DNI Avian Influenza Daily Digest

UNCLASSIFIED

Avian Influenza Daily Digest

October 31, 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.

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Contribute (U) Updates/Clarifications to a previously reported article
Contribute (U) Information anonymously
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Intelink Avian Influenza Resources:
U.S. Govt. IC: Intelink AI/Pandemic page https://www.intelink.gov/mypage/avianflu

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Article Summaries ...

Regional Reporting and Surveillance

Indonesia: September 2008 Poultry update
10/30/08 Poultry Indonesia--[edited, see link for full text article]--In the past two and half years, Muhammadiyah has seen 12,000 members in 12,000 villages carry out bird flu campaigns across the country, Ahmad said.
Regional Reporting and Surveillance

Science and Technology

First steps in the design of a system to monitor vaccine effectiveness during seasonal and pandemic influenza in EU/EEA Member States.
10/08 Euro Surveillance--[Abstract]--Estimating influenza vaccine effectiveness (IVE) early in the season helps measuring the consequences of a mismatch between the vaccine and the circulating strain and guiding alternative or complementary interventions. The European Centre for Disease Prevention and Control is funding a project to develop pilot studies to monitor IVE in the Member States (MS) of the European Union and European Economic Area (EU/EEA) during seasonal and pandemic influenza. To identify key methodological and practical issues in developing protocols for pilot studies, we conducted a survey among EU/EEA MS, a literature review on IVE methods, and consultations of experts. The survey and literature review highlighted the variety of the data sources used to estimate IVE and the difficulty to interpret data on IVE, which varies with age, risk group, outcome specificity and virus-vaccine mismatch. We also found that negative and positive confounding can bias IVE. The experts consultations lead to the following recommendations: to measure IVE in the same population in various seasons; to control for positive/negative confounding (including pre- and post-influenza season IVE estimates); and to include laboratory confirmation as outcome in various study designs. In the 2008-9 influenza season, two cohort studies using general practitioners' databases and six case control studies will be piloted in EU/EEA MS and will adhere to the above recommendations. The pilot studies will be the basis for the development of robust methods to monitor IVE in EU/EEA MS.
AI Research

Neutralizing human monoclonal antibody against H5N1 influenza HA selected from a Fab-phage display library
10/08 Journal of Virology--[Abstract]--Identification of neutralizing antibodies with specificity away from the traditional mutation prone antigenic regions, against the conserved regions of hemagglutinin from H5N1 influenza virus has the potential to provide a therapeutic option which can be developed ahead of time in preparation for a possible pandemic due to H5N1 viruses. In this study, we used a combination of panning strategies against the hemagglutinin (HA) of several antigenic distinct H5N1 isolates to bias selection of Fab-phage from a naive human library away from the antigenic regions of HA, toward the more conserved portions of the protein. All of the identified Fab clones which showed binding to multiple antigenically distinct HA were converted to fully human IgG, and tested for their ability to neutralize the uptake of H5N1-virus like particles (VLP) into MDCK cells. Five of the antibodies which showed binding to the relatively conserved HA2 subunit of HA, exhibited neutralization of H5N1-VLP uptake in a dose dependant manner. The inhibitory effects of these five antibodies were similar to those observed with a previously described neutralizing antibody specific for the 140s antigenic loop present within HA1 and highlight the exciting possibility that these antibodies may be efficacious against multiple H5N1 strains.
AI Research

Peptide mimics of a conserved H5N1 avian influenza virus neutralization site
10/08 Journal of Biochemestry--[Abstract]--A panel of 52 murine monoclonal antibodies was found to recognize antigenic determinants that had been conserved among all major genetic subgroups of the H5N1 avian influenza virus prevalent since 1997. Approach. We screened a phage display library for peptides recognized by one such antibody (8H5). 8H5 specificity of reactive peptides was analyzed as they were presented as fusion proteins of hepatitis B core protein (HBc) and hepatitis E virus structural protein, p239, and related to that of native HA molecule according to the capacity of fusion proteins to compete for 8H5 binding with different strains of H5N1 virus and that of antisera generated against fusion proteins to bind native HA molecules and to inhibit hemagglutination and arrest infection by the virus. Result. Nine reactive peptides of different amino acid sequences were identified, 6 of which were also reactive with the antibody in association with HBc and 4, in association with p239. Binding occurred with dimeric form of the 4 p239 and one of the HBc fusion proteins, but not with the monomeric form. The HBc fusion proteins blocked 8H5 binding with 4 strains of H5N1 influenza virus. Mouse antisera generated against fusion proteins bound to HA molecules, but did not cause HAI or arrest HEV infection. Conclusion. Findings inferred that 8H5 recognizes discontinuous sites presented by secondary and possibly higher structural orders of the peptides in spatially favorable positions for binding with the antibody, and that the peptides partially mimic the native 8H5 epitopes on the H5N1 virus.
AI Research

Emergence of Amantadine-Resistant H3N2 Avian Influenza A Virus in South Korea
10/08 Journal of Clinical Microbiology--[Abstract]--We found a relatively high frequency of unique amantadine-resistant H3N2 and H9N2 avian influenza viruses (Val27Ile on M2 protein) isolated from live poultry markets in South Korea and confirmed that a Val27Ile single substitution in the M2 protein is enough to acquire the amantadine resistance phenotype by using reverse-genetically created human-avian reassortant viruses.
Science and Technology

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Full Text of Articles follow ...

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Regional Reporting and Surveillance

Indonesia: September 2008 Poultry update

10/30/08 Poultry Indonesia--[edited, see link for full text article]--In the past two and half years, Muhammadiyah has seen 12,000 members in 12,000 villages carry out bird flu campaigns across the country, Ahmad said.

Campaigners work to remove poultry from residential areas, train local residents to properly handle infected chickens by covering up and burying diseased fowl instead of dumping it in rivers, and promote regular use of disinfectants to kill the H5N1 virus.

Under the Muhammadiyah Team to Tackle Avian Influenza, the organization has also established a network of 7,000 "Avian Influenza Force" volunteer groups in nine provinces: Jakarta, North Sumatra, Lampung, Banten, West Java, Central Java, Yogyakarta, East Java and Bali. "Our approach is to make people believe there is nothing to be afraid of with bird flu, because it is preventable," Ahmad said.

However, he said, it was not easy to teach villagers about the epidemic, especially when it comes to changing their deep-rooted knowledge and behavior. "In many cases, villagers were confused about the difference between symptoms of bird flu and those of Newcastle disease (ND). So, when they found their H5N1-infected chickens died, they thought it was simply because of ND, resulting in improper burying and the spread of the virus," Ahmad said.

The government has said it cannot control the avian influenza epidemic on its own due to limited resources. "As the government can't walk alone in fighting bird flu, community groups can definitely act to bring bird flu campaigns closer to the public as they have members across the country," Health Ministry Director General for Disease Control and Environmental Sanitation, I Nyoman Kandun, said during the campaign.

He said Muhammadiyah, with some 30 millions members, could help the government prevent and control bird flu outbreaks across the country. "With 500 hospitals and health clinics, as well as 17,000 educational institutions across the country, Muhammadiyah can back the government's effort to fight the epidemic in remote areas," Kandun said.

Besides Muhammadiyah, professional and religious groups like the Indonesian Veterinarian Association and Muslim organization Nahdlatul Ulama have also been working with the government in fighting bird flu for the past few years, Kandun said.

THE number of poultry, mostly chickens, that died of bird flu in Purbalingga regency in the first half of 2008 has surpassed the 2007 total, the head of the local development planning agency said last month.
"Some 58,000 poultry died of bird flu in 2007, while more than 60,000 died during the first six month of this year," Heni Ruslanto said. "The poultry were confirmed to have died of bird flu."

Heni added people in the region had limited information about preventive health measures and how to handle bird flu cases. "Therefore, we are calling related institutes to pay attention to this problem," he said.

THE North Sumatra Health Office remains on "extraordinary occurrence" (KLB) alert status following the deaths of three people and the hospitalization of 13 others believed to have contracted bird flu.
Office head Chandra Syafei said his office had imposed KLB status because it had so far not received autopsy reports to determine the causes of deaths from the Health Ministry, including results on blood samples and bodily fluid from the patients from Air Batu district in Asahan regency. He personally learned that the patients' blood tests were negative for bird flu from the ministry's website, but remained wary due to the lack of an official report from the ministry.

