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Avian Influenza Daily Digest
October 8, 2008 14:00 GMT
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Article Summaries ...
Regional Reporting and Surveillance
Singapore: Tamiflu sales up due to stockpiling, use on severe flu cases
10/8/08 News Asia--Drug company Roche said sales of anti-viral drug Tamiflu have gone up in tandem with flu cases this year. Tamiflu is not just being stockpiled to fight against the avian flu, but also prescribed to patients down with severe flu. When Dr Chong Yeh Woei sees patients with severe flu, he takes no chances, sending their blood samples for tests.
Antivirals, Regional Reporting and Surveillance
FAO conducts bird flu research activity in Cambodia
10/8/08 Xinhua--The Food and Agriculture Organization of the United Nations (FAO) Wednesday started a three-day workshop on avian influenza research activities in Cambodia, said a FAO press release.
Regional Reporting and Surveillance
Science and Technology
South Korea: Breakthrough in Avian Influenza Vaccine
10/8/08 Chosun--[news photo]--Guru in the field of avian influenza research, Prof. Suh Sang-hee, of the Dept. of Veterinary Medicine at Chungnam National University, announced on Tuesday that he has developed a human vaccine for HPAI (Highly Pathogenic Avian Influenza) for the first time in South Korea, following the US, the UK, and Japan.
Vaccines
Pandemic Preparedness
WHO Warns Against 'Bird Flu Fatigue'
10/8/08 IPS--So where is the pandemic? This is a question most often asked of health experts years after they warned about a pandemic influenza that could infect up to 35 percent of the world's population. The experts had say that pandemics are recurring events and that one was due anytime. They said a pandemic today, given the large volume of international travel, could reach all continents in less than three months and that the world?s medical facilities will have difficulty coping with the huge number of sick people.
Pandemic Preparedness
Truckers crucial in flu pandemic, study says
10/8/08 Toranto Star--Health care staff aren't the only ones who should get top priority When a flu pandemic hits, utility workers and truck drivers will be as valuable in resolving the ensuing crisis as doctors and nurses will be, and so should also get top priority when it comes to deciding who gets medical care, a new bioethics study says.
Pandemic Preparedness
Full Text of Articles follow ...
Vaccines
South Korea: Breakthrough in Avian Influenza Vaccine
10/8/08 Chosun--[news photo]--Guru in the field of avian influenza research, Prof. Suh Sang-hee, of the Dept. of Veterinary Medicine at Chungnam National University, announced on Tuesday that he has developed a human vaccine for HPAI (Highly Pathogenic Avian Influenza) for the first time in South Korea, following the US, the UK, and Japan.
According to the research team led by Prof. Suh, AI human vaccine CNUK-H5N1-08-01 was developed via a gene recombination technique while reducing the toxicity of the strain of H5N1 AI introduced in June 2007 after the approval of WHO (World Heal Organisation) and the US government. The team verified the vaccine by experimenting on ferrets.
South Korea has stockpiled imports of Tamiflu, a flu drug, to brace itself for the spread of avian influenza. However, an increasing number of people are demanding a new vaccine, since highly pathogenic H5N1 AI, which is immune to Tamiflu, appeared in Southeast Asia
Antivirals > Regional Reporting and Surveillance
Singapore: Tamiflu sales up due to stockpiling, use on severe flu cases
10/8/08 News Asia--Drug company Roche said sales of anti-viral drug Tamiflu have gone up in tandem with flu cases this year. Tamiflu is not just being stockpiled to fight against the avian flu, but also prescribed to patients down with severe flu. When Dr Chong Yeh Woei sees patients with severe flu, he takes no chances, sending their blood samples for tests.
And he has had to do more of it recently as more patients come in with bad bouts of flu, some even developing into pneumonia.
"In the last two months, (I've) prescribed maybe about 10 to 20 doses of Tamiflu. Most of them were very, very ill... and therefore we had to use that to solve their problem.
"If we get the diagnosis of infleunza right clinically, the results of Tamiflu can be quite spectacular... they get well very quickly," said Dr Chong, Atriamed Associates.
The National University Hospital, on the other hand, said it has not dispensed Tamiflu, but acknowledged that using anti-virals within 48 to 72 hours of the onset of viral flu can be beneficial.
Raffles Medical Group said that makes Tamiflu popular among senior managers who said they cannot afford to be down with flu, as "time lost means money loss."
"It's not a drug you would use casually; it's something you use judiciously and carefully, and preferably in very, very sick patients," cautioned Dr Chong.
The World Health Organisation said seasonal flu is now showing resistance to Tamiflu in 15 per cent of cases worldwide.
With the flu season expected to set in from next month, doctors and patients will have to balance this issue of resistance, against treating a viral flu quickly and effectively.
The MOH does not have guidelines on the use of Tamiflu on seasonal flu, but said it is not common practice.
