Avian/Pandemic Influenza Daily Digest: DNI Avian Influenza Daily Digest

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Avian Influenza Daily Digest

November 26, 2008 16:00 GMT

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60-Day HPAI H5N1 Outbreak Map
2008 WHO Confirmed Human Cases HPAI H5N1
AI Daily Digest Archive

Article Summaries ...

Quid Novi

Indonesia: Bird Die-Off in Lampung Selatan

India: Bird flu scare in Assam, 300 poultry dead

Conferences and Training

USAID Job Vacancies, Indonesia and Egypt

UNICEF Tajikistan Job Announcement

The 7th Annual ASM Biodefense and Emerging Diseases Research Meeting is scheduled for February 22-25, 2009 in Baltimore, MD

FAO: Avian Influenza Upcoming conferences

Regional Reporting and Surveillance

Knowledge about Avian Influenza, European Region
11/25/08 CDC EID Letter--Since the first identifications of avian influenza (H5N1) in Europe in late 2005 and early 2006, Eurobarometer survey data obtained during April?May 2006 have provided a unique opportunity to examine the knowledge of respondents across the European Union, Croatia, and Turkey about the risks and transmission of avian influenza. The H5N1 strain of avian influenza virus has caused >240 human deaths in central and Southeast Asia, the Middle East, and Africa (1). Four of these deaths occurred in Turkey in 2006.
Regional Reporting and Surveillance

China: Forum Members Discuss AI Outbreak Across Eastern Jiangsu Province
11/24/08 ARGUS--An industry forum included a posting dated November 24 by a Xuzhou farmer who posted a claim that in Hai?an and Taidong cities, a major outbreak of H5N1 Re-4 avian influenza (AI) has killed up to 10 million poultry birds. The farmer asked other forum members to verify the claim.
Regional Reporting and Surveillance

Egypt: $10 Million Loan in Support of Avian Influenza Fight
11/26/08 ARGUS--An international source reported that the Islamic Development Bank has given the Egyptian government a $10 million loan to aid the fight against AI. The AI loan is meant to be used to combat the disease in Egypt and strengthen the capacity to reduce the risk of transmission of AI among animals and humans.
Regional Reporting and Surveillance

India: Avian flu help increased (Op/Ed)
11/26/08 Central Chronicle--With an extended burst of applause, representatives from more han 120 nations closed an international meeting whose focus was highly pathogenic H5N1 avian influenza and the need to control and then eradicate the virus in poultry and prepare the planet for a human pandemic.
Regional Reporting and Surveillance

Indonesia says big market should spur drug makers to invest more
11/26/08 Reuters--Indonesia's huge market for prescription drugs should encourage foreign pharmaceutical firms to set up production plants in the country and comply with a new government decree, the health minister said on Wednesday.
Regional Reporting and Surveillance

Mayalsia: World's First Pandemic Logistics And Learning Exercise
11/26/08 Bernama--The world's first pandemic logistics and learning exercise, known as P2LX, is being held here to enhance readiness and response to a crisis situation triggered by the Avian Influenza or bird flu H5N 1 virus.
Regional Reporting and Surveillance

Malaysia: Stringent checks on poultry smuggling
11/25/08 Straits Times--The state Veterinary Services Department is stepping up checks to curb the smuggling of poultry from Thailand following the outbreak of bird flu there. The checks will target commercial vehicles passing through the checkpoints along the Malaysian-Thai border for frozen chicken.
Regional Reporting and Surveillance

Pakistan: Isolation units for bird flu patients still awaited
11/25/08 Dawn--The provincial health department has failed to establish respiratory isolation units for bird flu patients despite the lapse of one year, sources said. After confirmation of the first case of human-to-human transmission of avian influenza in Peshawar last year, the health department had planned to establish two respiratory isolation units (RIUs), one each in the Khyber Teaching Hospital in Peshawar and the Ayub Teaching Hospital in Abbottabad, to help treat patients suspected of carrying the H5N1 strain of virus.
Regional Reporting and Surveillance