"So far there has yet to be any report specifying whether the three victims in Asahan were positively or negatively infected with the bird flu virus. If the results are positive, we will have to monitor the area longer," Chandra said.

A number of health workers were still in Asahan to monitor the situation. "We are on full alert to monitor developments of a bird flu outbreak in Asahan. A team from the World Health Organization is still there to investigate the case," said Chandra.

He added that health officials were focusing on the three fatalities and the 13 current patients showing symptoms consistent with bird flu.

Authorities had disposed of 276 infected birds in Asahan and would continue to slay birds believed be infected with virus. Nearby Labuhan Ratu regency has killed 1,126 birds after seeing hundreds suddenly die in the past week.

Labuhan Batu Vice Regent Sudarwanto said the virus had affected the poultry population in six subdistricts of North Rantau: Padang Bulan, Cendana, Lobusona, Sirandorung, Ujung Bandar and Padang Matinggi. Sudarwanto said his office had taken several measures to prevent the spread of the disease, such as disposing of birds, conducting public awareness campaigns and using rapid testing. It has also set up posts in bird flu-prone areas. "We have so far carried out various anticipatory measures to curb the virus spread, and we urge people to remain alert," Sudarwanto said.

NEW Zealand has called on Indonesia to exempt from tariffs, 12 beef and dairy products exported to Indonesia. As compensation, they will provide assistance in technology transfer to guarantee the quality beef and dairy products. This can support Indonesia in meeting the demands for beef and milk supplies.
Agriculture Minister, Anton Apriyanto, has not approved the request because the compensation offered remains unclear. Indonesia had previously negotiated with New Zealand, and hoped that New Zealand will invest in Indonesia. The request for no tariffs for the 12 products is linked with the ASEAN-Australia-New Zealand Free Trade Agreement.

ANIMAL feed and processed chicken manufacturer PT Charoen Pokphand Indonesia Tbk more than doubled its first semester net profit from last year's, despite higher production costs and selling prices. The company, accumulated Rp 209.6 billion (US$22.8 million) net profit in the first semester of 2008, 120 percent higher than the Rp 95 billion profit in the same period last year and surpassing the entire year's profit of Rp 185.5 billion in 2007.
"We have a growing market and increasing prices. The whole industry is growing despite the fuel increase," the vice president of the company, Thomas Effendy, said.
The profit comes mainly from three types of product, all of which saw rising sales in terms of volume and price. Animal feed contributed 78 percent of sales, day-old chickens 13 percent and processed chicken meat 7.8 percent.
Sales volume of animal feed increased by 30 percent to 1.2 million tons since last year and the price rose by almost two-fifths to Rp 4.015 per kilogram.
Processed chicken meat became more popular, with sales volume tripling despite being three times more expensive than during the first half of last year. The demand for day-old chicken increased by 13 percent to 258 million chicks, with the price rising by 30 percent.
Thomas was confident the company would reach the Rp 12 trillion sales target and associated Rp 300 billion net profit target by the year end.
"The price of commodities, which are our raw materials, increased by around 40 percent. It cut the profit margin from 13.6 percent last year to 12.8 percent this year, but because the base price of sales is higher, we made higher net profits," he said.
The demand, he explained, was driven by the relatively cheaper price of chicken compared to other meats and stronger purchasing power of consumers outside Java, especially in regions with agriculture and mining. "Java is still the biggest market, but the Java share has declined from 65 percent of total sales last year, to 60 percent this year," he said.
The company managed to keep the rise in operating costs under 20 percent, despite rising fuel prices, because its seven feed mills in Java, Sumatra and Sulawesi do not rely on diesel fuel to generate electric power. Four of them are powered by coal, two by gas and only one is connected to the power grid.
Pokphand plans to develop more production outside of Java. A plant in Makassar, South Sulawesi is under construction, while another one in Lampung is being planned, with an initial budgeted investment cost of Rp 54 billion, plus an additional Rp 30 billion subsequently. Three-fifths of the funds would come from the company's own cash flow and the rest from Citibank loans, Thomas was quoted as saying, in a report from the Investment Coordinating Board.
It also received Rp 429 billion in loans from banks last month to cover its capital expenditure and to pay current obligations.

AI Research

First steps in the design of a system to monitor vaccine effectiveness during seasonal and pandemic influenza in EU/EEA Member States.

10/08 Euro Surveillance--[Abstract]--
Valenciano M, Ciancio B, Moren A; Influenza Vaccine Effectiveness Working Group.Collaborators (48)

Aavitsland P, Alexandrescu V, Bonmarin I, Buchholz U, Castilla J, Ciancio B, Cohen JM, Czumbel I, Dancona F, De Mateo S, Dijkstra F, Elliot A, Enstone J, Falcao JM, Fleming D, Gergonne B, Giesecke J, Larrauri A, Leino T, Levy Bruhl D, Linde A, Molbak K, Maltezou H, Mangtani P, Mazick A, McMenamin J, Mosnier A, Moren A, Nicoll A, O'Donnell J, O'Flanagan D, Oroszi B, Ortqvist A, Paget J, Pebody R, Puig-Barbera J, Quolin S, Rizzo C, Savulescu C, Shay DK, Simondon F, Uphoff H, Valenciano M, Van Der Sande M, Sbarcea C, Van Tam J, Weber T, Wuillaume F.
EpiConcept, Health Information System, Paris, France. m.valenciano@epiconcept.fr

Estimating influenza vaccine effectiveness (IVE) early in the season helps measuring the consequences of a mismatch between the vaccine and the circulating strain and guiding alternative or complementary interventions. The European Centre for Disease Prevention and Control is funding a project to develop pilot studies to monitor IVE in the Member States (MS) of the European Union and European Economic Area (EU/EEA) during seasonal and pandemic influenza. To identify key methodological and practical issues in developing protocols for pilot studies, we conducted a survey among EU/EEA MS, a literature review on IVE methods, and consultations of experts. The survey and literature review highlighted the variety of the data sources used to estimate IVE and the difficulty to interpret data on IVE, which varies with age, risk group, outcome specificity and virus-vaccine mismatch. We also found that negative and positive confounding can bias IVE. The experts consultations lead to the following recommendations: to measure IVE in the same population in various seasons; to control for positive/negative confounding (including pre- and post-influenza season IVE estimates); and to include laboratory confirmation as outcome in various study designs. In the 2008-9 influenza season, two cohort studies using general practitioners' databases and six case control studies will be piloted in EU/EEA MS and will adhere to the above recommendations. The pilot studies will be the basis for the development of robust methods to monitor IVE in EU/EEA MS.

AI Research

Neutralizing human monoclonal antibody against H5N1 influenza HA selected from a Fab-phage display library

10/08 Journal of Virology--[Abstract]--Identification of neutralizing antibodies with specificity away from the traditional mutation prone antigenic regions, against the conserved regions of hemagglutinin from H5N1 influenza virus has the potential to provide a therapeutic option which can be developed ahead of time in preparation for a possible pandemic due to H5N1 viruses. In this study, we used a combination of panning strategies against the hemagglutinin (HA) of several antigenic distinct H5N1 isolates to bias selection of Fab-phage from a naive human library away from the antigenic regions of HA, toward the more conserved portions of the protein. All of the identified Fab clones which showed binding to multiple antigenically distinct HA were converted to fully human IgG, and tested for their ability to neutralize the uptake of H5N1-virus like particles (VLP) into MDCK cells. Five of the antibodies which showed binding to the relatively conserved HA2 subunit of HA, exhibited neutralization of H5N1-VLP uptake in a dose dependant manner. The inhibitory effects of these five antibodies were similar to those observed with a previously described neutralizing antibody specific for the 140s antigenic loop present within HA1 and highlight the exciting possibility that these antibodies may be efficacious against multiple H5N1 strains.

