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Avian Influenza Daily Digest
September 11, 2008 14:00 GMT
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Article Summaries ...
Quid Novi
WHO: Situation in Indonesia Update #44
Togo quarantines village in suspected bird flu case
Regional Reporting and Surveillance
FAO calls for increased surveillance
9/10/08 Verlagsgruppe Deutscher Fachverlag, contributed by email--A strain of Avian Influenza previously not recorded in sub-Saharan Africa has been detected in Nigeria for the first time, FAO said. Nigeria has recently reported two new outbreaks in the states of Katsina and Kano. Laboratory results from Nigeria and an FAO reference laboratory in Italy show that the newly discovered virus strain (H5N1, clade 2, EMA3) is genetically different from the strains that circulated in Nigeria in 2006 and 2007. The new strain has never been reported before in Africa; it is more similar to strains previously identified in Europe (Italy), Asia (Afghanistan) and the Middle East (Iran) in 2007.
Regional Reporting and Surveillance
Indonesia: International solidarity secures global health
9/10/08 Jakarta Post--Recently, there has been a heated debate over the issue of whether a country infected with a pandemic virus effectively has "sovereignty" or property rights over samples of that virus taken from infected persons within its territorial jurisdiction.
Regional Reporting and Surveillance
Togo: bird flu hits poultry farm
9/10/08 All Africa--An outbreak of bird flu has been confirmed in the West African nation of Togo for the first time since last year, the Health Ministry said Tuesday.
Regional Reporting and Surveillance
Science and Technology
To find better vaccine, VU studies 1918 flu survivors
9/10/08 The Tennissean--The key to preventing influenza pandemics, or even yearly flu strains, could be in the hands of researchers at Vanderbilt University Medical Center.
Science and Technology
Public AI Blogs
Pandemic Preparation: SLU Launches Avian Flu Study
9/10/08 SLU--Saint Louis University School of Medicine seeks volunteers for one of the largest avian flu clinical trials in the United States to test a new vaccine approach to prevent the disease.
Public AI Blog Discussions
Full Text of Articles follow ...
Quid Novi
WHO: Situation in Indonesia Update #44
Avian influenza ? situation in Indonesia ? update 44
10 September 2008 -- The Ministry of Health of Indonesia has retrospectively announced two confirmed cases of human infection with the H5N1 avian influenza virus. The first case, a 38 year old male from Tangerang Municipality, Banten Province developed symptoms on 4 July 2008, was hospitalized on 9 July and died on 10 July. There were free roaming poultry throughout his neighbourhood, including a commercial poultry pen owned by a neighbour.
The second case, a 20 year old male from Tangerang District, Banten Province developed symptoms on 20 July, was hospitalized on 29 July, and died on 31 July. Reports indicate that chickens from the case's household had died in the week preceding the onset of his symptoms and that he had slaughtered and consumed some of his stock during this period.
Of the 137 cases confirmed to date in Indonesia, 112 have been fatal.
Public AI Blog Discussions
Pandemic Preparation: SLU Launches Avian Flu Study
9/10/08 SLU--Saint Louis University School of Medicine seeks volunteers for one of the largest avian flu clinical trials in the United States to test a new vaccine approach to prevent the disease.
The study will test whether an injection of an FDA-approved avian flu vaccine created in 2004 can "prime" the body's immune system so a second shot of a different avian flu vaccine can protect against avian flu infection. The second vaccine is an investigational vaccine, which has not yet been given to people.
"This study will answer several scientific questions, but the most important one is whether you can prime with one strain of influenza vaccine and boost the body's immune system with another," said Robert Belshe, M.D., director of the Center for Vaccine Development at Saint Louis University School of Medicine.
Vaccines protect against influenza by triggering the body to produce antibodies against infection. The study will examine the vigor of the body's antibody response and the safety of the vaccines.