India: Project to study role of birds in avian flu
11/24/08 The Hindu--A project, to be funded by the Food and Agriculture Organisation, will study the role of migratory birds in the spread of avian influenza, using tracking devices in three bird sanctuaries later this year, K. Balachandran, Indian co-ordinator of the project, has said.
Regional Reporting and Surveillance

USA: National Avian Influenza Surveillance Information
November 25, 2008 Samples Tested and Reported into HEDDS * Nov 25, 2008: 307 samples and tests were added to HEDDS for 2008. Total is now 64,182. * Nov 24, 2008: 1,842 samples and tests were added to HEDDS for...
Regional Reporting and Surveillance

Record-level US Support For Bird Flu Program - Indonesia, Viet Nam And Egypt Among Major Beneficiary Countries
11/14/08 Medical News Today--The United States will provide an additional $44.4 million in support of FAO's avian influenza control and prevention campaign, FAO announced today
Regional Reporting and Surveillance

One World, One Health edging onto a global agenda International community to draw on lessons from bird flu fight
11/24/08 FAO--A fresh input of US$ 350 million to the international fight against highly pathogenic avian influenza (HPAI) made the news when it was announced in Sharm El-Sheikh just over three weeks ago. Less coverage was given to endorsement of an ambitious new strategy to look at HPAI and other existing and emerging infectious diseases at the points where the animal, human and ecosystem domains meet.
Regional Reporting and Surveillance

EMPRES Transboundary Animal Disease Bulletin 31
November 2008 FAO[link to full text pdf English] Table of contents Participatory Disease Surveillance in the Republic of Sudan as of August 2007 Porcine reproductive and respiratory syndrome (PRRS) Capacity building for disease surveillance in wild birds FAO in action Workshops Meetings: recommendations Avian Influenza and Wildlife Regional Surveillance and Research Priorities for Asia International Meeting ? Bangkok, Thailand, 3?5 September 2007 News Contributions from FAO Reference Centres Stop the press EMPRES address list
Regional Reporting and Surveillance

S. Korean gov't issues bird flu warning
11/12/08 Yonhap News, contributed by email--The South Korean government on Wednesday issued a nationwide bird flu alert as migratory birds started arriving in the country for winter.
Regional Reporting and Surveillance

Syria: Launch of Avian Influenza Preparedness Project
11/19/08 ARGUS--A local source reported that the Ministry of Agriculture and Land Reform, in cooperation with the Food and Agriculture Organization?s (FAO) Regional Animal Health Center (RAHC) for the Middle East, has launched an Avian Influenza Preparedness project in Syria. The director of RAHC indicated that the implementation of the preparedness project in Syria is part of the initiative for implementing 9 projects in different countries of the region. He affirmed the FAO?s keenness to control the disease and prevention of its spread across continents. He also expressed the FAO?s willingness to provide, through special mechanisms, everything that would enable eradication of the disease.
Regional Reporting and Surveillance

Nigerian Government Compensates Farmers for AI-Related Poultry Losses
October 2008 This Day--(article was originally published early November when AI Digest was offline)--A national source reported that the Nigerian Federal government and the World Bank provided N630.9 million [US$5,354,264] to 3,037 farmers as compensation between February 2006 and 31 October this year for avian influenza (AI) related losses. According to an official [charged with the control of AI], 1,264,191 birds were depopulated in 97 local government areas across 26 states, and the latest WHO report on human H5N1 cases states there has been one confirmed AI-related death in Nigeria since 2003.
Regional Reporting and Surveillance

Science and Technology

Avian Influenza Outbreaks in Chickens, Bangladesh
11/25/08 CDC/EID--Volume 14, Number 12?December 2008 Dispatch [full text with graphics]--To determine the epidemiology of outbreaks of avian influenza A virus (subtypes H5N1, H9N2) in chickens in Bangladesh, we conducted surveys and examined virus isolates. The outbreak began in backyard chickens. Probable sources of infection included egg trays and vehicles from local live bird markets and larger live bird markets.
AI Research