AI Research

Peptide mimics of a conserved H5N1 avian influenza virus neutralization site

10/08 Journal of Biochemestry--
Wenxin Luo, Yingwei Chen, Mingqiao Wang, Yixin Chen, Zhenhua Zheng, Huijuan Song, Honglin chen, Yi Guan, Mun Hon Ng, Jun Zhang and Ningshao Xia

National Institute of Diagnostics and Vaccine Development in infectious diseases, Xiamen University, Xiamen, Fujian 361005, China.
Background. A panel of 52 murine monoclonal antibodies was found to recognize antigenic determinants that had been conserved among all major genetic subgroups of the H5N1 avian influenza virus prevalent since 1997. Approach. We screened a phage display library for peptides recognized by one such antibody (8H5). 8H5 specificity of reactive peptides was analyzed as they were presented as fusion proteins of hepatitis B core protein (HBc) and hepatitis E virus structural protein, p239, and related to that of native HA molecule according to the capacity of fusion proteins to compete for 8H5 binding with different strains of H5N1 virus and that of antisera generated against fusion proteins to bind native HA molecules and to inhibit hemagglutination and arrest infection by the virus. Result. Nine reactive peptides of different amino acid sequences were identified, 6 of which were also reactive with the antibody in association with HBc and 4, in association with p239. Binding occurred with dimeric form of the 4 p239 and one of the HBc fusion proteins, but not with the monomeric form. The HBc fusion proteins blocked 8H5 binding with 4 strains of H5N1 influenza virus. Mouse antisera generated against fusion proteins bound to HA molecules, but did not cause HAI or arrest HEV infection. Conclusion. Findings inferred that 8H5 recognizes discontinuous sites presented by secondary and possibly higher structural orders of the peptides in spatially favorable positions for binding with the antibody, and that the peptides partially mimic the native 8H5 epitopes on the H5N1 virus.

Science and Technology

Emergence of Amantadine-Resistant H3N2 Avian Influenza A Virus in South Korea

10/08 Journal of Clinical Microbiology--[Abstract]--College of Medicine and Medical Research Institute, Chungbuk National University, 12 Gaeshin-Dong Heungduk-Ku, Cheongju 361-763, Republic of Korea

Received 25 July 2008/ Returned for modification 7 August 2008/ Accepted 25 August 2008

We found a relatively high frequency of unique amantadine-resistant H3N2 and H9N2 avian influenza viruses (Val27Ile on M2 protein) isolated from live poultry markets in South Korea and confirmed that a Val27Ile single substitution in the M2 protein is enough to acquire the amantadine resistance phenotype by using reverse-genetically created human-avian reassortant viruses.

* Corresponding author. Mailing address: College of Medicine and Medical Research Institute, Chungbuk National University, 12 Gaeshin-Dong Heungduk-Ku, Cheongju 361-763, Republic of Korea. Phone: 82-43-261-3384. Fax: 82-43-272-1603. E-mail: choiki55@chungbuk.ac.kr

UNCLASSIFIED

DNI Avian Influenza Daily Digest

UNCLASSIFIED

Avian Influenza Daily Digest

October 30, 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
View 30-Day HPAI H5N1 outbreak data in Google Maps

---

Intelink Avian Influenza Resources:
U.S. Govt. IC: Intelink AI/Pandemic page https://www.intelink.gov/mypage/avianflu

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Article Summaries ...

Announcement

AI Outbreak data on Google Maps
AI Outbreak data can be viewed in Google Maps here. Claudinne
Announcement

Quid Novi

Thailand: Bird Flu Scare Emerges in Sukhothai

Regional Reporting and Surveillance

Uganda: ?Let poultry farmers grow marijuana?
10/30/08 New Vision--VETERINARY doctors from Makerere University have requested politicians to stop harassing poultry farmers for growing marijuana. The doctors said the drug was one of the leading herbs used in treating chicken. Dr. Rebecca Nalubega from the university?s veterinary department said local poultry farmers relied on the drug to treat their chicken.
Regional Reporting and Surveillance

The poultry industry in Great Britain: transmission routes for a potential avian influenza virus epidemic
10/30/08 Microbiology Bytes--The UK commercial poultry industry is an important industry to the British government, the consumer and farmers alike. Worth an estimated £3.4 billion at retail value, producing over 174 million birds for consumption per year, poultry diseases are of widespread interest, both from the point-of-view of understanding different poultry farming methods, and in terms of studying the potential impact of different diseases on poultry. However, our knowledge of how poultry farms in the UK are connected to each other by the movement of people and equipment is more limited. This is essential for effective prevention and control for potential outbreaks of diseases transmitted by the movement of people and equipment between farms within the commercial poultry industry. Diseases spread in such a way include avian influenza viruses (AIV), Newcastle disease virus, Salmonella and Campylobacter species.
Regional Reporting and Surveillance

Indonesia: 17 Human Fatalities out of 20 Confirmed AI Cases Reported Between January and October 2008, 37 out of 37 in 2007
10/30/08 ARGUS--A national source citing the Head of Komnas FBPI (National Committee for Avian Influenza Control and Pandemic Preparedness) reported 17 human fatalities out of 20 confirmed cases of avian influenza between January and October 2008. In 2007, there was reportedly a total of 37 fatalities out of 37 confirmed cases. The decrease in AI cases was attributed to heightened public awareness, especially among children, regarding preventive measures such as the importance of hand washing, reminding parents to cook chicken thoroughly, and being unwilling to play near chicken cages.
Regional Reporting and Surveillance

Fears of bird flu pandemic remain as donations dry up
10/30/08 Jakarta Post--The number of countries and institutions donating money to combat bird flu has decreased over the past three years despite suggestions the disease still poses a real and immediate threat.
Regional Reporting and Surveillance

Other Emerging Infectious Diseases

Infectious Diseases On The Rise
10/30/08 MediLexicon News--A new report from a non-profit health group in the US suggests that emerging infectious diseases are on the rise and the nation's defences are not ready for them.
Other Emerging Infectious Diseases

Science and Technology

Incubation Period for Human Cases of Avian Influenza A (H5N1) Infection, China
November 2008 EID/CDC/ Letter Since 1997, more than 400 human cases of highly pathogenic influenza A virus (H5N1) infection have been reported worldwide, including 30 from mainland China. Ascertainment of the incubation period for influenza virus (H5N1) is important to define exposure periods for surveillance of patients with suspected influenza virus (H5N1) infection. Limited data on the incubation period suggest that illness onset occurs <7 days after the last exposure to sick or dead poultry (1?4). For clusters in which limited human-to-human virus transmission likely occurred, the incubation period appeared to be 3?5 days (5?7) but was estimated to be 8?9 days in 1 cluster (5). In China, exposure to sick or dead poultry in rural areas and visiting a live poultry market in urban areas were identified as sources of influenza A virus (H5N1) exposures (8), but the incubation period after such exposures has not been well described.
AI Research

Pandemic Preparedness

U.S. looks at whether home drug stockpiles for flu pandemic makes sense
10/30/08 Canadian Press--Should people be allowed or even urged to buy and store in their homes flu drugs for use in an influenza pandemic? The U.S. government, which has been grappling with how to distribute antiviral drugs in the anticipated chaos of a pandemic, believes the idea bears exploring.
Pandemic Preparedness

Media Affects Disease Threat Perception
10/30/08 Red Orbit--Popular media coverage of infectious diseases greatly influences how people perceive those diseases, making them seem more dangerous, according to a new study from McMaster University.
Pandemic Preparedness

Withheld Bird Flu Samples Endanger World, U.S. Says
10/30/08 Bloomberg--The U.S. should continue to oppose countries that expose the world to ``even more danger'' by demanding payment in return for sharing samples of H5N1 bird flu, said the U.S. government's outgoing top health official.
Pandemic Preparedness

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Full Text of Articles follow ...

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Quid Novi

Thailand: Bird Flu Scare Emerges in Sukhothai

10/30/08 Thailand Outlook--Thailand might be in the grip of a fatal bird-flu scare again, after the H5N1 virus was found in chicken carcasses in northern Sukhothai Province.

[link to Google Map]

Livestock officials in Sukhothai Province reported the discovery of the H5N1 virus in domestic chickens raised by Mee Puengwang, a resident of Nong Wong Kwian Village in Swankalok District.

Assistant Village Chief Jamnien Puengwang said that 29 families in the village raised a total of nearly 1,000 chickens before a number of them began to die of suspicious causes.

She said there were no reports of the deaths of these fowls as some villagers were worried that their fighting birds might be slaughtered due to bird-flu fears.

After officials declared the discovery, all chickens in Sawankalok District were destroyed and their owners are to receive 32 baht per kilogramme for the killed birds.

Sukhothai Governor Yothin Samutkheeree has urged all related agencies to keep a close eye on the probable viral spread, especially in the areas where H5N1 was once found.

