high occurrence of severe adverse reactions.
For more information
Prevention and control of cholera outbreaks: WHO policy and recommendations
WHO Regional Office for the Eastern Mediterranean
WHO cholera fact sheet
Cholera in Iraq - Map [jpg 404kb]
Science and Technology > Vaccines
Novartis MF59®-adjuvanted Vaccine Rapidly Induces Protective Antibody Levels Against Diverse Strains Of Avian Flu
9/30/08 Medical News Today--A new study shows that individuals immunized six years earlier with an MF59 adjuvanted H5N3 (clade 0) vaccine mounted a protective immune response seven days after a single immunization with an H5N1 (clade 1) vaccine containing the Novartis proprietary adjuvant MF59. The immune response was broadly cross reactive and covered all H5N1 clades known to date. These data were presented at the Third European Influenza Conference in Vilamoura, Portugal.
Responses were seen even against viral strains not included in either vaccine[1] suggesting proactive priming strategies with an MF59 adjuvanted-H5 vaccine may have the potential to help save lives in an avian influenza pandemic situation.
"These data highlight the potential for priming the public against an avian influenza of pandemic proportion with the MF59 adjuvant. The results indicate that regardless of which avian strain individuals are originally primed with, they are quickly protected against a broad range of avian strains following their MF59-adjuvanted booster vaccine, even strains they were not initially inoculated against," said study investigator Iain Stephenson M.R.C.P., Infectious Diseases Unit, University Hospitals Leicester and Department of Inflammation, Infection and Immunity, University of Leicester, UK.
"These results potentially provide a rationale to prevent pandemic influenza by proactively immunizing the public with stockpiled pre-pandemic vaccines containing MF59," Dr Stephenson added. According to the trial results, healthy adults primed with an MF59-adjuvanted H5 vaccine at least 6 years ago, and boosted with the Novartis pre-pandemic vaccine AFLUNOV (7.5microgram MF59-adjuvanted A/Vietnam/1194/2004 clade 1 H5N1), showed a protective cross-reacting antibody response to diverse H5N1 virus variants. Response was seen within 7 days and results were significantly higher (P< 0.05) at 14 days than those primed with a un-adjuvanted vaccine[1]. In addition, these study results suggest primed individuals would only need one dose of an MF59-adjuvanted vaccine in a pandemic situation to elicit initial protection reducing overall response time, and potentially the spread of the virus[1].
"These findings show that priming subjects with the Novartis proprietary adjuvant MF59 included in AFLUNOV can induce long-lasting immune-memory and further supports a proactive priming strategy as part of pandemic preparedness efforts" said Dr. Joerg Reinhardt, CEO of Novartis Vaccines and Diagnostics, a division of Novartis. "Novartis Vaccines is committed to putting forth the most effective vaccine possible to help protect the global public against a possible pandemic situation." An influenza pandemic occurs when a new influenza strain emerges (one to which humans have no immunity), mutates and spreads globally as a virus. Although it is not possible to predict the actual pandemic influenza strain, global health authorities have identified H5N1 avian influenza as a strain with the greatest pandemic potential in humans[3]. H5N1 is currently circulating in birds and has caused serious illness in more than 380 people worldwide with a mortality rate, among people known to have been infected, of greater than 60 percent[4].
The purpose of pre-pandemic vaccination is to prime the immune system to better defend against infections from an H5N1 influenza virus and is intended for use before the World Health Organization (WHO) declares an influenza pandemic. AFLUNOV is the only pre-pandemic vaccine in development with an extensively-studied adjuvant, MF59, that is supported by more than 10 years of clinical safety data and commercial use.
Study details
In an open-label study, 54 healthy adults (age 23-60 years) received two doses of AFLUNOV (7.5microgram MF59-adjuvanted A/Vietnam/1194/2004 clade 1 H5N1) vaccine 21 days apart. Twenty-four subjects were primed with either MF59-adjuvanted or an un-adjuvanted H5N3 (A/duck/Singapore/1997 clade 0-like) vaccine at least 6 years earlier and 30 subjects were unprimed[1]. Some subjects also received a booster dose, 16 months after primary immunization. Pre and post-vaccination antibody to antigenically diverse H5 viruses were measured by hemagglutination-inhibition (HAI), neutralizing antibody (MN) and single radial hemolysis (SRH).
