UNCLASSIFIED
Avian Influenza Daily Digest
September 24, 2008 14:00 GMT
This digest is produced by the United States Government, Office of the Director of National Intelligence, Washington DC, USA. Articles and resource documents in this digest are from open sources and unclassified.
This digest contains raw open source content and is not an evaluated intelligence product. Readers are encouraged to contribute updates and/or clarifications that will be posted in subsequent issues of the digest. Articles may contain copyrighted material, further dissemination outside government channels may be prohibited without permission from the copyright owners.
Please note some links may only work while connected to the Intelink network.
Unsubscribe/Subscribe to the AI Digest
Contact AI Digest Editor/Contribute (U) Information
Contribute (U) Updates/Clarifications to a previously reported article
Contribute (U) Information anonymously
Intelink Avian Influenza Resources:
U.S. Govt. IC: Intelink AI/Pandemic page https://www.intelink.gov/mypage/avianflu
Article Summaries ...
Quid Novi
Indonesia: Chicken die-off reported in Merangin
Iraq: Reports of 7 Poultry Farms infected with LPAI in Dahuk
Regional Reporting and Surveillance
Indonesia: MOH Official Provides Totals for AI Cases in August
9/24/08 ARGUS--According to the Director of Zoonotic Diseases Control at the Indonesian Health Ministry (MOH), there were a total of 137 confirmed human cases of avian influenza with 112 fatalities as of August 2008. These cases were spread in 12 provinces. 51% of avian influenza patients were men and 49% were women. There are only two provinces that have not been infected with avian influenza, Maluku and Gorontalo. The highest number of confirmed cases occurred in Tangerang, Banten province, which caused the government to focus its control measures in this area.
Regional Reporting and Surveillance
Togo: Health Officials Intensify Vigilance to Prevent Future AI Occurrence
9/24/08 ARGUS--Togolese health officials alerted poultry breeders and consumers to remain vigilant and immediately alert health authorities of any sudden deaths of wild or domestic poultry. The official reinforced a ban on importations of wild birds and bird products originating from the sub-region [of West Africa, implied] until further notice and indicated that all birds sold in the markets must pass health inspections duly provided by official veterinary services. Article URL(s) http://news.abidjan.net/article/index.asp?n=304647
Regional Reporting and Surveillance
New Zealand unruffled over low pathogenic H5N1 discovery
9/24/08 Poultry Feed Internatioinal--The first ever identification of low pathogenic H5N1 avian influenza in wild birds in New Zealand has just been announced by the MAF Biosecurity Response Team. It essentially dismissed the finding as no danger whatsoever to either poultry or people in this two-island nation deep into the Southern Hemisphere. Are they right to be so laid back and does experience elsewhere indicate insufficient caution being taken?
Regional Reporting and Surveillance
Vietnam: Mekong birds duck away from avian flu
9/24/08 VNS--The Government is urging farmers to switch from raising free-range ducks, offering them incentives to incorporate bio-safety measures to help prevent another H5N1epidemic.
Regional Reporting and Surveillance
Gambia hosts sub-regional meeting on avian influenza
9/24/08 afriquenligne--Participants from five West African countries are taking part in a five-day seminar which opened in Gambia geared towards preventing and controlling Avian Influenza' in the sub-region, informed sources told PANA on Tuesday.
Regional Reporting and Surveillance
Jakarta Post/Indonesia: Bird flu cases down, but pandemic looms
9/24/08 Jakarta Post--Indonesia must continue preparing for a bird flu pandemic, despite reports suggesting declines in cases of bird-to-human and bird-to-bird infections, health officials said Tuesday.
Regional Reporting and Surveillance
Indonesia prepares for bird flu pandemic despite declining cases
9/24/08 Xinhua--The number of humans infected by the H5N1 virus in Indonesia this year was 20 as of August, with 17fatalities. Seeing the situation, Indonesia should persist in preparing for a bird flu pandemic despite reports suggesting declines in cases of bird-to-human and bird-to-bird infections.
Regional Reporting and Surveillance
India: Govt restricts meat imports on bird flu fears
9/24/08 Economic Times--Govt has imposed restrictions on meat imports, particularly from countries which have seen cases of bird flu, the commerce and industry ministry said on Wednesday.
Regional Reporting and Surveillance
Science and Technology
Pathogenesis of emerging avian influenza viruses in mammals and the host innate immune response
9/24/08 Immunological Reviews--Abstract--Influenza A viruses of avian origin represent an emerging threat to human health as the progenitors of the next influenza pandemic. In recent years, highly pathogenic avian influenza H5N1 viruses have caused unprecedented epizootics on three continents and rare but highly fatal disease among humans exposed to diseased birds. Avian viruses of the H7 and H9 subtypes have also infected humans but generally resulted in far milder disease, yet they too should be considered as possible pandemic threats. Influenza virus infection elicits a complex network of host immune responses that, in uncomplicated influenza, results in effective control of the virus and the development of long-term memory responses. However, fatal avian H5N1 virus infection in both humans and experimental mammalian models is characterized by a high viral load in the respiratory tract, peripheral leukopenia and lymphopenia, a massive infiltration of macrophages into the lung, and dysregulation of cytokine and chemokine responses. This review focuses on avian influenza viruses as a pandemic threat, their induction of host innate immune responses in mammalian species, and the contribution of these responses to the disease process.
