UNCLASSIFIED
Avian Influenza Daily Digest
November 24, 2008 15:00 GMT
This digest is produced by the United States Government, Office of the Director of National Intelligence, Washington DC, USA. Articles and resource documents in this digest are from open sources and unclassified.
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60-Day HPAI H5N1 Outbreak Map
2008 WHO Confirmed Human Cases HPAI H5N1
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Quid Novi
Indonesia: Poultry die-offs reported Central Java Province
Indonesia: Suspected Human case in Riau Province
Regional Reporting and Surveillance
Indonesia: Makassar stages first urban bird flu sim
11/24/08 Jakarta Post--Makassar municipality organized a bird flu pandemic simulation in Tamangapa sub district, Manggala district, Makassar, South Sulawesi in an effort to disseminate know-how and to train related institutions on how to cope with a bird flu pandemic.
Regional Reporting and Surveillance
FAO to conduct bird flu communication workshop in Cambodia
11/22/08 TMC.Net--The Cambodian Ministry of Agriculture, Forestry and Fisheries (MAFF) in collaboration with the Food and Agriculture Organization of the United Nations (FAO) will organize an Avian Influenza Emergency Risk Communication Workshop from Nov. 24 to 25, said a government press release here on Saturday.
Regional Reporting and Surveillance
Poultry markets major source of bird flu, govt says
11/22/08 Jakarta Post--The government has warned of an increase in bird flu cases across Java, saying the deadly virus may have already infected 50 percent of poultry sold at markets throughout Jakarta, Banten and West Java.
Regional Reporting and Surveillance
WHO: H5N1 avian influenza timeline of major events
November 2008 WHO Full text pdf report [link]
Regional Reporting and Surveillance
FAO GLEWS H5N1 HPAI Global Overview: September
November 2008 [send email request for full text pdf]--This overview is produced by the FAO-GLEWS team, which collects and analyses epidemiological data and information on animal disease outbreaks as a contribution to improving global early warning under the framework of...
Regional Reporting and Surveillance
OIE Update on HPAI, H5 and H7
11/21/08 OIE Link to Report
Regional Reporting and Surveillance
Science and Technology
Modeling Drug Resistant Influenza
11/21/08 contributed by email--In a mathematical modeling study published in Virology Journal, Brockmann and colleagues report that drug resistant influenza was capable of increasing hospitalization rates by up to 233% in a hypothetical Swiss town of 100,000 inhabitants. Coupled with increased reports of drug-resistant virus, these findings have implications for hospital planning, infection control activities, and chemoprophylaxis strategies.1
AI Research
Pandemic Preparedness
Minister For Health Dawn Primarolo To Give Evidence To Lords Science Committee On Risks Of Flu Pandemic, UK
11/23/08 Medical News Today--The House of Lords Science and Technology Committee, which in December 2005 published a report on the risks of pandemic influenza, will next week hold a follow-up evidence session with Dawn Primarolo MP, Minister of State for Public Health.
Pandemic Preparedness
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Quid Novi
Indonesia: Poultry die-offs reported Central Java Province
11/23/08 ARGUS--A local source reported 35 cases of poultry die-offs between January and November 2008 in which 3,309 tails of poultry were infected with avian influenza in Sragen regency, Central Java province. The last confirmed case occurred in October in Musuk Sambirejo village where 2 chickens died due to the virus. Authorities continue to vaccinate poultry and spray disinfectant in vulnerable areas.
