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Avian Influenza Daily Digest
October 3, 2008 14:00 GMT
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Thailand: Chicken Die-Off Due to Suspected H5N1
Regional Reporting and Surveillance
UK: Early warning call for H5N1 may have wrong indicator species
10/3/08 Poultry International--by Dr. Terry Mabbett, Speculation remains over which wild waterfowl species are most likely to harbour and spread H5N1 HPAI (highly pathogenic avian influenza) in the environment and into commercial poultry flocks. Bernard Matthews, the United Kingdom's (UK) top turkey-producing company, has more interest than most in pin-pointing and assessing wild bird risk. It was Bernard Matthews that suffered the UK's first outbreak of H5N1 HPAI in February 2007, losing 169,000 turkeys and a lot of public goodwill in the process.
Regional Reporting and Surveillance
Togo: Minister of Agriculture and Livestock Denies Rumors of AI Transmission from Birds to Humans
10/3/08 ARGUS--The Togolese Minister of Agriculture and Livestock denied rumors of bird to human transmission of H5N1 AI following the AI outbreak in 3 poultry farms on 9 September 2008 in Agbata village. The official stated that blood samples [human, implied] have been taken and examined and the results returned negative.
Regional Reporting and Surveillance
South Korea: North Cholla Province Conducts AI Testing of 1,582 Poultry Cases at 160 Farms
10/3/08 ARGUS--On 1 October that 1,582 heads of poultry from 160 farms within the province will be tested for avian influenza (AI) antibodies in two phases between 23 October and 30 December, according to North Cholla Province on 30 September. The source noted that the province will request that the National Veterinary Research Quarantine Service (NVRQS) conduct close examinations if tests results are positive for AI. The province will also request the implementation of emergency quarantine measures to all AI affected-farms in case of AI confirmation.
Regional Reporting and Surveillance
Science and Technology
Vaccines against epidemic and pandemic influenza
10/3/08 Expert Opinion on Drug Delivery October 2008, Vol. 5, No. 10, Pages 1139-1157 (doi:10.1517/17425247.5.10.1139) Mary Hoelscher? BS MBA, Shivaprakash Gangappa? DVM PhD, Weimin Zhong? MD PhD, Lakshmi Jayashankar? PhD & Suryaprakash Sambhara? DVM PhD National Center for Immunization and...
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Pandemic Preparedness
History: North Carolina and the "Blue Death"
10/3/08 University of North Carolina Library--October 1918 -- North Carolina and the "Blue Death" On October 3, 1918, Governor Thomas Bickett issued the first order in North Carolina's battle with an enemy which would prove more deadly to the state than the soldiers of the Central Powers against whom troops from North Carolina were fighting thousands of miles away in Europe. A hitherto unknown strain of influenza had appeared in Wilmington and was spreading west over the state, following the rail lines. North Carolinians were familiar with older forms of influenza, often called the "grippe," which were debilitating but only occasionally deadly. The new type of flu struck fast, causing two or three days of high fever which, in a distressingly large number of cases, led to death. The lungs of victims filled with fluid and their skin turned a dark blue, as their respiratory system failed and their tissue was starved for oxygen. The old influenza was most dangerous for the weak or elderly; the new flu preyed on the young and healthy.
Pandemic Preparedness
Australia: Launch Of Pandemic Influenza Planning Toolkit, Royal Australian College Of General Practitioners
10/3/08 Medical News Today--The Royal Australian College of General Practitioners (RACGP) is launching its Pandemic Influenza Planning Toolkit: the 'flu' kit, which has been designed to support general practitioners, practice managers and practice nurses in educating staff and patients as the practice develops a plan to respond to a potential influenza pandemic.
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Study: First flu wave in 1918 was vaccine for some
10/3/08 CIDRAP--In the influenza pandemic of 1918, those who got sick in the first wave of illness were up to 94% less likely to fall ill when the second and much more severe wave struck, according to a new analysis of historical data.
