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Avian Influenza Daily Digest
October 30, 2008 14:00 GMT
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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
Full Text of Articles follow ...
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.
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.
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* 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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