Locals have been asked to report any suspicious deaths of birds immediately.

During the months of August and September, bird-flu virus was reportedly spreading in Sawankalok District before it was recently detected again in a nearby district.

Conferences and Training

Talk Science: Infectious Disease: What Can Evolution Do For Us?

10/30/08 Imperial College London--[link to website for event]--Infectious agents evolve, just like other living things. And because they have short life cycles and large population sizes, they do it quickly. Are we destined always to be playing catch up in the evolutionary arms race?

Dr Bill Hanage of Imperial College London will introduce the debate on how natural selection leads to the virulence of the diseases we know, the emergence of new ones, and how it might affect the future of both.

* Are we doomed to be always playing catch up in the fight against resistant superbugs?
* Avian Flu, the next pandemic or a flash in the pan?
* HIV vaccine, dream or reality?
* Information technology and bioinformatics: can it help us predict evolution of new dangers?
* Humans vs pathogens: an arms race on a microscale?
* Why do some infectious diseases evolve to become less virulent?

AI Research

Incubation Period for Human Cases of Avian Influenza A (H5N1) Infection, China

November 2008 EID/CDC/

Letter

Yang Huai, Nijuan Xiang, Lei Zhou, Luzhao Feng, Zhibin Peng, Robert S. Chapman, Timothy M. Uyeki, and Hongjie Yu Comments to Author
Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China (Y. Huai, N. Xiang, L. Zhou, L. Feng, Z. Peng, H. Yu); Chulalongkorn University, Bangkok, Thailand (Y. Huai, R.S. Chapman); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (T.M. Uyeki)

Since 1997, more than 400 human cases of highly pathogenic influenza A virus (H5N1) infection have been reported worldwide, including 30 from mainland China. Ascertainment of the incubation period for influenza virus (H5N1) is important to define exposure periods for surveillance of patients with suspected influenza virus (H5N1) infection. Limited data on the incubation period suggest that illness onset occurs <7 days after the last exposure to sick or dead poultry (1?4). For clusters in which limited human-to-human virus transmission likely occurred, the incubation period appeared to be 3?5 days (5?7) but was estimated to be 8?9 days in 1 cluster (5). In China, exposure to sick or dead poultry in rural areas and visiting a live poultry market in urban areas were identified as sources of influenza A virus (H5N1) exposures (8), but the incubation period after such exposures has not been well described.

We conducted a retrospective descriptive study of 24 of 30 influenza virus (H5N1) cases in China to estimate and compare incubation periods for different exposure settings, including case-patients exposed only to sick or dead poultry versus those exposed only to a wet poultry market, where small animals and poultry may be purchased live or slaughtered (www.searo.who.int/en/Section23/Section1001/Section1110_11528.htm). Exposures may be direct (e.g., touching poultry) or indirect (e.g., no physical contact, but in close proximity to poultry, poultry products, or poultry feces). We excluded 6 cases, including 2 with unavailable epidemiologic data, 1 without an identified exposure source, 2 in a cluster with limited person-to-person transmission (6), and 1 in which the patient was exposed to both a wet poultry market and to sick or dead poultry. Epidemiologic data were collected through patients and family interviews and a review of case-patients' medical records.

The incubation period was defined as the time from exposure to symptom onset. The maximum time from first exposure to illness onset was limited to 14 days for biological plausibility. For case-patients with exposures on multiple days, we calculated each case-patient's median incubation period and then calculated the overall median and range of the distribution of these median incubation periods. Similarly, the minimum and maximum incubation periods for case-patients with exposures on multiple days was estimated by using the last or first known exposure day, respectively. The overall incubation period among these case-patients was estimated by determining the median of the distribution of case-patients' median incubation periods. Incubation periods were compared by using the Wilcoxon rank-sum test. All statistical tests were 2-sided with a significance level of ? = 0.05.

Of the 24 case-patients, 16 (67%) had exposure to sick or dead poultry only (median age = 25 years [range 6?44]; 25% male; 100% lived in rural areas). Eight (33%) had visited a wet poultry market only (median age = 30 years [range 16?41]; 63% male; 88% [7/8] lived in urban areas) (Table). For case-patients with >2 exposure days (n = 18), and for case-patients with a single exposure day (n = 6), the overall median incubation period was longer for those who had visited a wet poultry market than for those who were exposed to sick or dead poultry, but the difference was not significant. When data for single and multiple exposure days were combined, the overall median incubation period for case-patients exposed to a wet poultry market (n = 8) was significantly longer than for case-patients (n = 16) exposed to sick or dead poultry (7 days [range 3.5?9] vs. 4.3 days [range 2?9]; p = 0.045).

Our findings are subject to limitations. Proxies for deceased case-patients may not have known all of the case-patient's exposures. Surviving case-patients may not have recalled or identified all exposures that occurred, including environmental exposures. It was impossible to ascertain when infection occurred for case-patients with multiple days of exposures. Our limited data did not permit the use of other methods such as survival analysis to better define incubation periods. We did not quantify exposure duration and could not determine whether repeated exposures (dose-response) or a threshold of exposure to influenza virus (H5N1) exists to initiate infection of the respiratory tract. Laboratory testing was not performed to confirm that the exposure sources contained influenza virus (H5N1) or to quantify exposures.

Despite exposures of many persons in China to sick or dead poultry or to wet poultry markets, human influenza A (H5N1) disease remains very rare. Our findings suggest that the incubation period may be longer after exposure to a wet poultry market than after exposure to sick or dead poultry, and, therefore, a longer incubation period than the 7 days that is used widely (4,9) could be considered for surveillance purposes. However, because of the small number of influenza virus (H5N1) case-patients, our study was too underpowered to draw any firm conclusions; results should be interpreted cautiously. In a study of influenza virus (H5N1) cases in Vietnam, 5 case-patients did not have any identified exposure <7 days of illness onset (10). In China, the exposure period for surveillance of suspected influenza virus (H5N1) cases now includes exposure to a wet poultry market <14 days before illness onset. Although data on person-to-person virus transmission are limited, close contacts of patients infected with influenza virus (H5N1) in China are monitored daily for 10 days after the last known exposure. Further studies are needed to quantify the incubation period after exposure to sick or dead infected poultry, a wet poultry market, or to an influenza A virus (H5N1) case-patient and to investigate the basis for any differences.
Acknowledgments

We thank the Centers for Disease Control and Prevention of the Hunan, Anhui, Sichuan, Fujian, Guangdong, Hubei, Liaoning, Shanghai, Jiangxi, Guangxi, Zhejiang, Xinjiang, and Jiangsu Provinces and the local governments that assisted us in coordinating our field investigations, in data collection, and in logistical support. We also thank Ratana Somrongthong and Sopon Iamisirithaworn, for review of the manuscript.

References

1. Areechokchai D, Jiraphongsa C, Laosiritaworn Y, Hanshaoworakul W, O'Reilly M; Centers for Disease Control and Prevention. Investigation of avian influenza (H5N1) outbreak in humans?Thailand, 2004. MMWR Morb Mortal Wkly Rep. 2006;55(Suppl 1):3?6.
2. Tran TH, Nguyen TL, Nguyen TD, Luong TS, Pham PM, Nguyen VC, et al. Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med. 2004;350:1179?88. PubMed DOI
3. Oner AF, Bay A, Arslan S, Akdeniz H, Sahin HA, Cesur Y, et al. Avian influenza A (H5N1) infection in eastern Turkey in 2006. N Engl J Med. 2006;355:2179?85. PubMed DOI
4. Writing Committee of the Second World Health Organization. Consultation on clinical aspects of human infection with avian influenza A (H5N1). Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med. 2008;358:261?73. PubMed DOI
5. 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.
6. Wang H, Feng ZJ, Shu YL, Yu HJ, Zhou L, Zu RQ, et al. Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China. Lancet. 2008;371:1427?34. PubMed DOI
7. 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. PubMed DOI
8. Yu HJ, Feng ZJ, Zhang XF, Xiang NJ, Huai Y, Zhou L, et al. Human influenza A (H5N1) cases, urban areas of People's Republic of China, 2005?2006. Emerg Infect Dis. 2007;13:1061?4.
9. World Health Organization. WHO case definitions for human infections with influenza A(H5N1) virus [cited 2008 July 20]. Available from http://www.who.int/csr/disease/avian_influenza/guidelines/case_definition2006_08_29/en/index.html
10. 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 [serial on the Internet]. 2006 Dec [cited 2008 July 20]. Available from http://www.cdc.gov/ncidod/EID/vol12no12/06-0829.htm

Table

Table. Estimated incubation period of 24 human cases of infection with avian influenza A virus (H5N1), China
Suggested Citation for this Article

Huai Y, Xiang N, Zhou L, Feng L, Peng Z, Chapman RS, et al. Incubation period for human cases of avian influenza A (H5N1) infection, China [letter]. Emerg Infect Dis [serial on the Internet]. 2008 Nov [date cited]. Available from http://www.cdc.gov/EID/content/14/11/1820.htm

DOI: 10.3201/eid1411.080509

Pandemic Preparedness

U.S. looks at whether home drug stockpiles for flu pandemic makes sense

10/30/08 Canadian Press--Should people be allowed or even urged to buy and store in their homes flu drugs for use in an influenza pandemic? The U.S. government, which has been grappling with how to distribute antiviral drugs in the anticipated chaos of a pandemic, believes the idea bears exploring.