AI Research
Strict guidelines for GlaxoSmithKline and Roche flu drugs
9/24/08 UK Telegraph--Drug watchdog Nice has recommend the use of GlaxoSmithKline's Relenza and Roche's Tamiflu to fight influenza ? but only if the patient is in an "at-risk group" and "has not been effectively protected by vaccination". The National Institute for Health and Clinical Excellence, which judges drugs on their cost-effectiveness and decides which will be made available under the NHS, issued strict guidelines for when the antiviral medications should be used.
Vaccines
Report suggests refocusing US pandemic vaccine efforts
9/23/08 CIDRAP--The Congressional Budget Office (CBO) suggests in a new report that an increased focus on the development of vaccine adjuvants could save the US government money while improving the nation's preparedness for an influenza pandemic.
Pandemic Preparedness, Vaccines
ImmuneRegen Scientist to Present Viprovex(R) Pre-Clinical Study Findings
9/24/08 Market Watch--ImmuneRegen Scientist to Present Viprovex(R) Pre-Clinical Study Findings at 2008 BARDA Industry Day Drug Candidate Shown to Enhance the Safety and Efficacy of Tamiflu(R) for Treatment of Influenza-- ImmuneRegen BioSciences, Inc. will present pre-clinical study results that indicate that its drug candidate Viprovex(R) enhances the safety and efficacy of Tamiflu(R) (manufactured by Hoffmann-La Roche Inc.) in treating influenza at the 2008 Biomedical Advanced Research and Development Authority (BARDA) Industry Day. Heidi L. Pinyerd, scientific program manager at ImmuneRegen, will display findings in the poster entitled, "Viprovex Enhances Tamiflu Safety/Efficacy in Influenza A/H3N2 Exposed Cotton Rat" at 6 p.m., Sept. 24 and 25th, at the Crystal Gateway Marriott, Arlington, Va.
Vaccines
Full Text of Articles follow ...
AI Research
Pathogenesis of emerging avian influenza viruses in mammals and the host innate immune response
9/24/08 Immunological Reviews--Abstract--Authors: Maines, Taronna R.1; Szretter, Kristy J.1; Perrone, Lucy1; Belser, Jessica A.1; Bright, Rick A.1; Zeng, Hui1; Tumpey, Terrence M.1; Katz, Jacqueline M.1
Influenza A viruses of avian origin represent an emerging threat to human health as the progenitors of the next influenza pandemic. In recent years, highly pathogenic avian influenza H5N1 viruses have caused unprecedented epizootics on three continents and rare but highly fatal disease among humans exposed to diseased birds. Avian viruses of the H7 and H9 subtypes have also infected humans but generally resulted in far milder disease, yet they too should be considered as possible pandemic threats. Influenza virus infection elicits a complex network of host immune responses that, in uncomplicated influenza, results in effective control of the virus and the development of long-term memory responses. However, fatal avian H5N1 virus infection in both humans and experimental mammalian models is characterized by a high viral load in the respiratory tract, peripheral leukopenia and lymphopenia, a massive infiltration of macrophages into the lung, and dysregulation of cytokine and chemokine responses. This review focuses on avian influenza viruses as a pandemic threat, their induction of host innate immune responses in mammalian species, and the contribution of these responses to the disease process.
Keywords: avian influenza virus; pathogenesis; innate immunity
Document Type: Research article
DOI: 10.1111/j.1600-065X.2008.00690.x
Affiliations: 1: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
Quid Novi
Indonesia: Chicken die-off reported in Merangin
9/24/08 ARGUS--A local source reported that ?hundreds? of chickens died suddenly in Lantak Seribu village (Pamenang district, Merangin regency). Rapid testing confirmed avian influenza in ?several? of these chickens. Reportedly, these poultry die-offs have started since September 1; nevertheless, residents waited until a few days ago [date unspecified] to report them to local authorities. The local livestock agency is going to conduct limited culling, which means only culling chickens that came from the same cages as those that were infected.
Article URL(s)
http://www.jambi-independent.co.id/home/modules.php?name=News&file=article&sid=9765
Quid Novi
Iraq: Reports of 7 Poultry Farms infected with LPAI in Dahuk
9/24/08 ARGUS--The Veterinary Department has confirmed that low pathogenicity Avian Influenza (AI) virus has been reported on poultry farms in Dahuk province. The Veterinary Department warned of virus spread unless strict preventive measures are taken. The source indicated that the Department?s warning came during a seminar that discussed the dangers of AI spread, which was attended by poultry farm owners and local officials. The Director of the Veterinary Department indicated that surveys have been carried-out on 7 poultry farms and laboratory test results confirmed that 45% of the chickens on these farms are infected with a low-grade AI (H9) virus. The Director stressed that the closure of the poultry farms in the area for a certain period is a necessary measure for ensuring the success of preventive operations and limiting the spread of the disease. According to the source, poultry farms owners reported that the spread of AI which is caused by the H9 virus, has led to severe damage to their farms. A poultry farm owner indicated that he incurred damages amounting to D 55 million [US$46,704.515] within 50 days and witnessed an average daily 700 chicken die-off among his stock. The farm owners also expressed that they are willing to close the poultry farms provided that the Veterinary Department carries out the preventive measures to control the disease. The Veterinary Department statistics indicated that there are 86 small poultry farm projects in the province with a total production capacity of 7 million tons of chicken meat.
Analyst Note: The report did not provide further information on the numbers or date of reported AI infections.