AI Research
Modeling Drug Resistant Influenza
11/21/08 contributed by email--In a mathematical modeling study published in Virology Journal, Brockmann and colleagues report that drug resistant influenza was capable of increasing hospitalization rates by up to 233% in a hypothetical Swiss town of 100,000 inhabitants. Coupled with increased reports of drug-resistant virus, these findings have implications for hospital planning, infection control activities, and chemoprophylaxis strategies.1
Study Findings
Given the increasing prevalence of oseltamavir resistant influenza strains and the stockpiling of these agents for use in a future pandemic, the authors developed a mathematical model to assess the impact of this resistance. Parameters culled from prior studies and incorporated into their model include: a reproductive number (Ro) of 2.5; equivalent viral fitness of resistant and wild type virus; and the assumption that 1/3 of infected individuals are asymptomatic, 1/3 moderately sick, and 1/3 require medical help. The authors also incorporate the effects of antiviral treatment (for drug sensitive virus) and social distancing measures. Infection was introduced at day 0 and day 21 of the simulated outbreak.1
Addressing both de novo resistance development (occurring in 4.1% of children and 0.32% of adults, based on results from prior studies illustrating higher replication in rates in children) and importation of drug resistant virus, the authors find that resistant strains could not only increase hospitalization rates but also outpatient sickness rates, which increased by 129% in their model. The importation of a resistant virus into an area without prior resistance was found to have a much greater effect on these rates than de novo resistance, with a 121% vs. 233% increase in hospitalization rates based on de novo resistance occurring late in a treatment course and rendering the virus unable to be transmitted efficiently.1
Given that the benefits of anti-viral treatment?ameliorating the course of illness, decreasing the likelihood of hospitalization, and attenuating viral spread?would not be realized in those infected with a drug-resistant virus, higher hospitalization rates could be anticipated given no available pharmaceutical recourse.1
Neuraminidase Inhibitor Resistance Increasing with No Cost in Fitness
As previously reported in the CBN, H1N1 influenza viruses increasingly have been identified as harboring a resistance mutation, H274Y, that confers non-susceptibility to the neuraminidase inhibitor oseltamavir by altering the neuraminidase binding site. In certain regions of the world, drug resistant virus accounts for 100% of the isolates, completely displacing wild-type virus.2,4 Strikingly, these viruses are propagated without the selection pressure engendered by utilization of oseltamavir?a sign that the accumulation of these mutations does not hamper, and may in fact enhance, the ability of the virus to replicate and infect fresh hosts.3
Implications for Hospital infection Control
The authors elaborate on the implications of their study by drawing attention to the fact that current H1N1 oseltamavir-resistant strains have already shown the ability to spread efficiently person-to-person, and their importation into a previously uninfected area where oseltamavir is the main countermeasure may create a substantial increase in hospital utilization. Physicians and hospital policy makers should account for these contingencies when undertaking planning for seasonal influenza and making decisions regarding resource allocation, infection control, and chemoprophylaxis/treatment. Additionally, H5N1 avian influenza viruses have exhibited various degrees of oseltamavir resistance without reduced fitness, and, if adaptation to humans occurs, its high propensity for severe disease could have a catastrophic effect on the healthcare system.1 More ominous still would be genetic reassortment between co-circulating seasonal and H5N1 viruses resulting in widespread oseltamavir resistance in H5N1.
References
1. Brockmann SO, Schwehm M, Duerr H, et al. Modeling the effects of drug resistant influenza virus in a pandemic. Virology Journal. 2008, 5:133; http://www.virologyj.com/content/pdf/1743-422X-5-133.pdf. Accessed November 6, 2008.
2. Sheu TG et al. Surveillance for neuraminidase inhibitor resistance among human influenza A and B viruses circulating worldwide in 2004-2008. Antimicrob Agents Chemother 2008;doi:10.1128/AAC.00555-08. http://aac.asm.org/cgi/reprint/AAC.00555-08v1?view=long&pmid=18625765. Accessed November 6, 2008.
3. Deyde VM, Okomo-Adhiambo M, Sheu TG, et al. Pyrosequencing as a tool to detect molecular markers of resistance to neuraminidase inhibitors in seasonal influenza A viruses. Antiviral Research. 2008. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T2H-4TMC2BR-1&_user=88470&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=88470&md5=7040b699c8a94ef8ad8443190ff9ebc1. Accessed November 6, 2008.
4. World Health Organization. Influenza A(H1N1) virus resistance to oseltamivir?2008 influenza season, southern hemisphere. August 20, 2008. http://www.who.int/csr/disease/influenza/H1N1webupdate20082008_kf.pdf. Accessed November 13, 2008.
Regional Reporting and Surveillance
Indonesia: Makassar stages first urban bird flu sim
11/24/08 Jakarta Post--Makassar municipality organized a bird flu pandemic simulation in Tamangapa sub district, Manggala district, Makassar, South Sulawesi in an effort to disseminate know-how and to train related institutions on how to cope with a bird flu pandemic.
The two-hour simulation held on Saturday involved at least 300 people from various institutions, including the Health Agency, the Food Self-Reliance and Marine Agency, the Education Agency, the Communication Agency, the National Police, the Indonesian Army and the public service center.
The simulation started with a report about poultry deaths that allegedly triggered the death of two residents. The rapid tests conducted by the local authority at the incident site showed that the affected poultry and the two residents were positively infected by the bird flu virus.
In the simulation, the region then was declared a pandemic-affected area and had to be closed or isolated.