Among primed subjects, protective cross-reacting antibody titers to diverse H5N1 virus variants were seen by day 7 after a single vaccine dose[1]. In subjects primed with an MF59-adjuvanted vaccine responses were statistically significantly higher (P< 0.05) than those primed with un-adjuvanted vaccine. By day 7, after one dose of AFLUNOV, >=80% of MF59-H5 primed recipients achieved sero-protective HAI titers of >=1:40 to all clade 1, 2.1, 2.2, and 2.3 avian H5 virus variants tested as well as the original antigen. In MF59-H5N3 primed subjects, responses were greatest at day 14 with geometric mean antibody titers of 1:378, 1:1754 and 73mm2 to the clade 1 A/Vietnam/2004 vaccine strain and 1:347, 1:2128 and 72mm2 to a clade 2 A/Turkey/2005 variant by HAI, MN and SRH respectively[1].
Novartis Vaccines commitment to pandemic preparedness
The immune-enhancing Novartis Vaccines proprietary adjuvant MF59 may enhance the body's immune response to the vaccine's active constituent (antigen) and offer varying degrees of cross-protection to better defend against the potentially dangerous disease causing infections from an H5N1 virus. In the seasonal influenza vaccine Fluad®, MF59 has been shown to better enhance the antibody response to vaccination when compared to non-adjuvanted vaccines, to increase protection in the elderly, and to provide protection even against influenza strains not included in the vaccine[5], [6]. Fluad has a history of proven safety and tolerability, with more than 40 million doses distributed worldwide since 1997[7].
Novartis Vaccines is working closely with government and regulatory officials worldwide to support pandemic preparedness efforts, including engaging in government contracts to provide H5N1 vaccines for stockpiling. The Company has also been involved in discussions to educate government agencies about the benefits of proactive use of pre-pandemic vaccination in pandemic preparedness planning efforts.
Novartis Vaccines is supportive of the WHO's leadership role in global pandemic planning as discussed in the organization's "THE WORLD HEALTH REPORT 2007: Global Public Health Security in the 21st Century." The WHO is a key global hub for pandemic preparedness, ensuring cohesion and coordination among all players involved, including the industry, governments of both developed or developing countries and their populations.
The Company also recognizes the importance of pandemic influenza preparedness planning within the business community in an effort to protect the global economy. With this commitment, Novartis Vaccines is working with business leaders to support their continuity planning for pandemic preparedness.
Disclaimer
The foregoing release contains forward-looking statements that can be identified by terminology such as "may", "potential", "potentially", "suggest", "would", "can", "committed", "possible", "intended", or similar expressions, or by express or implied discussions regarding the potential that AFLUNOV® or an MF59 adjuvanted vaccine will be approved for sale in any market, or regarding potential future revenues from such products. You should not place undue reliance on these statements. Such forward-looking statements reflect the current views of the Company regarding future events, and involve known and unknown risks, uncertainties and other factors that may cause actual results with to be materially different from any future results, performance or achievements expressed or implied by such statements. There can be no guarantee that AFLUNOV® or an MF59 adjuvanted vaccine will be approved for sale in any market. Nor can there be any guarantee that such products will achieve any particular levels of revenue in the future. In particular, management's expectations could be affected by, among other things, unexpected regulatory actions or delays or government regulation generally; unexpected clinical trial results, including unexpected new clinical data and unexpected additional analysis of existing clinical data; the Company's ability to obtain or maintain patent or other proprietary intellectual property protection; competition in general; government, industry and general public pricing pressures; the impact that the foregoing factors could have on the values attributed to the Novartis Group's assets and liabilities as recorded in the Group's consolidated balance sheet, and other risks and factors referred to in Novartis AG's current Form 20-F on file with the US Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those anticipated, believed, estimated or expected. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.
About Novartis
Novartis AG provides healthcare solutions that address the evolving needs of patients and societies. Focused solely on healthcare, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, cost-saving generic pharmaceuticals, preventive vaccines, diagnostic tools and consumer health products. Novartis is the only company with leading positions in these areas. In 2007, the Group's continuing operations (excluding divestments in 2007) achieved net sales of USD 38.1 billion and net income of USD 6.5 billion. Approximately USD 6.4 billion was invested in R&D activities throughout the Group. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 98,000 full-time associates and operate in over 140 countries around the world. For more information, please visit http://www.novartis.com.