Article URL(s)
http://www.alnajafnews.net/najafnews/news.php?action=fullnews&showcomments=1&id=73573
Vaccines
Strict guidelines for GlaxoSmithKline and Roche flu drugs
9/24/08 UK Telegraph--Drug watchdog Nice has recommend the use of GlaxoSmithKline's Relenza and Roche's Tamiflu to fight influenza ? but only if the patient is in an "at-risk group" and "has not been effectively protected by vaccination". The National Institute for Health and Clinical Excellence, which judges drugs on their cost-effectiveness and decides which will be made available under the NHS, issued strict guidelines for when the antiviral medications should be used.
Nice said the drugs were "not recommended for general use during flu season for prevention of the illness", and stressed that they should be used alongside a flu vaccine rather than as a replacement.
Tamiflu, a pill, and inhaler Relenza have also been seen as potential treatments for H5N1, commonly known as bird flu.
However, Nice said that their guidance "does not cover the circumstances of a pandemic, an impeding pandemic, or a widespread epidemic of a new strain of influenza to which there is little or no community resistance".
The guidance, which was a review of a 2003 ruling, said that the drugs should only be issued if it has been determined that the flu virus is circulating, the patient is in an at-risk group such as the elderly, the drugs can be issued to the patient in time for them to work, and the patient has already had a flu vaccination.
The drugs could also be used in residential and nursing homes if there is a flu outbreak, Nice said.
Dr Gillian Leng, the deputy chief executive of Nice, said: "Vaccination is the main way to prevent flu and the Department of Health currently recommends that people who are at risk of flu infection or complications are vaccinated at the beginning of each winter. Oseltamivir (Tamiflu) and zanamivir (Relenza) can be used as an additional treatment option as they work in a way that stops the virus from multiplying in the body."
Regional Reporting and Surveillance
Indonesia: MOH Official Provides Totals for AI Cases in August
9/24/08 ARGUS--According to the Director of Zoonotic Diseases Control at the Indonesian Health Ministry (MOH), there were a total of 137 confirmed human cases of avian influenza with 112 fatalities as of August 2008. These cases were spread in 12 provinces. 51% of avian influenza patients were men and 49% were women. There are only two provinces that have not been infected with avian influenza, Maluku and Gorontalo. The highest number of confirmed cases occurred in Tangerang, Banten province, which caused the government to focus its control measures in this area.
Reportedly, Indonesians prefer to go to private hospitals at the onset of avian influenza symptoms because they believe that private hospitals will deliver better treatment. The government has chosen to distribute Tamiflu only to public hospitals and government-sponsored community health clinics. Indonesia, according to the source, is at ?phase three? of pandemic influenza in which humans are being infected with new subtype of influenza virus [subtype was not provided]. However, there is no human-to-human transmission, which, ?if it happens, happens because of close familial relationship.?
Article URL(s)
http://www.bipnewsroom.info/index.php?_language=Indonesia&_mainNo=11&_subNo=&_insideSubNo=&newsid=41437&_link=loadnews.php
Regional Reporting and Surveillance
Togo: Health Officials Intensify Vigilance to Prevent Future AI Occurrence
9/24/08 ARGUS--Togolese health officials alerted poultry breeders and consumers to remain vigilant and immediately alert health authorities of any sudden deaths of wild or domestic poultry. The official reinforced a ban on importations of wild birds and bird products originating from the sub-region [of West Africa, implied] until further notice and indicated that all birds sold in the markets must pass health inspections duly provided by official veterinary services.
Article URL(s)
http://news.abidjan.net/article/index.asp?n=304647
Regional Reporting and Surveillance
New Zealand unruffled over low pathogenic H5N1 discovery
9/24/08 Poultry Feed Internatioinal--The first ever identification of low pathogenic H5N1 avian influenza in wild birds in New Zealand has just been announced by the MAF Biosecurity Response Team. It essentially dismissed the finding as no danger whatsoever to either poultry or people in this two-island nation deep into the Southern Hemisphere. Are they right to be so laid back and does experience elsewhere indicate insufficient caution being taken?
Two ducks near the South Island city of Invercargill, one at an estuary 2km west of the city of and one at Roslyn Bush, were found to be carrying the virus following a surveillance programme in February 2008 that tested six other sites throughout the country. The findings were confirmed the week beginning September 15, 2008, said a report by Southland Times. Invercargill was the only site with infected wild birds.
A low path virus
MAF Biosecurity animal response team manager Dr. Andre van Halderen said it was the first time H5N1 LPAI (low pathogenic avian influenza) had been recorded in New Zealand. He stressed it should not be mistaken for H5N1 HPAI, the highly pathogenic avian influenza virus that has spread in parts of Asia, Middle East, Europe, and Africa, killing more than 200 people and forcing the destruction of millions of birds. H5N1 HPAI has not been recorded in New Zealand.
"The low pathogenic avian influenza viruses are adapted to waterfowl and shorebirds, which are their natural hosts," said van Halderen. He said nature of this low path virus meant it was impossible it could cross-species jump into humans and mutation was highly unlikely. "There's a negligible risk of it firstly getting into birds [poultry] and because it's low-path it causes very mild or no clinical disease in domestic poultry. It's only through mutation into highly pathogenic strains that you will get strains arising which cause problems," he said according to Southland Times and Stuff.co.nz.
Laid back attitude
This laid back attitude adopted by the New Zealand government appears to be based on the assumption that low path H5 (and H7) subtypes are completely benign. Does this view stack up with experience elsewhere? Unfortunately, the answer is no.