Avian Flu Virus Freed From Immune Recognition By Protein 'Tubules'
11/6/08 Medical News Today--A protein found in the virulent avian influenza virus strain called H5N1 forms tiny tubules in which it "hides" the pieces of double-stranded RNA formed during viral infection, which otherwise would prompt an antiviral immune response from infected cells, said Baylor College of Medicine researchers in an online report in the journal Nature.
AI Research

A New Way To Predict Outbreaks: Replikin Peptide Concentration In H5N1 Influenza Virus Genome As A Marker For Lethal Outbreaks
11/13/08 Medical News Today--WHO and CDC have stated that the predictive accuracy of their annual formulations for human influenza vaccines is "suboptimal" -- often correct less than 50% of the time, especially for seniors. Perhaps in part because we are not yet accurate in our predictions of upcoming influenza strains, approximately 36,000 people die each year of flu in the United States alone.
AI Research

New Centre To Fight Infectious Diseases - China-Australia Centre For Phenomics Research
11/24/08 Medical News Today--The fight against infectious diseases such as Avian influenza will receive a boost today with the official opening of the China-Australia Centre for Phenomics Research at The Australian National University.
AI Research

New Vaccines Protect Against Asian H5N1 Influenza A Viruses in Domestic Ducks
11/25/08 American Society for Microbiology--Scientists are looking at a novel strategy to prevent the spread of pandemic avian influenza. They have developed a vaccine that protects ducks, a known natural reservoir for the virus. They report their findings in the...
Vaccines

Highly Pathogenic Avian Influenza Virus (H5N1) Infection in Red Foxes Fed Infected Bird Carcasses
11/08 CDC/EID [link to full text pdf] Leslie A. Reperant, Geert van Amerongen, Marco W.G. van de Bildt, Guus F. Rimmelzwaan, Andrew P. Dobson, Albert D.M.E. Osterhaus, and Thijs Kuiken Author affiliations: Princeton University, Princeton, New Jersey, USA (L.A. Reperant, A.P. Dobson); and Erasmus Medical Centre, Rotterdam, the Netherlands (G. van Amerongen, M.W.G. van de Bildt, G.F. Rimmelzwaan, A.D.M.E. Osterhaus, T. Kuiken) Eating infected wild birds may put wild carnivores at high risk for infection with highly pathogenic avian influenza (HPAI) virus (H5N1). To determine whether red foxes (Vulpes vulpes) are susceptible to infection with HPAI virus (H5N1), we infected 3 foxes intratracheally. They excreted virus pharyngeally for 3?7 days at peak titers of 103.5?105.2 median tissue culture infective dose (TCID50) per mL; they became ill with severe pneumonia, myocarditis, and encephalitis. To determine whether foxes can become infected by the presumed natural route, we fed infected bird carcasses to 3 other red foxes. These foxes excreted virus pharyngeally for 3?5 days at peak titers of 104.2?104.5 TCID50/mL, but only mild or no pneumonia developed. This study demonstrates that red foxes fed bird carcasses infected with HPAI virus (H5N1) can excrete virus while remaining free of severe disease, thereby potentially playing a role in virus dispersal. Influenza A viruses rarely infect species of the order Carnivora. However, since 2003, highly pathogenic avian influenza (HPAI) viruses of subtype H5N1 have infected a wide range of carnivore species. Within the past 30 years, and before the emergence of HPAI viruses (H5N1), 5 documented outbreaks of influenza virus infections occurred in 2 carnivore species?the harbor seal (Phoca vitulina) (1?4), and the American mink (Mustela vison) (5). In both species, the infection resulted in respiratory disease. In addition, influenza virus infection has been detected by virus culture or serologic examination in other carnivores, namely, domestic dogs (Canis lupus familiaris) (6,7), domestic cats (Felis catus) (8,9), and bears kept in captivity (species not stated) (9); however, these animals did not show clinical signs of disease. Also, recent outbreaks of equine influenza virus (H3N8) infections resulted in respiratory disease in domestic dogs (10,11). In contrast, within the past 5 years, HPAI viruses (H5N1) have infected and killed carnivores belonging to 7 species: captive tigers (Panthera tigris) and leopards (P. pardus) (12,13); domestic cats (14?17); captive Owston?s palm civets (Chrotogale owstoni) (18); a domestic dog (19); a free-living stone marten (Martes foina) (20); and a free-living American mink (21). In these species, the infection resulted in both respiratory and extrarespiratory lesions, demonstrating systemic infection beyond the respiratory system. The most frequently reported clinical signs for all species were respiratory distress, neurologic signs, or both.
AI Research