But discussions Wednesday of a panel of experts convened to advise the U.S. Food and Drug Administration on the idea showed just how many sticky issues are enmeshed in the proposal to allow pharmaceutical companies to sell "flu medkits."

Concerns were raised about whether people could be trusted to store and use the drugs appropriately and whether misuse might fuel the development of resistance to the few influenza drugs on the market. Some experts worried whether parents would be able to gauge the amount of drug their children would need and mix a solution - by breaking open capsules - based on the child's weight.

Still others echoed the concerns raised by representatives of physician and pharmacist groups who argued against taking the responsibility for deciding when a person needs a prescription drug out of the hands of medical professionals.

But some members of the panel favoured the notion, reminding colleagues that personal stockpiling of the drugs oseltamivir (Tamiflu) and zanamivir (Relenza) is already taking place.

"It's going on already. What we need to do is to figure out a way to do it intelligently," said Dr. John Bradley, director of the division of infectious diseases at the Children's Hospital and Health Center in San Diego, Calif.

The meeting was not asked to give the U.S. Department of Health and Human Services (HHS), which is spearheading the idea, a "proceed" or "abandon" type of recommendation.

Instead, they were charged with discussing and in some cases voting on a series of questions aimed at fleshing out what kinds of studies the FDA - which would have to approve the marketing of medkits - would need before it could consider the products.

The group did indicate, through a 20-6 vote (with one abstention), that the FDA should require the two pharmaceutical companies that would produce the flu medkits to undertake more research than the companies have so far proposed.

Hoffman-La Roche, the maker of Tamiflu, and GlaxoSmithKline, which makes Relenza, were suggesting relatively minimal new research.

The companies, which have been asked to pursue development of medkits by HHS's Office of Biomedical Advanced Research and Development Authority, proposed studies to see if people can understand the proposed medkit labelling and could - in the case of Relenza - use the inhaler device needed to administer the drug.

Both companies also proposed to distribute medkits to a number of people with instructions not to use it for seasonal flu. They planned to later follow up to see whether the kits were still intact after one flu season.

The idea of medkits for pandemic flu comes from the doctrine of "shared responsibility," Dr. Robin Robinson, director of theBiomedical Advanced Research and Development Authority, said in an interview.

The U.S. federal government understands, he said, that it cannot meet every need in a crisis. Other parties in society have a role to play.

Robinson likened it to the philosophy of personal preparedness that was espoused in the civil defence programs of the 1950s - a time when people stockpiled food and even built fall-out shelters in anticipation of feared nuclear attacks.

"This is a return to that self-reliance," Robinson said. "Because all responsible officials tell people that the federal government is not going to be able to help provide everything all the time."

"Individuals, local (and) state governments, businesses and the federal government all have roles in this type of responsibility."

Canada does not currently envisage this approach to antiviral stockpiling.

Robinson said he knew of no other country that is pursuing a similar plan, but said other countries are watching the U.S. discussions to see where the debate leads.

Like many others, the U.S. federal government is stockpiling millions of doses of antiviral drugs for treatment of the ill in a pandemic. And some states too have bought additional stocks of the drugs. But how those drugs will be distributed when a pandemic hits is a dilemma many jurisdictions are struggling with.

It is expected that doctors and hospitals will be overwhelmed and won't be able to handle an influx of sick people looking for antiviral drugs. And it is thought distribution centres would spread disease at least as efficiently as they spread drugs.

"This is a real tough nut to crack for us," said panel member Robert Mauskapf, the director of emergency operations for Virginia's department of health.

He said his state has bought a large supply of antiviral drugs, but so far has been unable to figure out how to close the distribution gap that will be created when doctors are too busy to write prescriptions and emergency departments are "clobbered."

Mauskapf said he thought the medkit proposal might help close that gap.

Robinson said questions remain to be answered before any decision can be made.

"This is exploratory. This is a concept and we're trying to find the best way. If at the end of the day we can, then we would like to move forward with them in collaboration with physician groups and other health-care providers. And if there's not data there, then we won't go forward with it."

Regional Reporting and Surveillance

Uganda: ?Let poultry farmers grow marijuana?

10/30/08 New Vision--VETERINARY doctors from Makerere University have requested politicians to stop harassing poultry farmers for growing marijuana. The doctors said the drug was one of the leading herbs used in treating chicken. Dr. Rebecca Nalubega from the university?s veterinary department said local poultry farmers relied on the drug to treat their chicken.

Nalubega was presenting a paper about medicinal properties of herbs at Bwala social centre in Masaka town on Wednesday,

?It is good that we have politicians in this workshop. Why don?t you help poultry farmers growing marijuana since they don?t use it for human consumption?? Nalubega asked.

Teopista Mbabazi, the woman councillor for Kyazanga sub-county, objected to the request, saying a single plant of marijuana could be dangerous to the public.

?They told us there are over 60 herbs, which can be used in treating poultry. Why do they insist on marijuana?? she asked.

The half-day workshop was held to enlighten politicians and veterinary workers about bird flue.

Nalubega said the veterinary department was carrying out research on the local methods that could be used to protect poultry from diseases like bird flu.

?If bird flue attacked a district like Masaka, it would kill millions of chicken,? she said.

Regional Reporting and Surveillance

The poultry industry in Great Britain: transmission routes for a potential avian influenza virus epidemic

10/30/08 Microbiology Bytes--The UK commercial poultry industry is an important industry to the British government, the consumer and farmers alike. Worth an estimated £3.4 billion at retail value, producing over 174 million birds for consumption per year, poultry diseases are of widespread interest, both from the point-of-view of understanding different poultry farming methods, and in terms of studying the potential impact of different diseases on poultry. However, our knowledge of how poultry farms in the UK are connected to each other by the movement of people and equipment is more limited. This is essential for effective prevention and control for potential outbreaks of diseases transmitted by the movement of people and equipment between farms within the commercial poultry industry. Diseases spread in such a way include avian influenza viruses (AIV), Newcastle disease virus, Salmonella and Campylobacter species.

An epidemic of any poultry disease with high mortality or which is zoonotic, such as AIV, would result in the culling of significant numbers of birds, as seen in the Netherlands in 2003 and Italy in 2000. Such an epidemic would cost the UK government millions of pounds in compensation costs, with further economic losses through reduction of international and UK consumption of British poultry. In order to better inform policy advisers and makers on the potential for a large epidemic in the UK, we investigate the role that interactions amongst premises within the British commercial poultry industry could play in promoting an AIV epidemic, given an introduction of the virus in a specific part of poultry industry in the UK.

Poultry premises using multiple slaughterhouses lead to a large number of premises being potentially connected, with the resultant potential for large and sometimes widespread epidemics. Catching companies can also potentially link a large proportion of the poultry population. Critical to this is the maximum distance traveled by catching companies between premises and whether or not between-species transmission could occur within individual premises. Premises closely linked by proximity may result in connections being formed between different species and or sectors within the industry.

Even quite well-contained epidemics have the potential for geographically widespread dissemination, potentially resulting in severe logistical problems for epidemic control, and with economic impact on a large part of the country. Premises sending birds to multiple slaughterhouses or housing multiple species may act as a bridge between otherwise separate sectors of the industry, resulting in the potential for large epidemics. Investment into further data collection and analyses on the importance of industry structure as a determinant for spread of AIV would enable us to use the results from this study to contribute to policy on disease control.