Incidences of low path H5 and H7 avian influenza mutating into high path types during in poultry are not uncommon. Two of the most well established and costly examples involved H7 subtypes in Canada and the Netherlands. During 2004, low path H7N3 mutated into a high path virus strain during an outbreak in British Colombia Canada leading to eventual death and destruction by culling of 20 million birds.
Low path H7N7 mutating into high path virus in the Netherlands a year earlier wrought even more havoc. Over 30 million poultry were culled, around 80 poultry workers contacted the virus showing either conjunctivitis or flu-like symptoms, and many more were found to be carrying H7N7 antibodies. One veterinarian died from the disease and there was strong evidence of human to human transmission.
More recently (2008), an outbreak of high path H7N7 in the County of Oxfordshire in the United Kingdom (UK) is thought to have arisen by mutation from a low path virus resident in the flock. Even more bizarre was progress of low path H7N2 in North Wales and northwest England in 2007. Starting with the purchase of a dozen layer hens from a hobby bird market, it quickly moved into the human population as a low path virus. Though eventually controlled, it infected more humans than birds and achieved some human to human transmission. Most human symptoms were mild although one infected couple in the County of Lancashire told the media how they suffered full blown influenza and were so ill they ?thought they were going to die.? Wild birds are thought to have been the original source for all of these outbreaks.
Van Haldren said, "The risk of HPAI 'bird flu' reaching New Zealand is unchanged and remains low. This finding does not affect New Zealand's avian influenza disease-free status, and poultry consumers have no cause for concern." While this is certainly true in theory, the world is extremely sensitive to even a "whiff" of H5 or H7 bird flu, irrespective of whether high or low path.
Reaction from other countries
Governments are quick to ban imports from affected countries in an effort to stay completely free of the virus. This will include countries like the Philippines, one of only several East Asian nations to stay free of H5N1, and Hong Kong and Japan, which although currently H5N1 free, know first-hand the damage caused from previous outbreaks. Even countries where the disease is currently spreading or indeed endemic are quick to pull down the shutters on imports from countries announcing H5 or H7, high path or not.
A recent change in the World Organisation for Animal Health (OIE) official policy suggests this non-government organisation believes there is a real risk from low path H5 and H7 subtypes. In the past, there was no requirement for reporting or tracking LPAI H5 or H7 detections in wild birds, but the OIE then changed its requirement for reporting detections of avian influenza. Since 2006, all confirmed LPAI H5 and H7 subtypes must be reported to the OIE because of their potential to mutate into highly pathogenic strains. For this reason, the U.S. Department for Agriculture (USDA) now tracks these detections in wild birds, backyard flocks, commercial flocks, and live bird markets.
A very recent example of one country reacting to another?s low path H5 or H7 avian influenza was the Republic of the Philippines (RP) confiscating all poultry imports from Denmark. According to a Department of Agriculture (RP) report, Agriculture Secretary Arthur Yap directed quarantine officers and inspectors at all major airports and sea ports in the country to confiscate all incoming shipments of live birds, poultry, and poultry products from Denmark.
The ban was in response to an outbreak (April 29, 2008) of low pathogenic H7N1 at a wild duck farm on Fyn Island in Southern Denmark. The majority (1500) of the 2000 plus birds culled were wild mallard ducks because main business of the farm was breeding birds to re-stock wild bird populations for hunting purposes. The other birds culled were 250 domestic ducks and 300 geese. Though not widely reported, OIE was informed, which is presumably from where the RP authorities learned about this outbreak of disease in Denmark. This was in response to a low path H7 virus which does not carry the same "baggage" as H5N1.
Increased surveillance
The New Zealand authorities say their tests have indicated that low path H5N1 virus might have been in the country for some time and could even be endemic. The ducks were healthy and were not killed as a result of infection, Dr. Van Halderen said. This should not be taken as a source of comfort because it means they are free to excrete the virus and spread it in the environment. Ducks (wild and domestic) are not called the "silent carrier" or "Trojan Horse" of H5N1 without good reason. The authorities in New Zealand say they expect increased surveillance to show H5N1 LPAI is present elsewhere in the country.
Authorities in neighbouring Australia appear to be taking the finding a lot more seriously, according to a report by Stuff.co.nz, which said Australian poultry owners are being warned to step up their own biosecurity checks in the wake of the discovery. "Australian poultry owners should ensure wild water-birds cannot access poultry feed or water and should limit contact between wild water-birds and poultry," said Biosecurity Queensland's chief veterinary officer Ron Glanville. "This is just a commonsense, precautionary measure."
Pandemic Preparedness > Vaccines
Report suggests refocusing US pandemic vaccine efforts
9/23/08 CIDRAP--The Congressional Budget Office (CBO) suggests in a new report that an increased focus on the development of vaccine adjuvants could save the US government money while improving the nation's preparedness for an influenza pandemic.
Noting that the government has been spending large amounts to increase egg-based flu vaccine production capacity and develop cell-based production capacity, the CBO says it might be wise to shift some funds into the development of adjuvants (chemicals that reduce the amount of vaccine needed to generate an immune response).
"The arithmetic of pandemic vaccination changes dramatically . . . if adjuvanted vaccines are developed and approved," says the report. If adjuvants fulfill their promise, it adds, the egg-based and cell-based production facilities now available or under construction would be enough to meet HHS's goal of vaccinating every US resident within 6 months of the start of a pandemic.
The CBO published its findings on Sep 15. The 52-page report gauges progress the Department of Health and Human Services (HHS) has made since 2005, when it outlined two main vaccine goals in its pandemic plan: to increase production capacity by 2011 to vaccinate the entire US population within 6 months of a pandemic onset and to stockpile enough vaccine to inoculate 20 million people shortly after a pandemic begins.