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Science and Technology
Vaccines against epidemic and pandemic influenza
10/3/08 Expert Opinion on Drug Delivery
October 2008, Vol. 5, No. 10, Pages 1139-1157
(doi:10.1517/17425247.5.10.1139)
Mary Hoelscher? BS MBA, Shivaprakash Gangappa? DVM PhD, Weimin Zhong? MD PhD, Lakshmi Jayashankar? PhD & Suryaprakash Sambhara? DVM PhD
National Center for Immunization and Respiratory Diseases, Influenza Division, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Mail Stop G47, 1600 Clifton Road, Atlanta, GA 30333, USA +1 404 639 3800; +1 404 639 5180; ssambhara@cdc.gov
? Author for correspondence
Background: Preventative vaccination is the most effective way to control epidemic and, perhaps, pandemic influenza viral infections. However, the immunogenicity and efficacy of influenza vaccines against epidemic strains are suboptimal among older adults. The risk of serious complications from influenza viral infection is compounded by co-morbid conditions among older adults. Furthermore, despite annual influenza vaccination campaigns, the vaccination rates in high risk populations range from 60.5 ? 79.2% only [1]. In addition, H5N1 avian influenza viruses have the potential to cause a pandemic. However, H5N1 vaccines currently licensed in the US are poorly immunogenic in high doses in the absence of an adjuvant even in healthy adults. Objectives: In this review, we address the current status of vaccines against epidemic and avian influenza viruses of pandemic potential. Methods: We have limited the review to the discussion of technologies and strategies that have progressed to human clinical trials and/or licensure for seasonal and pandemic influenza. Results/conclusion: Improving the immunogenicity of vaccines against avian influenza viruses, as well as aggressive programs to vaccinate high risk populations against seasonal and pandemic influenza, are crucial for our public health efforts in minimizing the impact of influenza epidemics or pandemics.
http://www.informapharmascience.com/doi/full/10.1517/17425247.5.10.1139
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History: North Carolina and the "Blue Death"
10/3/08 University of North Carolina Library--October 1918 -- North Carolina and the "Blue Death"
On October 3, 1918, Governor Thomas Bickett issued the first order in North Carolina's battle with an enemy which would prove more deadly to the state than the soldiers of the Central Powers against whom troops from North Carolina were fighting thousands of miles away in Europe. A hitherto unknown strain of influenza had appeared in Wilmington and was spreading west over the state, following the rail lines. North Carolinians were familiar with older forms of influenza, often called the "grippe," which were debilitating but only occasionally deadly. The new type of flu struck fast, causing two or three days of high fever which, in a distressingly large number of cases, led to death. The lungs of victims filled with fluid and their skin turned a dark blue, as their respiratory system failed and their tissue was starved for oxygen. The old influenza was most dangerous for the weak or elderly; the new flu preyed on the young and healthy.
The influenza epidemic overwhelmed North Carolina's medical community and rudimentary public health system. The medicines and folk remedies on which people customarily relied were useless. The state's primary public health response?forbidding public gatherings and quarantining victims?began late and was almost impossible to enforce. When local public health services failed or where they were nonexistent, people working through war-preparedness groups and the Red Cross, organized volunteers to visit the sick and fetch medicine or food. Emergency kitchens were set up to cook for those too sick to help themselves.
What was happening in North Carolina was a part of the worst influenza pandemic in modern times. Present day research has identified the cause of the disease as an influenza A virus strain. The virus produced a violent reaction in the human immune system, which ironically led to the disease being deadliest among those whose systems were strongest, the young and fit. The virus swept in three waves through the populations of Europe and North America, already dislocated by World War I, and eventually spread to all parts of the earth. Overall, as many as 20 million people may have died.