Regional Reporting and Surveillance
FAO Vietnam Update
9/30/08 FAO Vietnam--Currently, 2 provinces ? Ben Tre and Ca Mau have 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.On 18 September, DAH reported HPAI in Ca Mau province, at a raiser in
Khanh Hai commune, Tran Van Thoi district. According to Regional Animal
Health Office No VII, there were 57 dead ducks (45-day-old and unvaccinated)
out of a flock of 500. The remaining flock has been destroyed.
On 6 September, DAH reported HPAI in duck flock at a raiser Nguyen Van
Tim, An Loi village, Binh Tay commune, Ba Tri district, Ben Tre province. Out
of a flock of 300, 6 died and 294 found sick. The whole flock have been culled
and preventive measures have been conducted.
On 18 August, DAH reported HPAI suspected case in Ben Tre province, Ba
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.
Regional Reporting and Surveillance
New system to quickly detect flu viruses
9/30/08 The Nation--A researcher team from Chulalongkorn University has come up with a new technique to quickly detect and identify influenza infections in humans. With this technique, doctors can determine the type of virus a patient has contracted within three hours and thus render the correct treatment.
The system was developed by Dr Yong Poovorawan, Kamol Suwannakarn and Sunchai Payungporn of the Centre of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn Univeristy.
According to team leader Dr Yong Poohworawan, who is also a virological expert, this technique uses molecular diagnosis to detect the virus genes. The team has developed the one-step Reverse Transcription-Polymerase Chain Reaction (RT-PCR) as a rapid and specific method for identifying the H5N1 and H6 influenza A virus.
He said this technique could detect and identify both human and avian flu viruses at the same time, which not only saves time but also money.
Yong explained that influenza viruses are classified into types A, B and C, based on the antigenic differences in their nucleo- and matrix proteins. The A and B types are main agents of human acute respiratory disease and affecting infants, the elderly and individuals with compromised cardiac, pulmonary or immune functions.
Most influenza pandemics are associated with the Type-A virus, which represents the most widespread human and animal pathogen. This type can be further classified into subtypes based on the antigenic variation of the hemagglutinin (HA) and neuraminidase (NA) glycoprotein on the surface of viral particles. To date, 16 HA and nine NA subtypes of Type-A viruses have been detected in wild birds and poultry across the world
As viruses of all subtypes have been isolated from aquatic birds, they are considered a reservoir of Type-A for other animal species. The number of viral subtypes found in mammals is limited, with the most common subtype of Type-A virus affecting humans being H1N1, H2N2, and H3N2. Though human infections from additional Type-A subtypes, including H5N1, H7N7, H7N3 and H9N2, have been reported over the past few years.
To mitigate an influenza outbreak, Yong said early and rapid detection of infectious strains and subtypes in each patient is required.
The technique has been approved and published by two international journals - "The Journal of Virological Methods" and "Tohoku Journal of Japan" - and hospitals can access details of the system in their websites.
Pandemic Preparedness
Updated: US Department of State ?fact sheet? on avian influenza A (H5N1) and pandemic influenza
US Department of State
Fact Sheet: Avian influenza A (H5N1) and pandemic influenza
The U.S. Government remains concerned about the possibility of an influenza pandemic that will affect Americans abroad. This fact sheet offers advice on measures Americans can take to prepare for and cope with a possible pandemic. It also includes information on the U. S. Government?s efforts to plan for and respond to such an event.
U.S. Government Pandemic Policy for Americans Abroad
The U.S. Government recognizes that in a pandemic, a variety of factors may lead Americans abroad to stay in the country they are residing in or visiting. Some may choose to remain in country to avoid mass transit, public gatherings or other situations that could increase their exposure to the virus. Others may be forced to remain in country, due to disruptions in air travel, quarantines or closed borders. Consequently, it is current U.S. Government policy for all overseas employees under Chief of Mission authority, and their accompanying dependents, to plan for the possibility that they will be remaining in country during a pandemic. Information for both official and private Americans on how to prepare for this possibility is contained in the flyer Remain in Country During a Pandemic, which urges Americans to maintain adequate provisions for a pandemic wave or waves that could last from 2 to 12 weeks.