Only the authorities, who wore protective suits, made up of protected clothing, masks, glasses, over-shoes and special gloves, were permitted to enter the affected area to evacuate the victims, to deal with the infected poultry and to sterilize the location, using disinfectant.
The ambulances also had to be sterilized before leaving the bird flu area.
A sterile area was prepared to handle the affected victims and to accommodate people who had just been evacuated from the pandemic location. The authority prepared an emergency post, shelters and a communal kitchen in the sterile location zone for evacuees.
Makassar mayor Andi Herry Iskandar explained that the bird flu virus had been spreading and had infected human beings, causing concern that the pandemic could potentially lead to massive deaths.
"The most frightening thing is that if there is a bird flu pandemic then it could cause massive deaths. Therefore, people and related institutions have to be trained to handle bird flu from the very beginning, just in case there is pandemic in their location," said Andi.
As of now, the city recorded that one resident has died of bird flu. The victim, Akirah, 14, resident of Jl. Maccini, Makassar, died in June 2006. The laboratory test of his blood and mucus specimens resulted in positive confirmation that he was infected by the H5N1 virus. The lab result was only disclosed three months after his death.
Three years ago, a resident of Sinjai regency in South Sulawesi, Khairil Anwar, 22, was identified as positively infected by the virus. Khairil, the first man in Indonesia declared to be infected by the bird flu virus, is still healthy up to now.
The head of the Makassar Health Agency, Naisyah Tun Azikin, said that Tamangapa was selected to be a drill location as it was located at the border area of Makassar and Gowa, which was prone to contagious diseases like bird flu, because it was a transit and distribution area for many products related to the poultry industry.
Naisyah disclosed that the municipality had scheduled to set up simulations at busy public places, for example in shopping mall centers, hospitals, schools, harbors and airports.
Meanwhile, seven out of 17 bird flu suspected patients in Wahidin Sudirohusodo general hospital in Makassar who have been declared bird flu free have been sent home, while the rest were still at the hospital, for further treatment.
Regional Reporting and Surveillance
FAO to conduct bird flu communication workshop in Cambodia
11/22/08 TMC.Net--The Cambodian Ministry of Agriculture, Forestry and Fisheries (MAFF) in collaboration with
the Food and Agriculture Organization of the United Nations (FAO)
will organize an Avian Influenza Emergency Risk Communication
Workshop from Nov. 24 to 25, said a government press release here
on Saturday.
"The two-day training will introduce the members of the Avian
Influenza Communication Task Force to steps necessary to plan and
develop a response so they can effectively communicate control
measures to contain an outbreak and prevent its further spread,"
it said.
Participants are provincial veterinarians, district
veterinarians, village chiefs and village animal health workers
from Pursat and Kampong Chhnang, two provinces which have not had
an outbreak of bird flu, and staff of the Ministry's Department of
Animal Health and Production.
These provinces will also be covered by the AI outbreak
simulation exercise to be conducted next week by the MAFF and FAO
to test the effectiveness of the Ministry's Guide for Avian
Influenza Outbreak Investigation and Emergency Response.
"The workshop will provide participants with practical
direction on how to effectively communicate correct information
and what to do during the pre-outbreak, outbreak and post-outbreak
periods. It is important to note that this training will only
address the communication aspect of a response to avian influenza,
Regional Reporting and Surveillance
Poultry markets major source of bird flu, govt says
11/22/08 Jakarta Post--The government has warned of an increase in bird flu cases across Java, saying the deadly virus may have already infected 50 percent of poultry sold at markets throughout Jakarta, Banten and West Java.
There was a ?strong indication? that poultry markets across western Java were affected, the National Committee for Bird Flu Control and Pandemic Preparedness said Friday.
Committee executive director Bayu Krisnamurthi said the government would focus its efforts on the management of markets in the affected areas, in an effort to stop the virus spreading.
Flouting of market regulations could give rise to a new main source of bird-to-human infections, he added.
?Markets with no zoning, in which the required three separate zones ? for poultry pens, slaughterhouses and retail outlets ? are not implemented, could pose higher risks of becoming a source of infections, as could markets using the same facilities for multiple species,? Bayu said.
He was speaking on the sidelines of a bird flu discussion between the Indonesian government and its international partners.
?Our discussion today highlighted the need to focus on live bird markets in dealing with bird flu. The national committee and international institutions will therefore intensify efforts to manage these markets,? he said.
He added since the H5N1 virus was first detected in humans in Indonesia in 2005, most bird-to-human infections were found to have stemmed from traditional methods of rearing poultry at home, with fewer cases caused by contact with poultry in markets.