More than 13,000 of those dead came from North Carolina. Influenza killed people in all walks of life and was particularly deadly on those who cared for the sick, both professional and volunteer. It killed with something like the speed of modern warfare: in many cases less than 48 hours passed between the first sneeze and the last breath; the president of the University of North Carolina died near the beginning of the epidemic; his successor died a month later. Soldiers in crowded training camps were especially vulnerable. At the railroad station that served Camp Greene near Charlotte coffins were stacked from floor to ceiling, taking home the bodies of young soldiers who never saw the war.
In some ways North Carolina benefited from the influenza epidemic. The 1920s witnessed an unprecedented boom in hospital construction in the state, fueled, at least in part, by the inadequacy of the old health care system, so graphically demonstrated in the epidemic. For much the same reason, the public health system began to take hold in North Carolina during the years following World War I. In the end, however, the disease, while deadly, was over quickly, and memory of the Blue Death faded. Old stories still circulate: a lonely house in the country where an entire family, parents and children, were found dead in their beds or the four country doctors serving an area at the beginning of the sickness, only two of whom were alive at the end or the woman who, on seeing a new-dug grave, said it reminded her of 1919, when the graveyards looked like they had been turned with a plow.
Harry McKown
October 2008
Sources:
David L. Cockrell. "'A Blessing in Disguise': the Influenza Pandemic of 1918 and North Carolina's Medical and Public Health Communities," North Carolina Historical Review, vol. 73:3 (July, 1996).
Selena W. Sanders, "The Big Flu," The State: Down Home in North Carolina, vol. 44:7 (December, 1976).
Robert Mason, "Surviving the Blue Killer, 1918," Virginia Quarterly Review, vol. 74:2 (Spring, 1998).
Jim Nesbitt, "When killer flu struck," News and Observer, November 26, 2006.
Annie Sutton Cameron. A Record of the War Activities in Orange County, North Carolina, 1917-1919. [electronic resource] [Chapel Hill, NC] Academic Affairs Library, University of North Carolina at Chapel, 2002.
Image Source:
The Health Bulletin. Raleigh, North Carolina State Board of Health. vol. 34:10 (October, 1919)
Regional Reporting and Surveillance
UK: Early warning call for H5N1 may have wrong indicator species
10/3/08 Poultry International--by Dr. Terry Mabbett, Speculation remains over which wild waterfowl species are most likely to harbour and spread H5N1 HPAI (highly pathogenic avian influenza) in the environment and into commercial poultry flocks. Bernard Matthews, the United Kingdom's (UK) top turkey-producing company, has more interest than most in pin-pointing and assessing wild bird risk. It was Bernard Matthews that suffered the UK's first outbreak of H5N1 HPAI in February 2007, losing 169,000 turkeys and a lot of public goodwill in the process.
Ironically, most of the fall out occurred when the incident inadvertently revealed how Bernard Matthews was importing a considerable amount of turkey meat into the UK. UK consumers had always been led to believe, through company advertising, that Bernard Matthews' turkey was exclusively home grown.
The Department for Environment, Food and Rural Affairs (Defra) claimed the most plausible source of the H5N1 outbreak in Bernard Matthews' turkey-growing sheds at Holton in the Country of Suffolk was from partly processed turkey meat imported into the UK from Hungary. A Bernard Matthews turkey processing plant was on the same site as the infected turkey farm, although the source, route of entry, and spread of the virus was never proven beyond absolute doubt. The virus had already been carried into Eastern Europe (including Hungary) on wild birds.
Concern over risk and role of wild birds
Bernard Matthews' concern over risk and role of infected wild birds spreading threatening to poultry is clearly heightened by perceived increased vulnerability related to a major overall in the company?s production systems. This was provoked by the H5N1 disaster and the subsequent controversy surrounding imports which led to Bernard Matthews brand sales halving at one point last year.
Bernard Matthews has promised to source all turkey from farms around its home base in East Anglia in the UK and to focus on free range production, which clearly raises the risk of H5N1 passing from wild birds into poultry. Together, with Defra's analysis that turkeys are almost 40 times more susceptible than chickens to H5N1 HPAI, it is easy to see why Bernard Matthews is very concerned.