Contact structures in the poultry industry in Great Britain: Exploring transmission routes for a potential avian influenza virus epidemic. BMC Vet Res. 2008 4: 27

Regional Reporting and Surveillance

Indonesia: 17 Human Fatalities out of 20 Confirmed AI Cases Reported Between January and October 2008, 37 out of 37 in 2007

10/30/08 ARGUS--A national source citing the Head of Komnas FBPI (National Committee for Avian Influenza Control and Pandemic Preparedness) reported 17 human fatalities out of 20 confirmed cases of avian influenza between January and October 2008. In 2007, there was reportedly a total of 37 fatalities out of 37 confirmed cases. The decrease in AI cases was attributed to heightened public awareness, especially among children, regarding preventive measures such as the importance of hand washing, reminding parents to cook chicken thoroughly, and being unwilling to play near chicken cages.

Article URL(s)
http://www.tempointeraktif.com/hg/nasional/2008/10/29/brk,20081029-142909,id.html

Pandemic Preparedness

Media Affects Disease Threat Perception

10/30/08 Red Orbit--Popular media coverage of infectious diseases greatly influences how people perceive those diseases, making them seem more dangerous, according to a new study from McMaster University.

The research, published online in the Public Library of Science: ONE, suggests diseases that show up frequently in the print media ?like bird flu ?are considered more serious than similar diseases that do not receive the same kind of coverage, such as yellow fever.

"The media tend to focus on rare and dramatic events," says Meredith Young, one of the study's lead authors and a graduate student in the Department of Psychology, Neuroscience & Behaviour. "When a certain disease receives repeated coverage in the press, people tend to focus on it and perceive it as a real threat. This raises concerns regarding how people view their own health, how they truly understand disease and how they treat themselves."

Researchers chose 10 infectious diseases drawn from the Centre for Disease Control database. Five were medical disorders that have been highly prevalent in the recent print media ? anthrax, SARS, West Nile virus, Lyme disease and avian flu ? and five were medical disorders that have not often been present in current media: Tularemia, human babesiosis, yellow fever, Lassa fever and hantavirus.

Two groups of students, undergraduate and medical students, were asked to rate how serious, how prevalent, and how "disease-like" various conditions were.

"We see that a single incident reported in the media, can cause great public concern if it is interpreted to mean that the potential risk is difficult to control, as with the possibility of a pandemic like in the case of Avian flu, and bioterrorism, as in the case of anthrax infection," says Young.

Conversely, when participants were presented with the descriptions of the disease, without the name, they actually thought that the diseases which received infrequent media coverage ?the control group ?were actually worse.

"Another interesting aspect of the study is when we presented factual information about the diseases along with the names of them, the media effect wasn't nearly as strong," says Karin Humphreys, one of the study's authors and assistant professor in the Department of Psychology, Neuroscience & Behaviour. "This suggests that people can overcome the influence of the media when you give them the facts, and so objective reporting is really critical."

Equally surprising, says Humphreys, is the fact that the medical students ?who would have more factual knowledge about these diseases ? were just as influenced by the media, despite their background.

The study was funded by the National Science and Engineering Research Council (NSERC).

Regional Reporting and Surveillance

Fears of bird flu pandemic remain as donations dry up

10/30/08 Jakarta Post--The number of countries and institutions donating money to combat bird flu has decreased over the past three years despite suggestions the disease still poses a real and immediate threat.

Head of the National Committee for Bird Flu Control and Pandemic Preparedness, Bayu Krisnamurthi, said in Jakarta on Wednesday that 35 countries and institutions had pledged to donate money to combat the disease during a bird flu conference in Beijing in January 2006, but that only 17 had actually made donations at the Bamako conference in December of the same year.

Only nine institutions made donations a year later in December 2007 during the New Delhi conference, and six donated in the Oct. 24-26 Sixth International Ministerial Conference on Avian and Pandemic Influenza in Cairo.

Bayu said the decline in the number of donations had forced Indonesia to cover a budget deficit.

"Between 2006 and 2008, donors committed to donate up to US$2.7 billion to finance the containment of bird flu. However, the deficit for the period reached $1.2 billion," he said in a press conference on the results of the Cairo conference.

He said that so far only 73 percent of the money donated over the three-year period had been disbursed.

Most countries cover such deficits using state money, Bayu said, adding that Indonesia had done the same.

He said Indonesia received $120 million for its bird flu control project between 2006 and 2008, including money submitted by foreign or international institutions operating in the country.

The amount covered about 50 percent of what was spent on the effort over the period, said Bayu, who is also deputy minister for agriculture and maritime at the Coordinating Ministry for the Economy.

"We're not worried about the impacts of the declining number of donors. The government is committed to continually combating bird flu," he said.

The Cairo conference reported declines in the number of confirmed human fatalities resulting from infection since 2007.

Since the first human was diagnosed with the disease in 2004, there have been 383 cases of human infection resulting in 241 fatalities world wide.

In Indonesia, the figures stand at 137 and 112, respectively. The decline in infection cases in Indonesia is the result of a campaign to raise awareness on how to avoid infection, especially among children, who are most prone to catch it, Bayu said.

As an example, he cited the results of a recent survey conducted by the bird flu committee on 1,700 students in Greater Jakarta which found the number of school children who washed their hands before eating had increased to 68 percent in 2008 from 37 percent last year.

The number of children who reminded their parents to thoroughly cook poultry before serving it increased to 92 percent from 57 percent; and the number of children who did not come into physical contact with poultry rose to 66 percent from 23 percent.

"Children play a strategic role in the control of the spread of bird flu. These changes show the community's active role in reducing the number of bird flu infections," Bayu said.

Pandemic Preparedness

Withheld Bird Flu Samples Endanger World, U.S. Says

10/30/08 Bloomberg--The U.S. should continue to oppose countries that expose the world to ``even more danger'' by demanding payment in return for sharing samples of H5N1 bird flu, said the U.S. government's outgoing top health official.

Michael Leavitt, preparing to step down as U.S. secretary of health and human services after next week's presidential elections, urged his successor to ``strongly defend'' a 60-year practice of countries sharing virus samples for free, according to the text of a speech in Washington yesterday.

Indonesia began withholding avian-flu virus samples in December 2006, saying the pathogens are its intellectual property. The country has demanded access to affordable drugs for Asia in exchange for sharing the H5N1 samples. Doctors can't produce up- to-date vaccines without the latest versions.

``Once compensation is paid, there will be no end to demands, and the system will fail, subjecting every one in the world to even more danger,'' according to the speech, which was e-mailed to Bloomberg News. The text didn't name specific countries.

Indonesia's Health Minister Siti Fadilah Supari said in a text message that the practice of virus-sharing supported by the U.S. and the World Health Organization is an unjust example of ``neoliberal capitalism'' that favors developed nations such as the U.S. and should be changed.

World Peace

``Developing countries realize that the system created by the U.S. at WHO for the past 60 years is merely for pharmaceutical trading for developed countries,'' Supari said. ``Such a system is no longer suited to attain world peace and welfare.''

At least 387 people in 15 countries have been infected with the H5N1 strain of the avian-flu virus since 2003, according to the Geneva-based WHO. Almost two of every three cases were fatal. So far this year, 36 cases have been reported, down from 74 in the first 10 months of 2007. About four-fifths of human cases have occurred in Asia.

Leavitt, 57, has been secretary of health since January 2005. He delivered the speech in a Webcast.

Other Emerging Infectious Diseases

Infectious Diseases On The Rise

10/30/08 MediLexicon News--A new report from a non-profit health group in the US suggests that emerging infectious diseases are on the rise and the nation's defences are not ready for them.

Trust for America's Health (TFAH) released their report titled "Germs Go Global: Why Emerging Infectious Diseases Are a Threat to America" on 29th October. The report states that at least 170,000 Americans die every year from newly emerging and re-emerging infectious diseases and that this number could go up dramatically in a pandemic of flu or other unknown disease.

The non-profit, non-partisan group said that globalization, increasing drug resistance, and climate change are some of the reasons.

TFAH Executive Director, Dr Jeffrey Levi said it's not just the developing world that is under threat from infectious diseases:

"They are a real threat right here, right now to America's economy, security, and health system."