Cuba working on bird-flu vaccine
11/11/08 EFE, contributed by email--Cuba will present its first results in its effort to obtain a vaccine against bird flu during the Nov. 30-Dec. 5 Biotecnologia Habana 2008 conference, the Genetic Engineering and Biotechnology Center, or CGIB, announced here Tuesday. The head of the CGIB's Animal Biotechnology division, Mario Pablo Estrada, said at a press conference that his agency was working "to achieve an effective vaccine against bird flu." The scientist said that "at this time they're performing some tests at the laboratory level on birds" with the two experimental vaccines the communist island has in hand.
Vaccines

Modeling Drug Resistant Influenza
11/25/08 Clinicians Biosecurity Network (republished with proper attribution) By Amesh A. Adalja, M.D., November 21, 2008 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

Hospital pandemic drill reveals major supply challenges
11/25/08

CIDRAP

--Hospital workers who followed official infection control guidelines for pandemic influenza for 1 day used 10 times as many gloves as usual, generated three times as much clinical waste, and found that many tasks took longer than normal, according to a new report.
Pandemic Preparedness

Book Review: David Swayne (2008) Avian Influenza
November 2008 Contributed by Mike Nunn, in Australia (Thanks Mike) Journal of Wildlife Diseases, October 2008 http://www.jwildlifedis.org/cgi/content/full/44/4/1056 Book review, Journal of Wildlife Diseases, 44(4), 2008, pp. 1056-1058 By: Steven Schwarzbach, Sabir Muzzafar and John Takekawa, Western Ecological Research Center, US Geological Survey, 3020 State University Drive, Sacramento, California 95819, USA. (steven_schwarzbach@usgs.gov).
Pandemic Preparedness

Full Text of Articles follow ...

Regional Reporting and Surveillance

Knowledge about Avian Influenza, European Region

11/25/08 CDC EID Letter--

Elias Mossialos and Caroline Rudisill Comments to Author
Author affiliation: London School of Economics, London, UK
Since the first identifications of avian influenza (H5N1) in Europe in late 2005 and early 2006, Eurobarometer survey data obtained during April?May 2006 have provided a unique opportunity to examine the knowledge of respondents across the European Union, Croatia, and Turkey about the risks and transmission of avian influenza. The H5N1 strain of avian influenza virus has caused >240 human deaths in central and Southeast Asia, the Middle East, and Africa (1). Four of these deaths occurred in Turkey in 2006. Understanding gaps in the public's knowledge about avian influenza risks and transmission provides guidance on which issues future public health information campaigns may wish to focus. From a public health perspective, a more informed general public will be less likely to unnecessarily alter their travel and food consumption behavior and more likely to take appropriate preventive actions.

A 2006 Eurobarometer survey asked 29,170 residents of the 27 countries in the EU, Croatia, and Turkey about their knowledge of avian influenza risks (2). Eurobarometer surveys are undertaken by the European Commission to monitor the European Union public's social and political opinions. The survey was conducted on a multistage random sampling basis. Therefore, the sample is representative of the whole territory surveyed. Each country's population was randomly sampled according to rural, metropolitan, and urban population densities. A cluster of addresses was selected from each primary sampling unit by using country-dependent resources such as electoral registers. Addresses were chosen systematically by using standard random route procedures, beginning with a randomly selected initial address. The survey was conducted by face-to-face interviews in respondents' homes.