Live poultry markets, however, were a proven threat in the spread of the virus, Bayu warned, citing a May 2006 case in Karo regency, North Sumatra, which killed six residents.
An anti-bird flu campaign at poultry markets was launched in early 2007, with market operators told to organize their poultry sections into the three separate zones as required.
However, the call got a hostile reception from local authorities and market operators ? the parties authorized to manage the markets, Bayu pointed out.
?They?re worried about the economic impact of the move. How will it affect the income of sellers? What about its impact on poultry suppliers?
?The bird flu issue is a complicated matter. We have to take note of cultural and socioeconomic factors when dealing with it,? he said.
The number of bird-to-bird and bird-to-human infections have declined in the country since 2007. As of October this year, there have been 112 deaths from 137 recorded infections. Just recently, 17 suspected bird flu patients, hospitalized in the South Sulawesi capital of Makassar, were cleared of having the virus.
Despite the drop in infection numbers, a bird flu pandemic still threatens the country. Friday?s meeting was held to prepare for such a contingency.
In attendance at the meeting were representatives from the Health Ministry, the Agriculture Ministry, the WHO, the FAO, UNICEF, the ILO, USAID, AUSAID and Germany?s Gesellschaft fur Technische Zusammenarbeit (GTZ).
The GTZ, in cooperation with the National Education Ministry, is developing modules for a bird flu awareness campaign in elementary schools, aimed at increasing public awareness of the virus.
Contrary to an earlier report in The Jakarta Post, the Health Ministry was not involved in this school campaign.
Pandemic Preparedness
Minister For Health Dawn Primarolo To Give Evidence To Lords Science Committee On Risks Of Flu Pandemic, UK
11/23/08 Medical News Today--The House of Lords Science and Technology Committee, which in December 2005 published a report on the risks of pandemic influenza, will next week hold a follow-up evidence session with Dawn Primarolo MP, Minister of State for Public Health.
The Committee's original report took the view that the first line of defence against a potential human influenza pandemic was effective surveillance and control of avian influenza, in particular in south east Asia. The Committee recommended more support for generic health services in Asia, where new strains of flu have emerged in recent years, and for Government departments to work together to produce a contingency plan in case of an outbreak of a strain of avian-flu that would easily transfer to human beings.
In this follow up session, to be held on Tuesday 25 November the Committee will ask Ms Primarolo about the UK's preparedness for flu pandemic, whether the NHS is adequately resourced and prepared for a flu outbreak, and for the Government's views on how essential public services would cope with a large-scale loss of staff due to illness caused by pandemic influenza.
Notes
1. For more details on the Committee, including a downloadable version of their original report please see: http://www.parliament.uk/hlscience
2. An audio stream of the evidence session will be broadcast live at: http://www.parliamentlive.tv
Regional Reporting and Surveillance
WHO: H5N1 avian influenza timeline of major events
November 2008 WHO Full text pdf report [link]
Regional Reporting and Surveillance
FAO GLEWS H5N1 HPAI Global Overview: September
November 2008 [send email request for full text pdf]--This overview is produced by the FAO-GLEWS team, which collects and analyses epidemiological data and
information on animal disease outbreaks as a contribution to improving global early warning under the
framework of the Global Early Warning for Transboundary Animal Diseases (TADs) including Major Zoonoses.
One hundred outbreaks of H5N1 HPAI were reported worldwide in September 2008 from six countries (Bangladesh*, Egypt, Indonesia, Lao People?s Democratic Republic, Togo and Viet Nam). No cases were reported in wild birds during September 2008.
Quid Novi
Indonesia: Suspected Human case in Riau Province
11/22/08 ARGUS/Riaupos--9-year-old boy from Sembuh has tested positive for avian influenza (AI) and is currently hospitalized at Arifin Achmad Hospital in Pekanbaru [the capital of Riau Province]. The toddler was initially taken to the Hospital Santa Maria before being referred to Arifin Achmad Hospital, where he has been receiving intensive treatment for a high fever since 14 November. As of 21 November, the child?s fever has diminished and he appears to be recovering. He is expected to leave the hospital in 2 weeks. The patient's family is said to raise poultry at home. Although a pediatrician at the hospital says this is a positive case of AI, the source states that provincial health authorities say they cannot yet determine whether this is the case because, as of Friday evening [21 November], the patient?s blood test results are still pending.
Article URL(s)
http://www.riaupos.com/v2/content/view/11384/46/
Regional Reporting and Surveillance
OIE Update on HPAI, H5 and H7
11/21/08 OIE