Earlier this year, the 2008 Temperton Fellow called on the UK government and the poultry industry to work together to establish an early-warning system for migratory birds that can carry H5N1 avian flu. Armed with this knowledge, free-range turkey producers would be able to take measures to avoid contact between wild birds and poultry, such as temporarily housing flocks during the high-risk period, he said.
080311PI_news
Delivering his Temperton Fellowship Report, Bernard Matthews Foods technical director Jeremy Hall highlighted the trend towards free-range Christmas turkeys. "TV chefs are encouraging consumers to go free range, which has led to a 15 percent growth in Christmas turkey volume. But outdoor farming brings risk and the sector needs to find how to manage this during the higher-risk autumn migration season. So the challenge is to rear turkeys through the highest risk months without any outbreaks,? Hall said.
One big limitation highlighted by Hall that undermines the industry's preparedness is the lack of information on movement of the virus. He claimed there was good European Union (EU) information on routine wild-bird testing but that the approach taken was disjointed. "The EC's [European Commission] way of reporting the previous quarter's results means that data is available only when it is about five months out of date. However, the European picture on virus movement is critical and we need a faster web-based reporting system," he said.
Hall went on to recount how he had meetings with the British Trust for Ornithology (BTO) and was amazed by the sophistication of its records and mapping. "Using those data with satellite tracking, we could track bird movement and know precisely when birds start their journey back to the UK," Hall said. "But the [UK] government needs to put more support into wild-bird testing and monitoring. At the moment, we are depending on the goodwill of the RSPB [Royal Society for the Protection of Birds] and BTO for bird spotting. Defra is inadequately supporting this and we need to halt the decline in bird collections for avian flu testing."
Defra's UK wild bird surveillance programme has previously come in for criticism from experts in continental Europe and North America. The extremely low detection rate of avian influenza viruses of any subtype suggest (36 out of 11,441 birds tested since 2006), and lower than continental Europe by a factor of around 30, indicates there could be a failure at some point in the sampling and/or sample storage/transportation procedure, they say.
Pochards, mallards potential long distance vectors
The pochard (Aythya farina) is the most likely candidate for carrying and harbouring the H5N1 avian flu virus in Europe, claimed Hall. "Looking at wild birds testing positive, there were mainly swans and pochards. But as swans either migrate short distances or don?t migrate at all, they are picking up infection from other species." In contrast, he said, the pochard travels huge distances to its breeding grounds in eastern Russia and China, and spends the summer in contact with wildfowl in areas known to have a high presence of infection. And about 84,000 of these return to the UK each autumn.
0809PIMallards
These views are not completely in tune with research carried out by a team of scientists at the Erasmus Medical Centre in Rotterdam, Netherlands, which includes acknowledged world expert Professor Albert Osterhaus. They acknowledge how wild birds are implicated in expansion of H5N1 HPAI outbreaks across Asia, the Middle East, Europe, and Africa (in addition to traditional transmission by infected poultry, contaminated equipment, and people).
Such a role, they say, requires wild birds to excrete virus in the absence of debilitating disease. By experimentally infecting wild ducks, they found that tufted ducks (Aythya fuligula), Eurasian pochards (Aythya farina), and mallards (Anas platyrhynchos) excreted significantly more virus than common teals (Anas crecca), Eurasian wigeons (Anas penelope), and gadwalls (Anas strepera). Only tufted ducks and, to a lesser degree, pochards became ill or died. They singled out mallards as the biggest potential long distance vectors of H5N1 HPAI while other species, like tufted ducks, were more likely to act as sentinels.
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Thailand: Chicken Die-Off Due to Suspected H5N1
10/3/08 ARGUS--A national source reported a die-off of 30 chickens on a farm in Sai Ngam district (Kamphaeng Phet province). The district was declared an avian influenza ?observation zone?. Local authorities have sprayed disinfectant at all poultry farms and banned transportation of poultry in the village of Ban Boh Kaew. Test results of the dead chickens are still pending.