The report, requested by Senate Majority Leader Harry Reid, D-Nev., was written by Julie Somers and Philip Webre of the CBO's microeconomic studies division. The authors consulted government, industry, and academic experts, including David Fedson, MD, a retired professor of medicine from the University of Virginia and former researcher with Aventis Pasteur who is an internationally known vaccine expert.
Though the CBO offers a range of options for HHS officials to consider, it does make recommendations in the report. The CBO's task is to provide Congress with nonpartisan background information, estimates, and projections for economic and budget decisions.
Adjuvants change the dynamic
Additional spending will be needed to pursue federal pandemic vaccine goals, and HHS isn't likely to meet its goal of being able to immunize 300 million people by 2011 in the event of a pandemic, the authors write.
However, the CBO says the development of adjuvants could change the course of the government's pandemic vaccine policy. Clinical trials suggest that adjuvants could be used to stretch supplies of antigen. The current pandemic (H5N1) vaccine in the national stockpile provides "poor-to-moderate" protection with two 90-microgram (mcg) doses, but adjuvanted vaccine candidates have been shown to provide acceptable protection with two 3.8- to 7.5-mcg doses of antigen. Also, the CBO says that policymakers have more information now about pandemic vaccines than they did in 2005 when plans were released.
"Adjuvants developed since 2005 could substantially reduce the amount of antigen needed per dose, raising the question about whether HHS's current policy is the most cost-effective approach to meeting its vaccine production goals," CBO Director Peter R. Orszag wrote in a Sep 15 blog post that accompanied the report.
"An extrapolation of the results from clinical trials leads to the preliminary conclusion that, by 2011, domestic egg-based manufacturing could produce enough antigen within six months of the onset of a pandemic to immunize 225 million people with adjuvanted vaccines at 15 micrograms per dose," the report says. But if adjuvants are not used, the projected capacity would be enough to immunize only about 38 million people, it adds.
The CBO says the existing pandemic stockpile is about 26 million doses, but 15 million doses have expired, leaving about 11 million, or enough to vaccinate about 5.6 million people.
The CBO predicts that if adjuvants fulfill their promise, HHS officials could consider setting new goals for boosting domestic production capacity. For example, the report estimates that it would cost between $1.2 billion and $1.8 billion to build production facilities to make adjuvanted cell-based vaccines, but places the building cost for making nonadjuvanted cell-based vaccines at between $7.6 billion and $11.4 billion.
HHS policy focuses on cell-based vaccine production because it offers a potentially more reliable production method that does not depend on chicken eggs and can be more quickly ramped up to meet production needs in a pandemic setting.
The report says that having too much cell-based production capacity during nonpandemic years could create another cost. "To keep the factories ready to operate, continuing federal support?in the form of purchases for the stockpile or direct payments?would probably be necessary," it states. However, if capacity is reduced, the resulting reliance on a small number of manufacturers, especially those that rely on poultry flocks, raises the risk of supply disruption during a pandemic.
Counting all stockpiling costs
Most of the government's work on the pandemic vaccine has involved acquiring vaccine in the first place, but the CBO says the cost to replace expired vaccine and adjuvant could be significant, with an annual price tag ranging from $350 million to $1.1 billion. Assuming a 3-year shelf life for an adjuvant, the CBO puts the annual cost of maintaining the supply of both adjuvant and antigen at $350 million. However, without the use of adjuvants, the yearly cost for replacing necessarily greater quantities of expired antigen would rise to $1.1 billion.
Jeff Levi, executive director of Trust for America's Health, a nonprofit public health advocacy group based in Washington, DC, told CIDRAP News that the discussion of the continuing costs of the vaccine stockpile is one of the most interesting points of the CBO's report. The annual cost of maintaining the stockpile hasn't been factored into federal budget projections, he said.
"That's a large amount of money, and it's large in the public health world. We obviously need to address this issue as well," Levi said.
Replacement and shelf-life issues regarding antiviral stockpiles are fairly straightforward, but maintaining vaccine stocks is much more complex, he said, adding, "The up side is the vaccine supply may need to be replenished to adjust for mutations."
More for next-generation vaccines?
The HHS pandemic plan contains few incentives for firms to develop next-generation vaccines, such as those that use recombinant DNA techniques, the CBO reports. However, if the use of adjuvants allowed HHS to cut back on the amount of antigen in the stockpile and on building production capacity, this could free up more resources to support the development of next-generation vaccines.
Use of a safe and effective adjuvant could also stretch the vaccine supply to immunize well above HHS's initial goal of 20 million people at the start of a pandemic.
The reports draws a contrast between the US policy of direct support for vaccine manufacturers and Europe's model for building pandemic vaccine supply and capacity through advance supply agreements, under which governments make advance payments to guarantee a supply of vaccine in the event of a pandemic.
Although the US approach of subsidizing the development of production capacity could result in a greater supply of vaccine, it does not guarantee there would be enough: "Manufacturers could exhaust their supplies when filling their European agreements before they have a chance to sell any to the United States," the report says. On the other hand, with advance supply agreements, there is a risk that manufacturers won't have the capacity to fulfill them.
Regional Reporting and Surveillance
Vietnam: Mekong birds duck away from avian flu
9/24/08 VNS--The Government is urging farmers to switch from raising free-range ducks, offering them incentives to incorporate bio-safety measures to help prevent another H5N1epidemic.