"Infectious diseases can come without warning, crossing borders, often before people even know they are sick," said Levi.

"Americans are more vulnerable than we think we are, and our public health defenses are not as strong as they should be," he added.

The TFAH said major threats include:

* New emerging diseases with pandemic potential like flu and SARS ( severe acute respiratory syndrome).

* Dengue fever, usually brought back to the US by travellers, infects 100 to 200 Americans a year.

* MRSA (Methicillin-resistant Staphylococcus aureus) has infected over 90,000 Americans and is the 6th leading cause of death in the US.

* Hepatitis: about 3.2 million Americans are infected with hepatitis C with a national healthcare cost of 15 billion dollars.
*

* HIV/AIDS: about 1.2 million Americans have HIV/AIDS while over half a million have died of AIDS since 1981. The total federal bill for HIV/AIDS, including medical care, prevention and research comes to 23.3 billion dollars.

* Re-emerging diseases such as mumps, measles and TB, which were thought to have virtually disappeared in the US.

In terms of fighting infectious diseases, the report found what it called many "major vulnerabilities" in US strategy, including:

* New drugs and treatments to fight infections from bacteria that are developing greater resistance have received less attention than how to counter an intentional biological attack.

* Monitoring and reporting of diseases should be faster and seamless across state and local health departments and other jurisdiction boundaries.

* Information needs to be shared more within the country and with other international bodies and countries to help detect new microbial threats and support global efforts to counter them.

* Better and faster diagnostic tests are needed across the board for all emerging infectious diseases especially at the point of care.

* The world's three largest killers, HIV/AIDS, TB and malaria still have no effective vaccine, while many of the children in the world do not receive currently available highly effective vaccines.

James Hughes, Professor of Medicine and Public Health at the School of Medicine and Rollins School of Public Health at Emory University and Former Director of the National Centers of Infectious Diseases at the US Centers for Disease Control and Prevention (CDC), said:

"There are a number of examples, including West Nile virus, SARS, monkeypox, and H5N1 influenza, which remind us that in today's world, microbes can spread rapidly across borders and from continent to continent."

"Trends in factors influencing infectious disease emergence -- for example, population growth and urbanization, international travel and commerce, climate and ecosystem changes -- generally operate in favor of the microbes," he added.

Hughes said it was in the national interest to show political will and act to:

"Address microbial threats domestically and globally in collaboration with a broad range of partners."

TFAH suggests a number of recommendations which are largely similar to those made by the Institute of Medicine's 2003 report "Microbial Threats to Health" and exhorts governments at all levels to give more funds to research, collaborate, share information and show global leadership in the fight against infectious diseases.

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October 29, 2008 14:00 GMT

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Article Summaries ...

Announcement

PlanFirst Webcasts on Pandemic Influenza
On October 29, 2008, at 1:00 pm ET, Secretary Leavitt will provide formal remarks regarding the Nation?s pandemic planning effort. He will then join a roundtable discussion with our special guests to discuss the Nation?s level of pandemic preparedness and related issues. As always, our guests, including Secretary Leavitt, will take questions from our viewing audience. No registration is required. Email your questions for the Webcast panelists before and/or during the program to hhsstudio@hhs.gov. Please include your first name, state and town. Before the Webcast, please ensure that your system can access the live stream: Test Your Video Player.
Announcement

Regional Reporting and Surveillance

Australia: Catching birds to stop the flu
10/29/08 ABC News Australia--Giant nets shot out of cannons are the latest tools being used to protect Australia from foreign diseases like Avian Influenza.
Regional Reporting and Surveillance

Egypt: Donors meeting nets funds for avian flu fight
10/29/08 CIDRAP--A group of international donors who met yesterday in the final session of an avian influenza conference in Sharm el-Sheikh, Egypt, pledged more support for avian and pandemic flu preparedness and prevention, led by $320 million from the United States.
Regional Reporting and Surveillance

New Zealand hosts bird flu exercise at Auckland International Airport
10/29/08 Radio New Zealand--New Zealand's ability to cope with an outbreak of bird flu is being tested on Wednesday in an exercise at Auckland International Airport.
Regional Reporting and Surveillance

Science and Technology

Pneumococcal vaccine could prevent numerous deaths, save costs during a flu pandemic, model predicts
10/29/08 Eureka Alert--A new predictive model shows that vaccinating infants with 7 valent pneumococcal conjugate vaccine (PCV7)--the current recommendation--not only saves lives and money during a normal flu season by preventing related bacterial infections; it also would prevent more than 357,000 deaths during an influenza pandemic, while saving $7 billion in costs.
AI Research

Rockeby Biomed Awarded 750,000 Dolars Of Grants By Singapore Government For Influenza And Bird Flu Research, Singapore
10/29/08 Medical News Today--Australia-listed, Singapore-based healthcare group, Rockeby biomed Ltd today announced that it has been awarded two grants by the Singaporean Standards, Productivity and Innovation Board (SPRING Singapore) under the Technology Enterprise Commercialisation Scheme (TECS). The first grant of S$250,000 awarded under Proof of Concept (POC) is for the development of a magnetic detection platform for influenza A, including avian flu, while the second grant of S$500,000 is awarded under Proof of Value (POV), to upscale the production of a rapid and sensitive test incorporating fluorescence technology for the field diagnosis of influenza A, including avian flu.
Vaccines

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Full Text of Articles follow ...

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Regional Reporting and Surveillance

Australia: Catching birds to stop the flu

10/29/08 ABC News Australia--Giant nets shot out of cannons are the latest tools being used to protect Australia from foreign diseases like Avian Influenza.

A group of bird enthusiasts in collaboration with Australian Quarantine Inspection Services are spending the week in Darwin using the nets to catch migratory shorebirds which have flown in from as far away as the Arctic.

Chief of the operation, Dr Clive Fenton, says the birds are banded, and faecal samples taken, to test if they've brought Avian Influenza into Australia.

"Because these migrant birds come through Asia where this disease is prevalent, it is possible they could bring it into Australia," he says.

"And we've set up a net, it's called a cannon net.

"It's pulled over the birds by a weight which you can set off in the hide here where we're observing the catching area.

"You can catch birds, sometimes five, 10, sometimes 100, sometimes 1000."

Regional Reporting and Surveillance

Egypt: Donors meeting nets funds for avian flu fight

10/29/08 CIDRAP--A group of international donors who met yesterday in the final session of an avian influenza conference in Sharm el-Sheikh, Egypt, pledged more support for avian and pandemic flu preparedness and prevention, led by $320 million from the United States.

Paula Dobriansky, the US State Department's undersecretary of state for democracy and global affairs, said in an Oct 25 statement that the new $320 million pledge brings the total US support for avian and pandemic flu assistance to $949 million. She announced the pledge at the Sixth International Conference on Avian and Pandemic Influenza.

The World Bank, in a press release today, did not name a total pledge amount, but noted that countries had an opportunity at the meeting to pledge additional support. Japan's Kyodo News Service said the total from the meeting was $350 million, including a pledge of $24 million from Japan, the second largest amount behind the United States.

Olga Jonas, the World Bank's influenza coordinator, said in the statement, "At this point, political commitment on response and preparedness is as important as funding.

The $350 million total from the donor's conference is well below the $500 million that United Nations officials had asked countries to pledge to help the world battle avian influenza and make pandemic preparations, according to previous reports. The amount pledged at this year's donor conference is also less than the $406 million raised at last year's conference in New Delhi.

The European Commission, the executive branch of the European Union, had indicated earlier that it would not pledge an additional amount, because it said half of the funds had not yet been spent, according to an Oct 25 report from Reuters.

The United Nations (UN) and the World Bank, in a recent progress report, expressed concern about a growing funding gap between what's needed to control and prevent avian flu and the amount donors are pledging. The report, which was published before the meeting in Egypt was held, said donors have pledged $2.7 billion, of which $2 billion has been committed. Of that total, $1.5 billion has been disbursed, of which 59% was cash or loans and 41% was in-kind contributions. Declines in funding threaten the sustainability of control and planning investments that have already been made, the report said.

African countries find challenges, success
The international conference drew representatives from more than 100 nations and 20 regional and international organizations, according to the State Department press release. Sessions included a review of progress, sharing of best practices, and discussion of the threat avian flu virus poses to the global community.