Public AI Blog Discussions
Study: First flu wave in 1918 was vaccine for some
10/3/08 CIDRAP--In the influenza pandemic of 1918, those who got sick in the first wave of illness were up to 94% less likely to fall ill when the second and much more severe wave struck, according to a new analysis of historical data.
The authors, led by historian John M. Barry, sifted data mostly from US Army camps, along with some from the British navy and British cities, to conclude that infection in the first wave acted like a vaccine, conferring immunity that protected people when the second wave arrived. Barry wrote the 2004 book The Great Influenza, a chronicle of the pandemic.
Their analysis "strongly points to cross-protection between outbreaks of respiratory illness during spring and early summer of 1918 and the influenza pandemic wave in the fall of 1918. The cross-protection effect was estimated to range from 35% to 94% for clinical illness and from 56% to 89% for mortality," says the report, published online by the Journal of Infectious Diseases.
The authors say their findings suggest that when novel flu viruses emerge and initially cause a mild wave of illness, public health authorities should think twice before taking aggressive steps to limit exposure, since people infected with the virus might benefit later on if the virus grows more virulent and triggers another wave of cases.
Besides Barry, the authors are Cecile Viboud of the Fogarty International Center in Bethesda, Md., and Lone Simonsen of George Washington University in Washington, DC.
The pandemic of 1918-19 occurred in three waves: a mild one in the spring or summer of 1918 (depending on location), a much more severe one in the fall, and a less severe one in the winter and spring of 1919, the authors note. The first wave began in March 1918 in the US Army and spread quickly through training camps and on to some civilian communities, and then faded by June. This initial wave came later in Europe, peaking in June and July, the report notes.
US Army records show that 11.8% of all personnel at all camps were hospitalized for respiratory illness in the spring wave from March through May, compared with 27.5% during the fall wave, the report says.
Multiple tests of hypothesis
The authors used several approaches to test the hypothesis of cross-protection. One was to examine detailed data available from five US Army camps on flu cases and deaths in seasoned troops?defined as those who had been in the Army at least 1 month?and new recruits during the second wave. New recruits were considered less likely to have been exposed in the first wave, because the spring epidemic was much larger in the army than in civilian communities. In fact, in only a few civilian areas was the spring wave large enough to be recognized as an epidemic at the time, the report says.
Using these data, the investigators estimated that at two of the camps, Camp Grant and Columbus Barracks, seasoned troops were, respectively, 56% (95% confidence interval [CI], 51% to 61%) and 89% (95% CI, 66% to 97%) less likely to die in the second wave, compared with new recruits. For the other camps, the seasoned troops, as compared with new recruits, had protection against clinical illness estimated at 94% (95% CI, 90% to 97%) for Fort McDowell, 49% for Camp Pike (95% CI, 48% to 51%), and 86% (95% CI, 84% to 87%) for Camp Lee.
The investigators acknowledge that some of the seasoned troops could have escaped the spring wave of illness and that some of the new recruits might have been exposed to the flu as civilians. But the resulting bias in their estimates would go against showing a protective effect, resulting in an underestimation rather than an overestimation of the true benefits, they write.
The authors also found useful data on two regiments of seasoned troops who were trained at Camp Dodge in the fall of 1918; one regiment had been exposed to the spring wave while stationed in Hawaii, and the other had escaped it while in Alaska. Of those who had been exposed in the spring, 6.6% (198 of an estimated 3,000 troops) contracted flu in the fall. In the regiment that had been in Alaska, 48.5% (1,455 of an estimated 3,000) became sick in the fall. In this case, the protective effect of prior exposure was estimated at 86% (95% confidence interval, 84% to 88%).
Data from the British Grand Fleet offered another opportunity for assessing cross-protection. A 1919 report in a medical journal supplied the numbers of sailors, out of the fleet total of 90,000, who were sick during each of the two waves and during both waves. From these numbers, the authors estimated that those who were sick in the spring had 72% protection (95% CI, 68% to 76%) against the fall wave.