On a 50sq.m yard in My Hoa Commune, Thap Muoi District, Dong Thap Province, three local veterinary workers are inoculating Le Minh Doi?s ducks against the H5N1 virus.
Ducks at a farm in Tay Ninh Province. To protect them from diseases the birds are regularly vaccinated and confined to the farm.
"This is the second time they?ve got the vaccine. The first was 15 days after the eggs hatched," Doi said. "Before vaccination, they were given drops of vitamins to build up their resistance against the vaccine?s side effects."
"We also vaccinated them for cholera and flu according to the schedule set by local vets."
The 48-year-old farmer is among many in the Cuu Long (Mekong) Delta incorporating bio-safety measures into the work of breeding ducks.
A worker undergoes bio-safety measures in cleaning the ducks' cages by spraying.
"My birds are raised on a closed farm. This is in keeping with experts? advice to watch where animals stay and live, to prevent them from mixing with wild birds, and to keep different animal species separate," Doi said. "We give the ducks industrially-processed food and clean water sources that are changed every four days."
"Using the safe farming model brings us a lot of benefits, like money," he said.
Ducklings are raised on the farm in carefully controlled conditions. Even the water they drink is supplied through cylinders.
To raise 1,000 ducks, Doi needs a VND30 million investment, but reaps a VND15-20 million profit in addition to a fish pond worth about the same amount after 60 days.
A duck brought up with bio-safety measures usually weighs 3 to 3.5kg, and is sold for VND35,000 per kilo. Meanwhile, ducks raised the traditional, free-range way end up weighing only 1.5 to 2kg, go for VND20,000 and 22,000 per kilo.
Thanks to a closed farm, Doi does not need to rely on others to raise up to 2,000 birds.
A worker feeds the birds industrially-processed feed.
"Now, I not only make more money, but have more time to do housework like gardening and helping my kids? with their schoolwork," he said. "Plus, duck droppings can be used in raising fish and that?s good for the environment."
When his ducks wandered free range on the paddy fields, two or three people had to be hired to watch over them. He also had to pay landowners VND220,000-250,000 for each hectare of harvested paddy to let the ducks feed on them.
Free-range birds face higher risks of infections from migratory birds and ingesting pesticides or chemical fertilisers. Doi?s ducks were dropping like flies.
"In 2003, I quit farming after losing over VND100 million when more than 4,000 of my ducks were culled because of bird flu. But then I restocked and went back to breeding ducks in late 2005 since I had no other career options," he said.
Huynh Tan Man of Long An Province?s Chau Thanh District has also reformed his ways. "I changed my farming methods in early 2007. Now the flock stays in a fenced area on a section of a canal for at least 10 days before they?re moved somewhere else."
"I always check the new field carefully in advance to make sure it?s epidemic-free. I also do all the necessary preventive measures, like vaccinations," he said.
"After more than a year of using the bio-safe method, I made a profit of VND100 million, along with almost VND50 million from raising fish with duck droppings," he said. The extra money has been used to take care of Man?s family of six as well as more ducks. He recently bought an incubator.
"The bio-safety measures really helped us avoid the nightmares that bird flu caused last time," he said.
In the last five years, six outbreaks of the H5N1 virus were responsible for the culling of 46 million birds in Viet Nam. Bird flu claimed the lives of 104 people in the country as well.
During the scare, the Government banned duck breeding temporarily as waterfowl are less resistant to infections than other kinds of poultry.
Soon after the outbreaks ended, farmers resumed raising ducks. Local authorities imposed several preventive measures to protect flocks from contracting the disease, including the promotion of new duck breeding methods. Dry breeding and breeding in closed farms became more and more popular across the Mekong Delta.
An Giang Province leads the delta in developing safe farming models. Over 13 per cent of the total duck raising households have closed farms. The figure is expected to jump 50 per cent by the end of the year.
In Tay Ninh Province, more than 20,000 ducks are now raised on closed farms, while farmers in Dong Thap Province use fenced trenches, fish ponds and rice fields to raise ducks. So far the new models have proven to be effective.
Many still left behind
Though the benefits of bio-safety are evident, the new methods are still out of the reach for most duck breeders in the Mekong Delta.
On a rough dirt road winding through green rice paddies, Nguyen Van Hoi of Phu Loi District, Soc Trang Province threw unhusked rice mixed with mash and dried fish to thousands of ducks wading around this thin legs.
Hoi still uses the traditional free-range model.
"I have been raising ducks for more than 20 years. I know all the advantages the bio-safety method can bring. However, I have neither the knowledge nor the cash or land to apply the new method so I?m using the traditional one," he said.
"I recognise that free-range farming is out of line with official policy but I cannot give up my means of living," said the father of five.
"The bio-safe model would cost us more money because I?d have to buy feed for the ducks and find enough land to enclose them," Hoi said. "My ducks now eat snails and insects because they roam freely."
Duong Van Chenh, a duck breeder in Soc Trang City, said: "Changing models is hard. The new one requires a big investment, and most of our capital sources limited."
According to him, most breeders don?t have the training to apply the new techniques. "We can only apply the bio-safety measures unless the Government and relevant agencies offer technical and financial support."
Richer resources
Dr Duong Xuan Tuyen, an expert from the National Institute of Animal Husbandry, attributes the Mekong Delta?s ideal natural conditions to why raising ducks is a main source of livelihood for a lot of farming households, especially poor ones, in the area.