Creating an effective vaccine for the avian flu is challenging. Like any other influenza bug, the avian flu virus -- known as H5 -- is constantly evolving. In addition, two doses of vaccine are likely to be needed to prevent avian flu infection, said Belshe, who is the study's principal investigator.
Avian flu occurs in birds, and in rare instances has crossed the species barrier to infect people. As of June 2008, the World Health Organization reported 385 human cases of avian flu and 243 deaths in Asia, Europe and Africa. The virus has not yet changed so it can be spread easily between people.
Public health experts are concerned that the avian flu could become the next influenza pandemic -- or outbreak of disease that sweeps around the globe, causing millions of deaths worldwide -- because previous outbreaks have been started by bird viruses. Consequently researchers are focused on finding a vaccine to protect against avian flu.
"Although many years have passed since the last major pandemic, the serious threat of pandemic influenza remains," Belshe said.
"So far there has been no substantial leap between the bird species and humans. However other pandemics have started when the organism jumps between species and we're worried it will happen again. A few genetic changes can occur in the virus and it would become highly infectious to humans. We're trying to prepare."
Saint Louis University is the lead site of the research, which is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health and will include up to five study sites. Of the 500 volunteers who are being recruited nationally, up to 167 people will be enrolled at SLU's NIAID-funded Vaccine and Treatment Evaluation Unit (VTEU).
The study involves four to nine visits to the VTEU and overall the study lasts six to 12 months, depending upon the group to which a participant is randomly assigned.
Potential study volunteers must be healthy, between 18 and 49 years of age, not pregnant and not allergic to eggs.
Participants will receive two vaccines -- one or two doses of the 2004 avian flu vaccine that currently is stockpiled; one or two doses of the investigational vaccine that matches a different strain of the avian flu; or both vaccines.
For more information about enrolling in the study, please call the Saint Louis University VTEU at (314) 977-6333 or email vaccine@slu.edu.
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first M.D. degree west of the Mississippi River. Saint Louis University School of Medicine is a pioneer in geriatric medicine, organ transplantation, chronic disease prevention, cardiovascular disease, neurosciences and vaccine research, among others. The School of Medicine trains physicians and biomedical scientists, conducts medical research, and provides health services on a local, national and international level.
Regional Reporting and Surveillance
FAO calls for increased surveillance
9/10/08 Verlagsgruppe Deutscher Fachverlag, contributed by email--A strain of Avian Influenza previously not recorded in sub-Saharan Africa has been detected in Nigeria for the first time, FAO said. Nigeria has recently reported two new outbreaks in the states of Katsina and Kano. Laboratory results from Nigeria and an FAO reference laboratory in Italy show that the newly discovered virus strain (H5N1, clade 2, EMA3) is genetically different from the strains that circulated in Nigeria in 2006 and 2007. The new strain has never been reported before in Africa; it is more similar to strains previously identified in Europe (Italy), Asia (Afghanistan) and the Middle East (Iran) in 2007.
Regional Reporting and Surveillance
Indonesia: International solidarity secures global health
9/10/08 Jakarta Post--Recently, there has been a heated debate over the issue of whether a country infected with a pandemic virus effectively has "sovereignty" or property rights over samples of that virus taken from infected persons within its territorial jurisdiction.
This issue was initially raised by Indonesian Health Minister Siti Fadilah Supari at the 60th World Heath Assembly in May 2007, and again at numerous WHO meetings on avian flu virus sharing and benefit sharing which have taken place recently in Geneva.
Indonesia observed that global activities concerning influenza control had been largely directed at industrialized nations -- mainly for their profit-oriented influenza-related pharmaceutical industries, most of which are based in those countries.
And Indonesia was disappointed to find that these vaccine manufacturers used Indonesian specimens for commercial purposes without first obtaining permission to do so or acknowledging that the benefits of their findings would go beyond the mere confirmation of the virus and/or research purposes for which the samples were submitted in the first place.
Therefore, it is fair to say that unless the benefits derived from the specimens are shared, the current framework for the sharing of viruses is not equitable with the countries that submit virus samples; this is especially true of cases such as Indonesia, where the H5N1 virus is active and where the damage from it (to humans and animals) has been greatest.