A British government report on flu cases in 12 civilian communities with a total population of 24,706 provided still another pathway for testing the hypothesis. In this population, 11.6%, or 2,863 people, were hit by the first wave. The authors estimated that these people gained 35% protection (95% CI, 27% to 43%) against the second wave, compared with those who escaped the earlier wave.
However, using data from the same report, the investigators concluded that illness during either the first or the second wave did not seem to confer protection against the third wave in the winter.
But overall, the authors conclude, illness in the first wave yielded about as much protection against the second wave as modern flu vaccines, which are about 70% to 90% effective in healthy adults. The finding of cross-protection matches the impressions of contemporary US Army epidemiologists, they note.
Viral evolution and cross-protection
Barry and colleagues write that the simplest explanation of their findings is that the spring and fall waves of the pandemic were caused by "sequential variants" of the influenza A/H1N1 virus. The spring virus might not have been fully adapted to humans, they say, since it apparently didn't spread effectively in civilian communities. By fall, it had evolved into a fully human-adapted and more virulent form.
But there is at least one other possible explanation: that nearly identical viruses circulated during both waves, but respiratory bacterial pathogens exacerbated the disease in the fall.
The authors suggest that their findings may help explain why pandemic mortality rates in the fall of 1918 varied almost fourfold among US cities. Though recent studies suggest that these differences can be largely explained by differences in nonpharmaceutical interventions, "we propose that geographical differences in population immunity acquired during the first wave could have contributed to the observed variation during the second wave," they write.
The investigators see at least two policy implications in their findings. One is that timely surveillance is crucial for learning the transmissibility, virulence, and age-group impact of influenza in the early stages of a pandemic.
"Second, if indeed a mild first wave is documented, the benefits of cross-protection during future waves should be considered before implementing public health interventions designed to limit exposure," they write.
Other experts impressed
Several other infectious disease experts said they were impressed with the study and found it convincing, though one military medical historian saw problems with some details of the data presented.
"I think you have to say they make a strong circumstantial case," said Richard J. Hatchett, MD, of the National Institute of Allergy and Infectious Diseases (NIAID), who has studied the effects of nonpharmaceutical interventions in the 1918 pandemic.
"It's really amazing that we can go back after almost 100 years and get any useful data on an epidemic that occurred in 1918," said Hatchett, who is an associate director of emergency preparedness in the NIAID's Division of Allergy, Immunology and Transplantation.
He said the evidence of a sizable spring epidemic in cramped Army camps but only a minor one in civilian communities suggests that initially the virus was not well-adapted for human-to-human transmission and that the camps, with their continual influx of new recruits, may have served to incubate and sustain the virus until it became more transmissible and much more lethal.
"If this were the case, the fall pandemic would've been a direct consequence of the war and social arrangements that allowed this inefficient virus to spread through the population. There's probably a useful lesson in that experience, if that speculative observation were proved," he said.
"I'm not sure there is any direct application of the results of this paper to current pandemic planning," Hatchett said. He added, however, "I think their [the authors'] recommendation of not implementing aggressive nonpharmaceutical interventions in a mild pandemic is in line with what the government is currently recommending." He referred to Centers for Disease Control and Prevention (CDC) guidelines, which link interventions to a pandemic severity index.
Dr. Christophe Fraser, an infectious disease epidemiologist at Imperial College London, said Barry and colleagues' results are in line with his own findings in a study that has not yet been published.
"We have analyzed some previously unpublished data from the USA in 1918, and our conclusions are very concordant with Dr. Barry and collaborators' work, and even go a bit further," Fraser told CIDRAP News by e-mail.
He also commented, "This issue, of whether the population was protected by exposure to a limited spring epidemic of flu, is rather important for the current debate as the fall wave of 1918 is being used as one of the baseline scenarios for pandemic preparedness. If a significant proportion of the population were actually immune, then that means it's not a good baseline to plan around."