Data were collected from March 27 through May 1, 2006. This period is especially interesting when looking at Europeans' knowledge about avian influenza risk because the first European cases of avian influenza (H5N1) were found in October 2005 in Turkey; additional cases were found later that month in Romania, Croatia, and the United Kingdom. Therefore, the period would have included media coverage about avian influenza as well as any targeted public health efforts to inform residents about avian influenza risks. By the end of this survey's fieldwork period, 17 of the 29 countries surveyed had reported influenza virus (H5N1) in birds, 3 in mammals, and 1 in humans (3).

Respondents were asked 7 questions about their knowledge of the risks humans face regarding avian influenza (Table). When we looked at these results with the aim of setting future public health information campaign objectives, we considered incorrect or "don't know" responses to indicate public health information campaign failures. Uncertainty regarding avian influenza risks appeared to involve consumption of eggs and vaccinated, cooked poultry and whether the virus can be transmitted between humans. However, for all questions asked, more than half of the respondents answered correctly except when asked about eating poultry that had been vaccinated against avian influenza. This question also had the highest number of "don't know" responses. Respondents are most knowledgeable about the preventive measure of culling chickens, perhaps because of the media attention these events attract. The large percentage of correct answers for some questions points to successes of previous information campaigns and media coverage, but the 40% of respondents answering incorrectly or "don't know" to questions about poultry and egg consumption and human-to-human virus transmission leaves areas for further work.

These results support previous findings that knowledge about avian influenza, especially about prevention and human-to-human transmission, has scope for improvement (4,5). Persons in Europe reported that they have little ability to prevent themselves from getting avian influenza (6). Previous research in the Lao People's Democratic Republic examined how consumers' knowledge of avian influenza risk reduced the likelihood that consumers will substitute poultry for other foods during an avian influenza crisis. This research indicates the importance of informing persons about consumption and transmission-related risks to reduce the likelihood of unnecessary behavioral changes that can cause larger macrolevel market effects (7).

The state of knowledge about avian influenza in Europe during the outbreak in the spring of 2006 leaves room for further public health information campaign efforts, especially those that increase consumers' understanding of consumption-related avian influenza risks. Persons in Europe appear to be aware of culling procedures and the risks of touching infected birds but have a more limited understanding of how avian influenza in their region should influence their consumption patterns.
References

1. Sanco DG. Confirmed human cases of avian influenza since 1997 sorted by subtypes [cited 2008 May 27]. Available from http://ec.europa.eu/health/ph_threats/com/Influenza/avian_influenza_human_en.htm
2. Eurobarometer. Avian influenza June 2006 [cited 2008 Mar 15]. Available from http://ec.europa.eu/public_opinion/archives/ebs/ebs_257_en.pdf
3. World Health Organization. H5N1 avian influenza: timeline of major events [cited 2008 May 22]. Available from htttp://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
4. Abbate R, Di Giuseppe G, Marinelli P, Angelillo IF. Knowledge, attitudes, and practices of avian influenza, poultry workers, Italy. Emerg Infect Dis. 2006;12:1762?5.
5. Di Giuseppe G, Abbate R, Albano L, Marinelli P, Angelillo IF. A survey of knowledge, attitudes and practices towards avian influenza in an adult population of Italy. BMC Infect Dis. 2008;8:36.
6. De Zwart O, Veldhuijzen IK, Elam G, Aro AR, Abraham T, Bishop GD, et al. Avian influenza risk perception, Europe and Asia. Emerg Infect Dis. 2007;13:290?3.
7. Suder G, Inthavong S. New health risks and sociocultural contexts: bird flu impacts on consumers and poultry business in Lao PDR. Risk Anal. 2008;28:1?12. PubMed DOI

Table

Table. Knowledge of human risks associated with avian influenza, European region, 2006
Suggested Citation for this Article

Mossialos E, Rudisill C. Knowledge about avian influenza, European region [letter]. Emerg Infect Dis [serial on the Internet]. 2008 Dec [date cited]. Available from http://www.cdc.gov/EID/content/14/12/1956.htm