Once the World Health Organization (WHO) confirms a severe pandemic ? defined as the emergence of a sustained, efficient human-to-human transmission of a new influenza virus that kills at least 1-2% of the people it infects ? American citizens (including non-emergency government employees, their dependent family members and private citizens) residing or traveling overseas should consider returning to the United States while commercial travel options (air, land or sea) are still available. Americans will be permitted to re-enter the United States, although the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (HHS/CDC) may quarantine or isolate incoming travelers, depending on their health status and whether they are traveling from or through an area affected by pandemic influenza.
At such a time, non-emergency U.S. Government employees and all U.S. Government dependents affected by a severe pandemic will be allowed to return to the United States for the duration of the pandemic. Employees who return to the United States will be expected to work during the pandemic unless they take leave. Private American citizens abroad should make an informed decision: either remain in country, as noted above, to wait out the pandemic or return to the United States while this option still exists. Any American, whether overseas in a private capacity or employed by the U.S. Government, or a dependent of a U.S. Government employee, who chooses not to return to the United States via commercial means while still available, might have to remain in country for the duration of the pandemic if transportation is disrupted or borders close. Americans should be aware that only in cases of a breakdown in civil order within a country will the U.S. Government consider non-combatant evacuation operations.
Those who feel they would be at greater risk by remaining abroad during a pandemic, or who prefer returning to the United States to access American medical and health care services, may opt to return to the United States. Individuals with chronic medical conditions identified by the WHO and CDC may be at higher risk of suffering complications from influenza and should consider returning to the United States early at the onset of a pandemic or of postponing travel during a pandemic. Those at high risk may include: pregnant women; adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus); adults and children who have immunosuppression (including that caused by medications or by human immunodeficiency virus); and adults and children who have any condition (e.g. cognitive dysfunction, spinal cord injuries, seizure disorders or other neuromuscular disorders) that can compromise respiratory function.
Due to legal restrictions and a lack of sufficient resources, the U.S. Department of State is not in a position to provide private American citizens traveling or living abroad with medications or supplies, or medical treatment, in the event of a pandemic. Therefore, private American citizens should carefully weigh the risks of remaining in country versus the risks of traveling, keeping in mind the potential benefits of returning to the United States. Returning to the United States could provide Americans with greater access to antiviral medications, respirators, face masks and pandemic vaccine. However, traveling also could increase one?s potential for exposure to the virus and even result in being stranded in a third country if flights are diverted.
U.S. Government assistance to private American citizens who are forced or choose to remain in country would be limited to traditional consular protection, i.e. communicating with family and friends, monitoring quarantine/detention conditions as permitted by local health authorities, arranging for transfers of funds or granting temporary subsistence loans, and providing information regarding the availability of medical care (to be paid for by the individual). Private American citizens should be aware that the U.S. Government cannot demand their immediate release if they have been detained or quarantined abroad in accordance with local public health and legal authorities.
Current Situation - Avian Influenza A (H5N1)
At this writing, countries continue to report outbreaks of avian influenza A (H5N1), commonly referred to as "bird flu," in their domestic and wild bird populations. In addition, countries have reported, on a very limited basis, H5N1 infections in other wild and domestic animals. A small number of confirmed cases of H5N1 among humans have been reported, approximately 60% of which have resulted in death. More information is available on the WHO web site at http://www.who.int/csr/disease/avian_influenza/country/en. Please refer to this website for the most current information on countries affected by H5N1 and the number of confirmed human cases and deaths.
The vast majority of reported human infections have resulted from direct contact with avian influenza A (H5N1)-infected poultry. Although there is evidence to suggest very limited, human-to-human transmission, primarily in family groups involving close exposure to a critically ill member, there is no evidence to suggest the virus can be easily transmitted from human to human in a sustained manner at the present time. HHS/CDC, the WHO, and the U.S. Department of State are nonetheless concerned about the potential for the virus to adapt or mutate into a strain that could cause a human influenza pandemic, and are working closely with all U.S. Government agencies to prepare for the possibility of pandemic influenza. Information on the U.S. Government's overall planning and response efforts is available at www.pandemicflu.gov.
Travel and Avian Influenza A
The U.S. Department of State, HHS/CDC and the WHO have not issued any health precautions, travel alerts or warnings for areas infected with avian influenza. During a pandemic, these agencies, as well as the U.S. Department of Transportation (www.dot.gov), will provide regular situational updates and appropriate guidance to the American public. The information will be tailored toward specific geographic regions, depending on how the virus evolves and on local conditions, including regional variations in the mortality rate and the availability of medical care.