Fraser said Barry and colleagues' findings?combined with certain other evidence, such as a recent report that Scandinavian countries had a major spring epidemic?suggest that that fall wave of 1918 would have been worse without the protective effective of the earlier epidemic.
"This is not as outlandish as it may seem," he wrote. "Indeed one of the big discoveries from the historical record, now widely replicated, is that the 1918 fall wave virus was not very infectious. It was virulent, even lethal in many cases, but not easy to transmit compared to many other common viruses."
Some discrepancies seen
Carol R. Byerly, PhD, a historian at the University of Colorado and author of the 2005 book Fever of War: The Influenza Epidemic in the US Army during World War I, said that some Army physicians at the time had a sense that soldiers who were sickened in the spring of 1918 may have had some immunity when the second wave of flu arrived in the fall. But, while making clear she is not an epidemiologist, she said she saw some flaws in the data.
For a few examples, she said:
* The report says that the Army conducted disease surveillance at 37 of 39 training camps, but the Medical Department provided detailed information on at least 40 camps, all of which did surveillance.
* The authors say that five Army camps provided detailed data for illnesses and deaths as a function of length of time in service, but she knows of at least eight monographs on the experiences at individual camps.
* Army medical officers' definition of "seasoned" recruits varied in different studies, so it is inaccurate to state that the criterion was clearly defined as just 1 month of service. Most studies used 3 or 4 months.
* Whereas the report says Army documents show that 475,000 men had respiratory illness in 1918, the actual figure War Department records show for all hospitalizations for respiratory illness in 1918 is 756,676.
"I am therefore concerned about the construction of a statistical analysis on top of such a poorly defined database," Byerly said.
Reconsidering assumptions
Another disease expert, Michael T. Osterholm, PhD, MPH, said he found the study "quite convincing," adding, "I think it adds another piece to our understanding of what happened" in 1918.
The results suggest a possible need to rethink some assumptions about pandemics, which by definition involve viruses to which the population has no immunity, said Osterholm, who is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News.
"If we have wave 1 and it's relatively mild, and a number of people are exposed to that virus, that may actually be a very positive thing relative to a second wave in which the disease is much more severe," he said. "That could mean a lot of infection in a first wave is actually a good thing, with much of the world not having a vaccine."
But he added, "This is all theoretical. . . . As to whether there are any policy decisions we should make on the basis of this, I think at this point it's just unclear."
"I think the point it demonstrates very clearly is that pandemic waves may act very differently, in large part due to the virulence of the virus and the subsequent immunity that may develop," Osterholm said.
Barry JM, Viboud C, Simonsen L. Cross-protection between successive waves of the 1918-1919 influenza pandemic: epidemiological evidence from US Army camps and from Britain. J Infect Dis 2008 Nov 15;198 (early online publication) [Abstract]
Regional Reporting and Surveillance
Togo: Minister of Agriculture and Livestock Denies Rumors of AI Transmission from Birds to Humans
10/3/08 ARGUS--The Togolese Minister of Agriculture and Livestock denied rumors of bird to human transmission of H5N1 AI following the AI outbreak in 3 poultry farms on 9 September 2008 in Agbata village. The official stated that blood samples [human, implied] have been taken and examined and the results returned negative.
Article URL(s)
http://www.french.xinhuanet.com/french/2008-09/27/content_729704.htm
Regional Reporting and Surveillance
South Korea: North Cholla Province Conducts AI Testing of 1,582 Poultry Cases at 160 Farms
10/3/08 ARGUS--On 1 October that 1,582 heads of poultry from 160 farms within the province will be tested for avian influenza (AI) antibodies in two phases between 23 October and 30 December, according to North Cholla Province on 30 September. The source noted that the province will request that the National Veterinary Research Quarantine Service (NVRQS) conduct close examinations if tests results are positive for AI. The province will also request the implementation of emergency quarantine measures to all AI affected-farms in case of AI confirmation.