DOI: 10.3201/eid1412.080858

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

Caroline Rudisill, London School of Economics, LSE Health, Cowdray House, Houghton St, London WC2 2AE, UK; email: a.c.rudisill@lse.ac.uk

Quid Novi

Indonesia: Bird Die-Off in Lampung Selatan

11/26/08 ARGUS-- national source reported a bird die-off of unspecified number of chickens in Rejomulyo village (Jatiagung district, Lampung Selatan regency, Lampung province) since 19 November. However, residents only reported the incident a week later. Local authorities suspected avian influenza; however, it has not been confirmed. They have sprayed disinfectant in the area. The source did not mention any testing or culling procedure.

All 17 districts in Lampung Selatan regency have been affected by the virus throughout 2008; meanwhile, all regencies in Lampung province are endemic areas for avian influenza. In 208, Lampung Timur and Lampung Selatan are the worst affected regencies in this province. The source noted that residents are expecting the provincial government to restrict poultry movement in the area since Jatiagung and the nearby Jatimulyo district are major centers for the poultry industry.

Article URL(s)

http://www.kompas.com/read/xml/2008/11/26/18262932/flu.burung.kembali.muncul.di.lampung.selatan

Quid Novi

India: Bird flu scare in Assam, 300 poultry dead

11/26/08 (IANS-- More than 300 poultry birds have died in the past five days in some villages in Assam, fuelling fears of bird flu, officials said here Wednesday, adding that a general alert was sounded in the area.A veterinary department official said up to 300 chicken and ducks died an unnatural death in some villages around Hajo, about 35 km west of Assam?s main city of Guwahati.

?We have sent samples for laboratory tests to Pune and Bangalore for confirmation. We don?t know for sure if the poultry deaths were due to bird flu,? a veterinary department official said requesting not to be named.

Authorities Wednesday imposed a ban on sale of poultry and have sounded a general alert in about 40 villages in a radius of five kilometers from the area where the deaths were reported.

?By Thursday we shall be getting the laboratory test reports and maybe we have to start the culling process as there has been large-scale reports of deaths coming in from nearby areas,? Kamrup district magistrate R.C. Jain said.

?We have imposed a ban on sale and purchase of poultry and have asked people in the area not to consume chicken or duck as a precautionary measure.?

A general health alert was also sounded in the area. Teams of experts are now camping in the area and were contemplating culling birds as a precautionary measure.

Residents of the area said a large number of birds were falling sick.

?We saw normal birds dying almost instantly without any symptoms. Now we find some of the poultry in the area a little sick,? said Biswa Das, a villager.

Conferences and Training

USAID Job Vacancies, Indonesia and Egypt

https://www.ghfp.net/recruitment/index.fsp?FUNC=1&PID=12790

Title: Avian Influenza Technical Advisor/Program Manager
Location: Cairo, Egypt
Number: GHFP-08-120
Status: Open
Close Date: 12/19/2008
Global Health Fellows Program
Technical Advisor III: Avian Influenza Technical Advisor/Program Manager
USAID/Egypt
Location: Cairo, Egypt
Assignment: Two year fellowship
GHFP-08-120

https://www.ghfp.net/recruitment/index.fsp?FUNC=1&PID=11346
Title: Senior Avian and Pandemic Influenza Advisor
Location: Jakarta, Indonesia
Number: GHFP-08-101
Status: Open
Close Date: 12/15/2008
Global Health Fellows Program
Technical Advisor III: Senior Avian and Pandemic Influenza Advisor
Office of Basic Human Services, United States Agency for International Development
Location: Jakarta, Indonesia
Assignment: Two year fellowship
GHFP-08-101

Conferences and Training

UNICEF Tajikistan Job Announcement

VACANCY ANNOUNCEMENT
Post Title: Avian Influenza (AI) Communication Officer, Temporary Fixed Term at NOA level
Duty Station: UNICEF, Dushanbe, Tajikistan
Duration: 01 Jan. -31 Dec. 2009
Closing date: 05 December 2008

Duties and responsibilities:

Under the general supervision of the Health Specialist, assist UNICEF Tajikistan in implementing communication activities planned under the communication component of the prevention of Avian Influenza Control and Human Pandemic Preparedness Project. This requires close collaboration with the Ministry of Health, Ministry of Agriculture, State Committee on Emergency and Civil Defence, State Committee on TV/Radio and various counterparts.