The ministry advised instead that the elderly and younger children get their annual influenza vaccinations.
Pandemic Preparedness
WHO Warns Against 'Bird Flu Fatigue'
10/8/08 IPS--So where is the pandemic? This is a question most often asked of health experts years after they warned about a pandemic influenza that could infect up to 35 percent of the world's population. The experts had say that pandemics are recurring events and that one was due anytime. They said a pandemic today, given the large volume of international travel, could reach all continents in less than three months and that the world?s medical facilities will have difficulty coping with the huge number of sick people.
They also pinpointed avian flu as the possible cause of the next pandemic.
However, there has been little news about avian influenza lately, compared to the highly publicised cases just a year ago. This development might be considered by some as a good thing, but it could also lull the public into a false sense of security, something that has left the Geneva-based World Health Organisation (WHO) worried.
An official of the WHO?s Western Pacific Regional Office headquartered in Manila said people may be growing apathetic to the avian flu problem and could be letting their guard down in protecting themselves against the disease.
"I have observed ?avian influenza fatigue? or apathy among the people," said Dr. Takeshi Kasai, regional adviser on communicable disease surveillance and response. "They think they have already done enough, and that is our worry in the WHO," he told IPS.
The first known case of avian influenza infection among humans was reported in 1997. The virus, the H5N1 strain in particular, crossed the species barrier and was transmitted from birds to humans through direct contact with infected poultry or surfaces contaminated by droppings.
According to the WHO, there have been a total of 387 avian flu cases among humans, with 245 fatalities. Most of the cases occurred in rural areas where poultry roam freely in homes and backyards. Countries with the most cases are Indonesia, Vietnam, Thailand, Egypt and China.
The most recent case was confirmed last September: a man in Indonesia who developed avian flu symptoms in July.
Health experts have been closely monitoring the H5N1 strain because it has already met two of three conditions that could spark an influenza pandemic (global epidemic). It is a new influenza virus subtype and it infects humans, causing serious illness. The third condition is that the virus spreads easily on a sustained basis among humans. If the H5N1 evolves into a form that is as contagious as normal influenza, it could start a pandemic.
"The risk that avian influenza could cause the next pandemic remains the same. It has not changed at all since 2003," Kasai said.
He said the avian flu virus continues to mutate. "In 1997 there was only one strain, now there are more than 10 groups," he said. "We have already seen changes in the virus."
As long as opportunities for human infections occur, the risk that the H5N1 virus will acquire the ability to cause an influenza pandemic will persist, the WHO said. And these opportunities will remain as long as the virus circulates in birds.
The WHO is concerned that the H5N1 virus is now entrenched in many Asian countries, bringing with it the risk that more human cases will occur. And each new case gives the virus the opportunity to become more transmissible in humans.
Although the outbreak of avian flu in birds continues, the number of cases is still limited in humans, a development that Kasai sees as "good news." He said health education and information programmes could have contributed to the low infection rate among humans.
Delegates at a WHO regional meeting in Manila late September noted the considerable progress already made to improve "country-level" readiness for avian flu. Because of their strengthened capacity for surveillance and response, countries affected by the disease have been rapidly responding to human infections of the virus and gained the confidence of the public, the delegates noted.
The WHO has assisted countries in testing and validating their pandemic preparedness plans. Laos conducted rapid containment exercises in November 2007, followed by the Philippines in March 2008. Lessons learnt from these exercises will help develop programmes for pandemic influenza containment operations.
Several countries have also strengthened their infection control, laboratory bio-safety and field epidemiology training.
Acknowledging the WHO?s contributions in containing avian flu in his country, Vietnamese health minister Nguyen Quoc Trieu pledged increased international cooperation in the public health sector.
Bird flu has infected 105 people in Vietnam and killed at least 51 of them since it first appeared in the country in late 2003. This year bird flu outbreaks were detected in 26 Vietnamese provinces, killing five people and forcing authorities to cull more than 60,000 ducks.
Although it is not known what H5N1 strain will cause the next pandemic or if it would be caused by the H5N1 virus at all, an H5N1 pandemic is still an important possibility. As such the development of an avian flu vaccine remains a crucial part of the global strategy for pandemic preparedness.
At present the available vaccines act only against a single strain of the virus. Large-scale commercial production of a vaccine against a pandemic virus can only start until the new virus has emerged and a pandemic declared.
According to Kasai, a number of countries have already stockpiled vaccines against the prevalent strain in their areas. But because the virus mutates quickly, it is important to further develop the vaccines.
Kasai said there are ongoing trials to determine whether receiving a vaccine against a single strain would increase one?s chances of protection against other strains. "There is a theory that once your body has a memory against [one strain], it could boost your immunity against the other [strains]," he explained.