The province reportedly plans to conduct fecal tests for migratory birds near Keum, Mangyeong Rivers, Paeksan Reservoir, and Ongjang Triburary along with four high risk regions including Kimje, Iksan, Jeongeup Cities and Kochang County by the end of this year.
An official from the province stated that this year?s provincial system of conducting AI inspections prior to actual outbreaks reflects a revised approach to the AI countermeasure system. The official stated that the new system reflects a more proactive method instead of depending on outbreak reports from AI-affected farms, as was done in the past. The official also advised the public to immediately report any suspicious AI cases.
Article URL(s)
http://www.sjbnews.com/news/articleView.html?idxno=276857
Quid Novi
FAO/GLEWS: Thailand follow-up
10/2/08 FAO field officer--Regarding the suspected human case of H5N1 infection and related mortalities in free-range ducks in Pho Prathap Chang District, the test results for the human case were negative to AI. Also, there was nothing unusual ducks or other poultry.
Pandemic Preparedness
Australia: Launch Of Pandemic Influenza Planning Toolkit, Royal Australian College Of General Practitioners
10/3/08 Medical News Today--The Royal Australian College of General Practitioners (RACGP) is launching its Pandemic Influenza Planning Toolkit: the 'flu' kit, which has been designed to support general practitioners, practice managers and practice nurses in educating staff and patients as the practice develops a plan to respond to a potential influenza pandemic.
The pandemic 'flu' kit has been developed with the support of the Australian Government Department of Health and Ageing and will be launched on Saturday, 4 October during the Wonca Asia Pacific Regional Conference/RACGP Annual Scientific Convention (ASC) 2008 in Melbourne. The workbook will be available through the RACGP website at http://www.racgp.org.au/pandemicresources.
"An influenza pandemic will challenge our health system. General practitioners will play a critical front line role in responding to a potential influenza pandemic, in supporting public health goals in disease control and in providing essential health care to patients," said Dr Chris Mitchell, RACGP President and GP in Northern NSW.
"We don't know when the next influenza pandemic will occur, but we can plan ahead. If an outbreak were to occur, people will turn to their general practice for care. We need to be ready.
"With appropriate planning for early interventions, it might be possible to limit the impact of an influenza outbreak and therefore the outbreak accelerating to a pandemic.
"General practice has an important role in the clinical assessment and management of acutely unwell influenza patients and the ongoing management of non influenza related care, as well as disease surveillance.
"In responding to a pandemic, general practices will need to develop systems to provide for the safety of practice staff and the continuation of high quality clinical care to patients," said Dr Mitchell.
The pandemic 'flu' kit, will guide GPs and their practice staff through a series of actions to help practices develop a plan to respond to a pandemic and to build knowledge and competency in managing the impact of an emerging pandemic.
Pandemic preparedness of a general practice requires careful consideration and planning across a wide range of contingencies. From the first patient with influenza-like symptoms presenting for an appointment, through to how an acutely unwell patient is managed while in isolation in their own home.
"As the kit outlines, simple measures such as hand washing, wearing a mask and isolating potentially infected patients are effective in preventing the spread of respiratory virus infections," said Dr Chris Mitchell.
The pandemic 'flu' kit consists of a CD with the education modules and five practice posters. A copy of the pandemic 'flu' kit will be sent to every general practice in Australia. For more information on pandemic influenza planning and other useful resources please visit http://www.racgp.org.au/pandemicresources
GPs can earn RACGP QA&CPD points as they work through the pandemic 'flu' kit. There is a range of learning options across Category 1 and 2 points.
The RACGP would like to thank the members of the expert reference group who generously contributed their time and knowledge to this project.
The Royal Australian College of General Practitioners (RACGP) is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP has the largest general practitioner membership of any medical organisation in Australia and represents the majority of Australia's general practitioners.
Royal Australian College of General Practitioners
Article URL: http://www.medicalnewstoday.com/articles/124109.php