1. In close cooperation with WHO, WB, FAO and other agencies advocate for Avian Influenza/ Human Influenza planning, coordination and monitoring arrangements, operating within existing sector-wide coordination mechanisms under government leadership.

2. Act as liaison between UNICEF and Project Management Unit in coordinating all issues related to timely implementation of Project Action Plan, disbursement of instalments, submission of quarterly reports and financial statements.

3. Facilitate and coordinate activities of the local and international NGOs/ SCOs selected by UNICEF for the implementation of communication actions and community mobilization interventions addressing avian influenza prevention.

7. Assist the UNICEF AI focal point in organizing planned media events and field trips related to the Campaign, including development of background materials for media, constant communication with media and support of the logistics.

8. Assist the UNICEF in monitoring of the impact of the campaign and adjusting strategies and messages for a possible next phase;

9. In close cooperation with Communication Working Group and other partners facilitate development of the questionnaires for the KAP survey, coordinate conduction of the survey in selected areas;

10. In close consultation with the State Committee on statistics and JHU/CCP M&E focal point facilitate timely analysis of the survey results and its presentation to the project stakeholders;

11. Assist UNICEF in conduction of final evaluation of project activities, prepare regular inputs to progress reports; undertake regular field monitoring, control allotments and expenditures; ensure accurate implementation of UNICEF rules and procedures.

Qualification:
University degree in Education, Social Sciences, Behavioural Sciences and Communication ? two years professional experience in the area of communication, especially related to health, preferably with International organizations ? knowledge of and experience with communication for behavioural impact ? professional writing skills ? fluency in Tajik, Russian, and English ? familiarity with & knowledge of UNICEF context/priorities ? ability to learn quickly and apply procedures in an international organization

The Vacancy Announcement will be advertised through webs- www.unicef.org/tajikistan and www.untj.org/vacancies and through newspapers-"Asia Plus" & "Digest" .

Letter of application, along with detailed CV should be addressed to:
UNICEF, 37/1 Bokhtar street,
734001 Dushanbe, Tajikistan
Attention to: Operations Manager ? Confidential or e-mailed to recruitmentdushanbe@unicef.org

UN candidates should provide the latest performance evaluation.

-Only short listed candidates will be notified.
-UNICEF is a smoke-free environment.
-Qualified women are encouraged to apply.

National Avian Influenza (AI) Communication Officer, Temporary Fixed Term at NOA level
Duty Station: UNICEF, Dushanbe, Tajikistan
Duration: 01 Jan. -31 Dec. 2009
Closing date: 04 December 2008

BACKGROUND

Avian flu and the subsequent risk of a human pandemic poses one of the most challenging issues in our times. UNICEF as a knowledge based organization needs to be able to rapidly understand the context of this disease in order to develop appropriate response and advocacy strategies. At the same time it needs to establish baseline indicators and data against which to measure the impact of any strategies that it develops. Advocacy rests on the articulation and provision of good evidence

Since 2003, there have been multiple outbreaks of the Influenza A(H5N1) virus (avian influenza), and recently it has begun to spread from Asia to Europe. More than 150 million poultry have died, either from the disease itself or from culling. The H5N1 virus has also caused 142 laboratory-confirmed human infections, over half of them fatal. It already exhibits some of the same mutations as the virus which caused the 1918 pandemic; should it become transmissible between humans, it will almost certainly cause a pandemic. Thus, the immediate priority is to prevent human exposure to the virus. The recent outbreak of AI in Turkey and Azerbaijan underlines the need for urgency in this regard.
UNICEF Tajikistan will be the main leading agency in implementation of communication activities on AF within WB funded AI prevention project. The communication activities will include intensified communication and social mobilization efforts: interpersonal communication, community mobilization, outdoor communication and communication via a variety of media channels.