And the WHO Global Influenza Surveillance Network (GISN) actually facilitates this unjust, non-transparent and inequitable process.
On the other hand, the global community is facing an unprecedented opportunity to develop and produce a pandemic vaccine. As part of efforts undertaken, the ongoing risk assessment for the influenza virus has necessitated particular attention and research to determine potential vaccine strains and their likely geographical spread.
Currently, fewer than 10 countries have domestic companies engaged in the production of pandemic vaccines. This is certainly not an area in which a small number of players is in the public interest.
Clearly, the more companies available to work and collaborate in this field, the greater the opportunity of developing interventions thus increasing the likelihood of producing a more effective and affordable vaccine.
Furthermore, at present 90 percent of the production capacity for all influenza vaccines is concentrated in Europe and North America. This percentage, it should be recalled, consists of countries that account for only 10 percent of the world's population.
The WHO estimates the current global manufacturing capacity (estimated at 400 million doses of regular trivalent influenza vaccine per year, when produced by 5 international manufacturers) would be utterly inadequate to meet expected global needs (at least 6 billion doses of vaccine) during a pandemic situation.
If the right to carry out this work is restricted to companies located in only a few countries (for the sake of argument, those that are industrialized), in the event of a pandemic the majority of developing countries might have little or no access to vaccines during the first wave, and possibly throughout its duration.
This situation would thereafter engender an explosive increase in the price of a vaccine, rendering it unaffordable for entire populations in any but developed countries.
As we have already seen, the vaccination of poultry and poultry workers in the most affected countries is already barely affordable, while they serve as perhaps the most important target groups for preventing the spread of the virus to the wider population.
Therefore, aside from considerations relating to the injustice of the selective use of the virus, the current virus-sharing pattern also entails an ethical and moral dilemma.
The best way to describe this is perhaps to use the simple analogy of a situation whereby a bike is borrowed from someone and later painted a different color and modified slightly. Can the borrower later call that bike his own and then sell it back to the original owner quoting a higher price?
"Viral sovereignty" does not mean affected countries are not willing to share virus samples with the WHO system or other individual countries or institutions. Rather it provides for the right of countries infected by the virus to decide whether it will be researched by its own laboratories or submitted to other parties, the right to information on the movements of these virus samples, and the rights to a share benefits.
In this regard, Indonesia declared it would only share H5N1 virus samples with parties who agreed not to use them for commercial purposes, and who would provide benefits sharing from the virus for global influenza pandemic preparedness, and who accepted the Material Transfer Agreement (MTA) -- as required by Indonesian national laws and regulations.
During the "vacuum" period of the international virus sharing mechanism, Indonesia sent virus samples in 2007 to parties who accepted Indonesia's requirements.
Since January 2007, Indonesia has developed a new Bio Safety Laboratory 3 (BSL-3) with an international license to monitor and detect the development of potential pandemic influenza viruses.
Through this laboratory, research for risk assessment on pandemic influenza can now be conducted within Indonesia and by Indonesian experts.
This means global health security will not be at risk, and therefore it is misleading to assume that "sovereignty of viruses" would cause major conflicts or be a potential trigger for a new north-south or rich-poor dichotomy.
The writers are both Indonesian diplomats based in Geneva, Switzerland. The views expressed herein are their own.
Science and Technology
To find better vaccine, VU studies 1918 flu survivors
9/10/08 The Tennissean--The key to preventing influenza pandemics, or even yearly flu strains, could be in the hands of researchers at Vanderbilt University Medical Center.
Antibodies recovered from elderly survivors of the 1918 flu pandemic show the body's long-lasting immune response to the virus and may help researchers create vaccines to stop future outbreaks, said Dr. James Crowe, professor of pediatrics at Monroe Carell Jr. Children's Hospital.