"The region now has 10 provinces that are raising more than 20 million ducks, accounting for 34 per cent of the country?s total," according to Tuyen.
"Many still use free-range techniques because they require modest investments and no breeding facilities. Between 65 to 70 per cent of ducks in the Mekong are raised that way," he said.
In addition to cutting costs, letting ducks loose benefits rice crops because they eat pests like brown plant hoppers and yellow snails, provide manure, and clean fields.
"However, the traditional free-range model creates opportunities for epidemics to break out. It?s difficult to contain their spread once they do," said Tuyen.
"To ensure sustainable development of the local duck industry, we have to augment the application of bio-safety models on a large scale and minimise small scale production with drastic measures."
Nguyen Ba Thanh, director of the Region 7 Veterinary Centre, said: "Farmers should be familiarised with preventive steps like vaccinations, bio-safety measures or epidemic surveillance. Local veterinary workers should have opportunities to participate in training courses to improve their professional skills.
"It?s easy to adopt such measures against epidemics at industrial or closed farms, but small scale ones are hard to keep track of," Thanh said.
Bui Xuan Men, head of Can Tho University?s Agriculture Faculty, said: "Developing duck breeding is developing the delta?s strengths since it would utilise available natural resources and give resource-poor farmers bigger profits, gainful employment and better dietary standards."
Men suggests that the new models be promoted via mass media so all farmers can apply them and that poor breeders receive low-interest loans to do so.
The Government has approved a breeding development strategy until 2020 under which the country?s breeding industry will shift to industrial production, said Nguyen Thanh Son, deputy director of the Livestock Production Department.
"The main objective is to have farm-based breeding increase from the current 20 per cent to 33 per cent in 2010, 49 per cent in 2015 and 60 per cent in 2020," Son said.
The Government has enacted policies and measures to reach its goals. For example, a master plan for zoning of commercial poultry farms to ensure they are right for their ecological conditions is in the works, he said.
Preferential policies have also been granted to individuals and corporations investing in central breeding and processing operations.
"Breeders using closed farms can get complete financial support from the State to build infrastructure facilities off the farms, and enjoy other perks dealing with land lease times and fees," Son said.
(Source: VNS)
Vaccines
ImmuneRegen Scientist to Present Viprovex(R) Pre-Clinical Study Findings
9/24/08 Market Watch--ImmuneRegen Scientist to Present Viprovex(R) Pre-Clinical Study Findings at 2008 BARDA Industry Day Drug Candidate Shown to Enhance the Safety and Efficacy of Tamiflu(R) for Treatment of Influenza-- ImmuneRegen BioSciences, Inc. will present pre-clinical study results that indicate that its drug candidate Viprovex(R) enhances the safety and efficacy of Tamiflu(R) (manufactured by Hoffmann-La Roche Inc.) in treating influenza at the 2008 Biomedical Advanced Research and Development Authority (BARDA) Industry Day. Heidi L. Pinyerd, scientific program manager at ImmuneRegen, will display findings in the poster entitled, "Viprovex Enhances Tamiflu Safety/Efficacy in Influenza A/H3N2 Exposed Cotton Rat" at 6 p.m., Sept. 24 and 25th, at the Crystal Gateway Marriott, Arlington, Va.
"Studies conducted by ImmuneRegen, Virion Systems, Inc. and PanFlu, LLC indicated that a combination of Viprovex and Tamiflu was more effective in treating viral infection with human influenza A/H3N2 in cotton rats compared to treatment with Tamiflu alone," said Hal Siegel, Ph.D., ImmuneRegen's vice president and chief scientific officer. "Results showed that Viprovex reduced the lung inflammation resulting from infection in cotton rats -- the preferred small animal for studying influenza virus pathogenesis -- while those treated only with Tamiflu experienced no reduction."
Added Siegel, "The other key finding indicated that influenza-infected animals experienced infection-associated hypothermia and weight loss, but those administered Viprovex underwent substantial improvement. Good Laboratory Practice compliant safety studies are underway and our goal is that human clinical trials involving Viprovex will start in 2009."
Studies also indicated that animals on the combined drug regimen had a lower mortality rate (7 percent) compared to those on Tamiflu alone (14 percent) while those that only received Viprovex all survived.
Viprovex is an intranasal drug candidate for potential use against infectious diseases as a vaccine adjuvant or as part of combination therapy. It is based on Homspera(R), ImmuneRegen's adult stem cell active compound, which has shown in studies that it may function to regenerate and strengthen the immune system and enhance wound healing. Tamiflu is an antiviral drug approved by the U.S. Food and Drug Administration for the treatment and prevention of uncomplicated influenza in adults and children at least one year old. It has been taken by tens of millions of patients and stockpiled by governments worldwide. However, increasing reports of adverse events in children and viral resistance to Tamiflu have sparked concern about Tamiflu's effectiveness against influenza.
The 2008 BARDA Industry Day provides an open forum for companies interested in working with the Federal Government to showcase technological advances in medical countermeasures to man-made and naturally occurring threats. Presenters will demonstrate the progress of current activities in advanced research and development of medical countermeasures that will contribute to the success of the U.S Health and Human Services Pandemic Influenza Plan, Project BioShield, BARDA, and the HHS Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Strategy and Implementation Plan.
Regional Reporting and Surveillance
Gambia hosts sub-regional meeting on avian influenza
9/24/08 afriquenligne--Participants from five West African countries are taking part in a five-day seminar which opened in Gambia geared towards preventing and controlling Avian Influenza' in the sub-region, informed sources told PANA on Tuesday.