HHS/CDC advises American citizens traveling to or living abroad in countries affected by avian influenza to avoid:
· poultry farms;
· contact with animals in live food markets;
· any surfaces that appear to be contaminated with feces or fluids from poultry or other animals; and
· consumption of poultry and eggs that are not thoroughly cooked.
American citizens traveling to or living in countries affected by avian influenza should consider the potential risks and keep informed about the latest medical guidance in order to make appropriate plans. Specific HHS/CDC travel information relating to H5N1, including preventive measures, is available at http://www.cdc.gov/flu/avian/index.htm and http://www.cdc.gov/travel/default.aspx. WHO guidance related to avian influenza is available at http://www.who.int/csr/disease/avian_influenza/en/.
Areas of known H5N1 outbreaks in poultry have been quarantined by governments in those countries within 24 hours, restricting (if not preventing) movement into and out of the affected area. If the virus evolves into a form that can be easily transmitted from human to human in a sustainable manner, governments will likely respond by imposing public health measures that restrict domestic and international movement. This would limit the U.S. Government's ability to assist Americans in those countries. During a pandemic, Americans abroad might expect such measures to be implemented very quickly.
Americans who are planning travel to a country that has reported outbreaks of avian influenza A (H5N1), or who are concerned about avian influenza, are advised to monitor the HHS/CDC and WHO websites for up-to-date information. Additional country information can be obtained from the U.S. Department of State's Country Specific Information and Embassy and Consulate web pages. You may also call the U.S. Department of State's toll-free number, 1-888-407-4747, or if calling from overseas, 1-202-501-4444.
Prevention, Response and Treatment ? Taking Charge
The avian influenza type A (H5N1) virus is continually evolving and cannot, at present, easily pass from human to human in a sustainable manner. A vaccine for humans that effectively prevents infection with the avian influenza type A (H5N1) virus is not yet readily available. Experts anticipate a four- to six-month lag between identification of a pandemic influenza virus and commercial development and distribution of an effective vaccine.
HHS/CDC research shows that antiviral medications such as oseltamivir and zanamivir (commonly known by their brand names of Tamiflu® and Relenza®) may be effective in treating avian influenza type A (H5N1) if taken early in the infection, although their efficacy will not be known with certainty until a pandemic strain emerges and is analyzed. As with all prescription medications, side effects may occur, and rare but serious side effects have been reported with both oseltamivir and zanamivir. For more information, Americans should consult their healthcare provider or see the package insert approved by the U.S. Department of Health and Human Services/Food and Drug Administration (HHS/FDA). Expired medications must not be taken.
These influenza antiviral medications can be obtained by prescription from a healthcare provider in the United States. If such medications or adequate medical treatment are not readily available at an overseas location or travel destination(s), Americans should consider discussing with their personal physicians the advisability of obtaining an advance supply of appropriate medication for a trip or period of stay overseas. More information is available at http://wwwn.cdc.gov/travel/contentDiseases.aspx#influ.
The U.S. Department of State has pre-positioned supplies of antiviral medications at its embassies and consulates worldwide for eligible U.S. Government employees and their dependents. However, due to legal restrictions and a lack of sufficient resources, the U.S. Department of State is not in a position to provide private American citizens traveling or living abroad with medications or supplies, or medical treatment, in the event of a pandemic. Americans should also be aware of the potential health risk posed by counterfeit drugs, including those represented as oseltamivir or zanamivir, by scam artists who sell products on the Internet or in countries with lax regulations governing the production and distribution of pharmaceutical products. For more information on counterfeit drugs, please visit HHS/FDA?s web site at http://www.who.int/csr/disease/avian_influenza/en/.
Complete planning guidance on how private citizens can prepare to remain in country during a pandemic, including stocking food, water and medical supplies, is available at www.pandemicflu.gov/plan/individual/index.html. In addition, the guidance suggests that individuals who need to enter crowded areas should consider use of a face mask for protection against others who are coughing and to limit the wearers? ability to cough on others. However, there are no definitive studies regarding the effectiveness of face masks in preventing the transmission of the flu virus. Should Americans choose or be forced to remain in a country experiencing a pandemic, they should limit exposure to the virus (through such measures as avoiding mass transit and public gatherings) and take the hygienic precautions outlined at the website cited above.