Representatives from West Africa said their countries were vulnerable to the virus, because of porous borders, weak infrastructure, and poverty, Reuters reported today.

Anna Nyamekye, Ghana's deputy agriculture minister, told the conference about the difficulty in monitoring the movement of people and animals across unapproved routes. "Nigeria still has it [avian influenza in poultry], Togo, our direct neighbor still has it, and on our north we are bordered by Burkina Faso, which also has it," she told Reuters. "We are hemmed in."

However, some West African countries have had success controlling outbreaks quickly by offering farmers compensation for dead or culled poultry. Junaidu Maina, Nigeria's chief veterinary officer, told Reuters that since 2006 the country has culled 1.3 million birds and paid $5.4 million in compensation.

Nyamekye said Ghana also has a compensation program that provides farmers financial incentives to abide by national biosecurity standards.

UN officials warn against flu fatigue
David Nabarro, the UN's influenza coordinator, warned against complacency in the fight against avian influenza, according to a report today from Integrated Regional Information Networks (IRIN), part of the UN Office for the Coordination of Humanitarian Affairs. "Things are a lot better now than they were when we started this work in 2005, but they are not good enough," he said. "We are not sufficiently prepared to properly bring a pandemic under control quickly."

Nabarro pointed to difficulties in getting government departments, other than health ministries, to work on pandemic prevention and preparedness, and he called for greater international cooperation.

Piers E. Merrick, who helps coordinate the World Bank's avian flu response in the East Asian and Pacific regions, said in the statement that despite some success in controlling the spread of H5N1, the disease represents the persistent threat of zoonotic diseases. "Addressing many of these infections will require a more sophisticated and comprehensive long-term action plan" he said.

Next year's international avian flu conference and donors meeting will be held in Vietnam, according to a report today in The Guardian, a British newspaper.

Announcement

PlanFirst Webcasts on Pandemic Influenza

On October 29, 2008, at 1:00 pm ET, Secretary Leavitt will provide formal remarks regarding the Nation?s pandemic planning effort. He will then join a roundtable discussion with our special guests to discuss the Nation?s level of pandemic preparedness and related issues. As always, our guests, including Secretary Leavitt, will take questions from our viewing audience.

No registration is required. Email your questions for the Webcast panelists before and/or during the program to hhsstudio@hhs.gov. Please include your first name, state and town.

Before the Webcast, please ensure that your system can access the live stream: Test Your Video Player.

AI Research

Pneumococcal vaccine could prevent numerous deaths, save costs during a flu pandemic, model predicts

10/29/08 Eureka Alert--A new predictive model shows that vaccinating infants with 7 valent pneumococcal conjugate vaccine (PCV7)--the current recommendation--not only saves lives and money during a normal flu season by preventing related bacterial infections; it also would prevent more than 357,000 deaths during an influenza pandemic, while saving $7 billion in costs.

Keith P. Klugman, PhD, professor of global health at Emory University's Rollins School of Public Health, will present results of the research using the predictive model at the joint ICAAC/IDSA meeting in Washington, DC, Oct. 25-28. (Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Disease Society of America.

Bacterial infections, particularly pneumococcal disease, can follow a viral illness such as flu and cause secondary infections that worsen flu symptoms and increase influenza-related risk. Bacterial infections may have been the cause of nearly half of the deaths of young soldiers during the 1918 flu pandemic.

"We've known for years that bacterial infections can develop after influenza," says Klugman. "Unlike the 1918 flu pandemic, which preceded the antibiotic era, we now have vaccines that can prevent these types of pneumococcal infections. This model shows what a dramatically different outcome we could expect with standard PCV vaccination."

Klugman and colleagues at Harvard University, i3 Innovus in Medford, Ma. and Wyeth Research constructed a model to estimate the public health and economic impact of current pneumococcal vaccination practices in the context of an influenza pandemic.

Since 2000 the Centers for Disease Control and Prevention (CDC) Immunization Practices Advisory Committee (ACIP) has been recommending PCV vaccinations for infants and children.

The new predictive model was used to compare the results of no PCV vaccination to the current routine vaccination of infants less than two years old. The researchers assessed the effect of vaccination policies under both normal and pandemic influenza conditions. They included both direct vaccination effects in vaccinated individuals and indirect vaccination effects (called herd immunity) in the unvaccinated. For manifestations of pneumococcal disease, they included invasive pneumococcal disease (meningitis or bacteremia), all-cause pneumonia and all-cause acute otitis media (ear infections). The model's estimates were based on the 1918 pandemic.

The new model predicted that current pneumococcal vaccination practices reduce costs in a typical flu season by $1.4 billion and would reduce costs by $7 billion in a pandemic. In a pandemic, they would prevent 1.24 million cases of pneumonia and 357,000 pneumococcal-related deaths.

"Our research shows that routine pneumococcal vaccination is a proactive approach that can greatly reduce the effects of a future flu pandemic," says Klugman. Countries that have not yet implemented a pneumococcal vaccination program may want to consider this as part of their pandemic flu preparedness."

Regional Reporting and Surveillance

New Zealand hosts bird flu exercise at Auckland International Airport

10/29/08 Radio New Zealand--New Zealand's ability to cope with an outbreak of bird flu is being tested on Wednesday in an exercise at Auckland International Airport.

Exercise Spring Fever is based around the scenario that a plane arrived with suspected influenza patients aboard.

More than 20 health, border control and Government agencies will be involved as if the outbreak was real.

The Ministry of Health says the exercise is designed to test how prepared New Zealand is for a global influenza pandemic.

Vaccines

Rockeby Biomed Awarded 750,000 Dolars Of Grants By Singapore Government For Influenza And Bird Flu Research, Singapore

10/29/08 Medical News Today--Australia-listed, Singapore-based healthcare group, Rockeby biomed Ltd today announced that it has been awarded two grants by the Singaporean Standards, Productivity and Innovation Board (SPRING Singapore) under the Technology Enterprise Commercialisation Scheme (TECS). The first grant of S$250,000 awarded under Proof of Concept (POC) is for the development of a magnetic detection platform for influenza A, including avian flu, while the second grant of S$500,000 is awarded under Proof of Value (POV), to upscale the production of a rapid and sensitive test incorporating fluorescence technology for the field diagnosis of influenza A, including avian flu.

The letters of offer were presented to Dr. Tan Sze Wee, Managing Director and CEO of Rockeby biomed at the TECS award ceremony today.

The POC project is planned to take one year. After which, the platform will give Rockeby a unique patent protected technology that can also be applied to human seasonal influenza. Under the Proof of Value, the project is planned to take two years. The platform can then be expanded to other infectious disease tests such as Chlamydia, Dengue, Hand, Foot & Mouth. Both projects that have been approved for funding by TECS work towards the development of faster and more sensitive tests for influenza A including avian flu, which have been subjected to fears of pandemics worldwide.

Under POC, proposals were assessed on their technicality feasibility and commercial potential while POV is for applicants keen to further R&D developments on proprietary technology projects, including the development of working prototypes. Rockeby biomed has been granted the maximum funding of S$250,000 and S$500,000 respectively for each project.

Dr. Tan said: "We are pleased to have been able to participate in the inaugural call for applications by the SPRING TECS programme, and proud to have two applications formally approved by the committee. We believe that the programme will help to develop innovation among technology-driven small and medium enterprises in Singapore, and provide Singapore with the competitive advantage going forward."

About Rockeby biomed

Rockeby biomed Limited is a Singapore-based, ASX-listed (ASX: RBY) healthcare company specialising in research, development and marketing of rapid testing technologies for infectious disease in humans and animals and lifestyle health products including CanDia5®, Avian Influenza Virus test kits and Pepp®. The company currently has products that do rapid testing for diseases such as the Avian Flu, HIV, Vulvovaginal Candidiasis and Systemic Candidiasis. For more information, visit http://www.rockeby.com.

About SPRING Singapore

SPRING Singapore is the enterprise development agency for growing innovative companies and fostering a competitive SME sector in Singapore. It works with partners to help enterprises in financing, capabilities and management development, technology and innovation, and access to markets. As the Singaporean national standards and accreditation body, SPRING also develops and promotes internationally-recognised standards and quality assurance to enhance competitiveness and facilitate trade. TECS was established this year by SPRING Singapore to provide vital support and resources for start ups and small and medium enterprises (SMEs) to develop prototypes for commercialisation.

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