The seminar on "Avian Influenza Incident Command System" is jointly organized by United States Government and Gambia's National Agricultural Development Agency.
In his opening address, Gambia government representative, Kekoi Kuyateh said despite numerous efforts made towards containing and stopping the disease, it seems to be spreading across Africa and beyond.
"Avian Influenza posses a real threat to the lives and livelihoods of millions of people around the world; to the economy and human health," he said.
"Cognizant of this fact, the Gambia commits itself to harmonized, coordinated and partnership building approach as the most effective way in dealing with the disease."
The participants are drawn from Gambia, Senegal, Ghana, Liberia and Sierra Leone.
Dakar - 23/09/2008
Regional Reporting and Surveillance
Jakarta Post/Indonesia: Bird flu cases down, but pandemic looms
9/24/08 Jakarta Post--Indonesia must continue preparing for a bird flu pandemic, despite reports suggesting declines in cases of bird-to-human and bird-to-bird infections, health officials said Tuesday.
Erna Tresnaningsih, the Health Ministry's director for animal-vector diseases, said the confirmed number of humans infected by the H5N1 virus in Indonesia this year was 20 as of August, with 17 fatalities.
This is a decline, she claimed, from 55 cases with 45 fatalities in 2006 and 42 cases with 37 fatalities in 2007.
Indonesia has recorded a total of 137 confirmed bird-to-human infections, 112 of them fatal, since July 2005, when H5N1 was first found to attack humans.
Erna added 12 of the country's 33 provinces had recorded infections in humans, but seven of the provinces saw no new cases in the past year, leaving incidents of bird flu infections concentrated in West Sumatra, Banten, Jakarta, West Java and Central Java.
"Praise be to God, with good partnership we've been able to push the figures," she told a forum on boosting businesses' preparedness for a possible bird flu pandemic.
Muhammad Azhar, the Agriculture Ministry's avian influenza control unit coordinator, reported a declining trend in the number of poultry infected by the H5N1 virus.
He said poultry in 31 provinces had been infected by H5N1, with only Gorontalo and North Maluku free from the virus, but added that nine of the provinces had not reported any new cases in the past six months.
"Areas still at risk are those on Java Island, because it is the main producer of both pedigree and non-pedigree chickens," Azhar said.
Despite the declining number of infections, Indonesia has to be alert to the possibility of a bird flu pandemic, which, once it breaks out, could infect up to 66 million people, the Health Ministry warned.
Emil Agustiono, deputy to the coordinating minister for people's welfare, said a bird flu pandemic was unpredictable, but could happen through either the breeding of the H5N1 avian influenza virus with the H3N2/H1N1 human influenza virus, or through the mutation of the H5N1 virus in the human body.
Both processes could produce a new type of deadly, transmittable human-to-human influenza virus, which could then lead to a new influenza pandemic, he said.
Subhash Salunke, the World Health Organization's (WHO) representative to Indonesia, warned that once the pandemic struck, Indonesia would see an overwhelming of health care services, the collapse of critical public services, workforce absenteeism, public fear and panic, and the closure of borders, travel and trade.
He said Indonesia could suffer from economic losses of US$1.4 billion if the pandemic lasted six months, or up to $5.8 billion if it lasted a year.
Salunke emphasized the need for preparedness and intervention in the case of a pandemic, so as to minimize its severity, adding that if a new flu pandemic did strike, it could cause 160-300 million deaths globally.
Alan Boulton, the International Labor Organization's (ILO) Indonesia country director, said if employers wanted their businesses to keep running during such a pandemic, they would have to start preparing their workplaces and developing business continuity plans involving their employees.
Regional Reporting and Surveillance
Indonesia prepares for bird flu pandemic despite declining cases
9/24/08 Xinhua--The number of humans infected by the H5N1 virus in Indonesia this year was 20 as of August, with 17fatalities. Seeing the situation, Indonesia should persist in preparing for a bird flu pandemic despite reports suggesting declines in cases of bird-to-human and bird-to-bird infections.
"This is a decline, from 55 cases with 45 fatalities in 2006 and 42 cases with 37 fatalities in 2007," the Jakarta Post daily on Wednesday quoted the Indonesian Health Ministry's director for animal-vector diseases Erna Tresnaningsih as saying.
Indonesia has recorded a total of 137 confirmed bird-to-human infections, 112 of them fatal, since July 2005, when the H5N1 virus was first found to attack humans.
Twelve of the country's 33 provinces had recorded infections in humans, but seven of the provinces saw no new cases in the past year, leaving incidents of bird flu infections concentrated in West Sumatera, Banten, Jakarta, West Java and Central Java.
Regional Reporting and Surveillance
India: Govt restricts meat imports on bird flu fears
9/24/08 Economic Times--Govt has imposed restrictions on meat imports, particularly from countries which have seen cases of bird flu, the commerce and industry ministry said on Wednesday.
For countries where bird flu cases have been reported, India has banned imports of live birds, including poultry; bird meat and eggs or their products; pigs and unprocessed pig products; and products intended for use in animal feeding, agriculture or industrial use.
The ministry said the restrictions would apply both to cases of "highly pathogenic" and "low pathogenic notifiable avian influenza". From countries where bird flu has not been reported, imports of all birds other than poultry and captive birds have been stopped.
The government has also banned unprocessed meat and meat products from "avian species" from these countries. The curbs are listed in a government order dated September 23, which appeared on the ministry's official website on Wednesday.