CDC Contact Information
Public Inquiries:
English (888) 246-2675
Spanish (888) 246-2857
TTY (866) 874-2646
Mon-Fri 8am-11pm EST
Sat-Sun 10am-8pm EST
Address:
Centers for Disease Control and Prevention
1600 Clifton Rd.
Atlanta, GA 30333
USA (404) 639-3311
Traveler's Website
http://wwwn.cdc.gov/travel/default.aspx
WHO Liaison Office in Washington, DC
Contact Information: Telephone: (202) 974-3787
WHO Website
http://www.who.int/en/
Address:
WHO Liaison Office
1889 F Street, NW, Suite 369
Washington, DC 20006 USA
Pandemic Preparedness
CDC Awards $24 Million for Innovative Pandemic Preparedness
9/30/08 HS Today--As fears continue to grow over the emergence of a pandemic strain of influenza in the near future ? mutations of several strains other than H5N1 have given rise to increased worry - a Centers for Disease Control and Prevention (CDC) program has awarded $24 million to 29 state and local public health departments to fund 55 projects to come up with innovative approaches for influenza pandemic preparedness, including several preparedness areas of concern that have been raised by numerous public health officials and planners.
They include engaging the public in the public health decision-making process and better collaborative planning among healthcare providers to ensure the delivery of essential services during a pandemic.
These are just some of the vital issues pandemic planners across the nation have expressed concerns about, as HSToday.us and HSToday have reported.
CDC intends for the recipients to implement promising practices or to develop effective approaches and models that can be replicated nationally.
?What is learned from these projects can benefit everyone because it could improve national, regional and local public health detection and response to a pandemic involving influenza,? said Dr. Richard Besser, director of CDC's Coordinating Center for Terrorism Preparedness and Emergency Response.
A total of 184 funding applications were submitted by state and local health departments in a competitive application process. Eligible applicants for the awards were limited to the 62 state, local and territorial public health departments that currently receive federal funding through CDC's Public Health Emergency Preparedness (PHEP) Cooperative Agreement.
The 29 award recipients have one year to complete the projects, which begin on Sept. 30.
A list of the 29 award recipients and their projects can be found here.
AI Research
Avian influenza viruses detected by surveillance of waterfowl in Ireland during 2003?2007
9/30/08 Epidemiology and Infection Cambridge University Press [abstract]--
P. J. RALEIGHa1 c1, O. FLYNNa1, M. O'CONNORa1, T. O'DONOVANa1, B. PURCELLa1, M. DE BURCAa1, V. REGAZZOLIa1, D. MINIHANa1, J. CONNELLa2, B. K. MARKEYa3 and D. J. SAMMINa1
a1 Central Veterinary Research Laboratory, Department of Agriculture, Fisheries and Food Laboratories, Backweston Campus, Stacumny Lane, Celbridge, Co. Kildare, Ireland
a2 National Virus Reference Laboratory, University College Dublin, Belfield, Dublin, Ireland
a3 School of Agriculture, Food Science and Veterinary Medicine, Veterinary Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
SUMMARY
Specimens for the detection of avian influenza virus (AIV) were collected from 1937 waterfowl on the Wexford Sloblands, a major wetland reserve in southeast Ireland, between January 2003 and September 2007. During the same period, 1404 waterfowl were sampled at other locations in Ireland. Specimens were tested either by virus isolation or real-time reverse transcriptase polymerase chain reaction (rtRT?PCR). A total of 32 isolates of AIV, comprising nine subtypes, was obtained from specimens from the Sloblands compared with just one isolate from elsewhere in Ireland. Samples from nine other waterfowl, five of which were from the Sloblands, tested positive for AIV by rtRT?PCR. Ecological factors are likely to have contributed to the higher detection rate of AIV at the Sloblands compared with the rest of Ireland. It was concluded that targeted surveillance at such sites is a cost-effective means of monitoring the circulation of new AIVs in waterfowl, whereas widespread opportunistic sampling is unproductive and wasteful of resources.
(Accepted August 11 2008)
Key Words:Avian influenza; real-time RT?PCR; targeted surveillance; virus isolation; waterfowl
Correspondence:
c1 Author for correspondence: Mr P. J. Raleigh, Central Veterinary Research Laboratory, Department of Agriculture, Fisheries and Food Laboratories, Backweston Campus, Stacumny Lane, Celbridge, Co. Kildare, Ireland. (Email: pat.raleigh@agriculture.gov.ie)