Kasai said countries must prepare for a pandemic because it will surely develop.
"We think we?ve been very lucky," said Kasai, that there has been no influenza pandemic yet. "But we have a responsibility to tell the public that they should not stop preparing for it."
Regional Reporting and Surveillance
FAO conducts bird flu research activity in Cambodia
10/8/08 Xinhua--The Food and Agriculture Organization of the United Nations (FAO) Wednesday started a three-day workshop on avian influenza research activities in Cambodia, said a FAO press release.
The workshop took place in Sihanoukville with support from the Cambodian Ministry of Agriculture, Forestry and Fisheries with the aim of bringing together researchers from various disciplines to share the results of their HPAI H5N1-related research in Cambodia, said the release.
It also aimed to facilitate dynamic exchange of views between researchers and decision makers on epidemiological, social and economic issues relevant to HPAI H5N1 in Cambodia, according to the release.
It still aimed to identify and prioritize major knowledge gaps that research needs to fill and how to best address them in the near future and contribute to the development of a second generation of science-based HPAI H5N1 risk management strategies that carefully consider their impacts on the livelihoods of the poor, the release added.
Compared to neighboring Thailand and Vietnam, Cambodia was only mildly affected by HPAI. Nevertheless, Cambodia's animal and public health authorities heavily engaged in HPAI H5N1 control and monitoring, and many of the implemented measures are still in place, said the release.
Alongside these control measures, a wide array of field and laboratory research was initiated in Cambodia, both by national and international agencies, it said.
As much of this research is reaching completion or has been completed and as the HPAI H5N1 control paradigm is shifting from emergency reaction to longer term disease management, it is timely to collate, review and synthesize research carried out in Cambodiaon various aspects of HPAI to inform policymaking, investment and further research, it added.
Pandemic Preparedness
Truckers crucial in flu pandemic, study says
10/8/08 Toranto Star--Health care staff aren't the only ones who should get top priority
When a flu pandemic hits, utility workers and truck drivers will be as valuable in resolving the ensuing crisis as doctors and nurses will be, and so should also get top priority when it comes to deciding who gets medical care, a new bioethics study says.
"It takes a lot of people to keep society going," says Nancy Kass, a professor at the Johns Hopkins Berman Institute of Bioethics and lead author of the study in the most recent edition of the journal Biosecurity and Bioterrorism.
Traditional pandemic planning calls for giving first priority for medical treatment to hospital staff and "first responders" to a crisis, such as firefighters and ambulance workers, so that the immediate health crisis can be dealt with effectively.
But as Hurricane Katrina showed three years ago, the study argues, "the after-effects of a disaster can be as damaging as the precipitating event," as electricity and heat are cut off, clean water becomes scarce and sewage starts to back up.
"There could be widespread social chaos, significant outbreaks of other infectious diseases, and severe anxiety, with the possibility of social degeneration, looting, or even violence as people try to secure needed supplies," the study says.
Even people whose homes were not damaged by the hurricane had trouble getting food, electricity and gasoline, Kass says in an interview.
Up to 40 per cent of the workers whose job it is to keep the lights on and the water flowing could be absent from work after a pandemic, the study says. That's enough to cause a breakdown of such services.
At the same time, the study says a blanket priority given to health care workers makes "no apparent distinction between, for example, infectious disease experts and podiatrists." Better, it says, to restrict which health care workers get priority during a crisis and dedicate some resources to others.
After all, it says, health care workers can't do their job without clean water, electricity, sewage systems and other basic infrastructure.
The study urges businesses and government to work together to determine how many people are needed to keep infrastructure operating, and then seek commitments from enough workers to keep the services running.
Those making that commitment, and their families, would then be given priority for medical services and protective gear during and after a pandemic, the study says.
"To expect these other individuals to come to work because their jobs are crucial to maintain `essential functions' not only requires psychological preparation, it also requires special commitments to them and, arguably, to their families," the study says.
The researchers also point out that few stores or factories keep large inventories of supplies these days, relying on a "just in time" delivery system that distributes goods and equipment only as they are needed ? usually by truck.
Grocery stores, the study says, typically have only three days' worth of food, gas stations need deliveries every one to three days, and water treatment plants keep only one to two weeks' worth of chlorine on hand for water treatment.
As a result, truck drivers will be urgently needed to replenish supplies, and should therefore be given higher priority for treatment. The same goes for those involved in distributing food, such as store clerks.
The study also predicts there will be limited resources for helping those in need, so recommends that the rich and middle class be expected to stockpile their own food, water, batteries, medicines and other supplies, allowing scarce public resources to be dedicated to helping the most vulnerable in society.
Acknowledging that whatever decisions are made, there will be some disagreement, the study says some priority must also be given to communications workers to ensure that the public is fully informed of what is happening, and why.
"Communications are key," Kass says.