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Crowe, along with a team of Vanderbilt researchers, tested the blood of survivors of the sweeping outbreak 90 years ago, which circled the globe at least twice and killed at least 40 million people, including many young, healthy adults.
Researchers initially thought it would be impossible to recover antibodies from
elderly survivors, who are now in their 90s and 100s, Crowe said.
After a virus is cleared by the body, the body responds by creating B cells, which mount a defense against the virus in the future.
Those cells typically float around the body for a few weeks or months, and then dissipate. The fact that there were so many B cells still in the bloodstream 90 years later gave hope to researchers, Crowe said.
"The 1918 virus was a bird flu and there are a number of bird flus that are threatening to cause a pandemic today," Crowe said. "We might be able to develop a drug or vaccine for bird flu."
Crowe thinks the antibodies may have remained in the bloodstream so many years later because of the strength of the original 1918 virus.
Survivors of the outbreak were eager to participate in the study, Crowe said.
"It's very moving. Many of them recall family members who died in the home or neighbors who died," Crowe said. "Even though these people are extremely elderly now, they have very vivid memories of how difficult a time it was."
The threat of bird flu, which affected people in Asia but has not yet crossed into the Western Hemisphere, has spurred the government and medical industry to give higher priority to creating a better influenza vaccine, said Dr. William Schaffner, who chairs the department of preventive medicine at Vanderbilt University.
"This investigation answers some questions but more importantly raises a whole series of others that will keep us working," Schaffner said. "It will stimulate us to think about how we could produce an influenza vaccine that might provide long-term protection from the annual strains even if they vary a bit from year to year."
Quid Novi
Togo quarantines village in suspected bird flu case
9/10/08 Reuters--Togo has imposed a quarantine on a southern village after a suspected outbreak of bird flu killed nearly 4,000 poultry in the small West African state, the government said on Wednesday.
The government's website said the sudden death of the birds at Gbata near Avepozo in the coastal Lacs prefecture indicated a possible outbreak of bird flu.
Samples from the dead chickens were being sent to laboratories in Ghana and Italy to test for the highly pathogenic H5N1 strain of the disease, the website added.
Togo, one of a string of West African countries to be hit by outbreaks of bird flu over the past two years, reported several cases last year of H5N1 avian influenza among poultry.
Togo's Agriculture and Livestock Ministry had reinforced an existing ban on the import of poultry and also tightened controls on ports, markets and frontiers with neighbours Ghana, Benin and Burkina Faso, the website said.
The H5N1 strain, which has swept through bird populations in Asia, Europe, the Middle East and Africa, only rarely affects people but has killed 243 out of 385 people infected globally so far, according to the World Health Organisation.
People can catch the virus from close contact with infected birds or by eating their meat if not properly prepared, but scientists fear the virus could mutate and jump between humans, threatening a much more deadly flu pandemic.
Outbreaks in Africa have raised alarm bells because epidemiologists fear the continent's widespread poverty, lack of proper veterinary and medical facilities and huge informal farming sector could allow outbreaks to go unnoticed longer, increasing the risk of the virus mutating.
Regional Reporting and Surveillance
Togo: bird flu hits poultry farm
9/10/08 All Africa--An outbreak of bird flu has been confirmed in the West African nation of Togo for the first time since last year, the Health Ministry said Tuesday.
The virus was detected at a poultry farm housing more than 4,500 birds in the village of Agbata outside the capital, Lome, said a ministry statement read over state television. It was not known how many birds died, but more than 80 per cent of those infected by the flu were fatalities, the ministry said.
The statement did not say whether the birds were infected with the deadly H5N1 strain of the virus, which has scientists concerned because it has the potential to infect humans. At least 235 people have died of bird flu worldwide since 2003, according to the World Health Organization.
Most human cases have been linked to contact with infected birds, but health experts worry the virus could mutate into a form that passes easily among humans, sparking a pandemic that some say could kill millions of people and overload health care systems.
The Health Ministry banned the sale of all chicken and poultry products in the region around the farm.