UNICEF works in global partnerships with various agencies and government stakeholders that give leadership to national governments to take a leading role in coordination of efforts and implementation of action plan. Support will be based on country comprehensive action plan on AI prevention. At country level, UNICEF will work with the WB, WHO, FAO and relevant ministries and agencies to advocate for Avian Influenza/ Human Influenza planning, coordination and monitoring arrangements, operating within existing sector-wide coordination mechanisms under government leadership. UNICEF will play a leading role in providing technical support in development of comprehensive communication strategic plan and its implementation at community and family levels in close cooperation with aforementioned agencies. The main focus will be placed on the interpersonal communication.
In this context, the implementation of specific communication activities outlined below, monitoring of the communication material distribution and use process and organization of a special action in schools and communities requires additional capacities in the area of communication.
To assist in their implementing, UNICEF Office in Tajikistan will recruit National Project Officer.

PURPOSE OF ASSIGNMENT
Under the general supervision of the Health Specialist, assist UNICEF Tajikistan in implementing communication activities planned under the communication component of the prevention of Avian Influenza Control and Human Pandemic Preparedness Project. This requires close collaboration with the Ministry of Health, Ministry of Agriculture, State Committee on Emergency and Civil Defence, State Committee on TV/Radio and various counterparts.

SPECIFIC ACTIVITIES
1. In close cooperation with WHO, WB, FAO and other agencies advocate for Avian Influenza/ Human Influenza planning, coordination and monitoring arrangements, operating within existing sector-wide coordination mechanisms under government leadership.

4. In coordination with JHU/CCP facilitate the preparation and conduction of four-day communication research training to UNICEF M&E staff, researchers of the State Strategic Research Centre, Department of Statistics, and other relevant partners. The overall objective of the workshop will be to educate participants in the development of an evaluation plan, including setting research objectives and indicators, selecting an appropriate methodology, and developing preliminary research instruments for their communication interventions.

5. Develop with the partners Media Plan for the Mass Media and Social Mobilization Campaign, including new communication materials and channels. Develop clear guidelines on the use of the new materials. Follow-up on distribution of materials, their use and efficiency. Undertake selective field visits to rayons, jamoats, families and schools in order to check the adequacy of the local distribution processes and use. Undertake planned field visits to monitor project implementation.
6. Assist in the development of thematic media programmes and interventions on avian flu, involving main specialists in the area, and including a variety of formats in order to reach a wide range of audiences.
7. Assist the UNICEF AI focal point in organizing planned media events and field trips related to the Campaign, including development of background materials for media, constant communication with media and support of the logistics.
8. Assist the UNICEF in monitoring of the impact of the campaign and adjusting strategies and messages for a possible next phase;

9. In close cooperation with Communication WG and other partners facilitate development of the questionnaires for the KAP survey, coordinate conduction of the survey in selected areas;

10. In close consultation with the State Committee on statistics and JHU/CCP M&E focal point facilitate timely analysis of the survey results and its presentation to the project stakeholders;

11. Provide clear guidance to the AI assistant on the monitoring and evaluation activities. Ensure timely and qualitative feedback to the counterparts on the results of field monitoring.

12. Assist UNICEF in conduction of final evaluation of project activities, prepare regular inputs to progress reports; undertake regular field monitoring, control allotments and expenditures; ensure accurate implementation of UNICEF rules and procedures.

MAIN OUTPUTS
1. Communication materials for families, guidelines for teachers, information sheets for students developed in two languages.
2. Information and education materials for health and veterinary workers and volunteers
3. Distribution plan for communication materials, including new audiences and channels.
4. Guidelines for the interpersonal communication on avian flu.
5. Completed media plan for the second phase of the campaign.
6. Report on the activities and results of the consultancy.

DELIVERABLES AND DELIVERY DATES
All the materials will be presented in hard copies and in electronic formats.
SUPERVISION ARRANGEMENTS
The consultant will work under the supervision of the Health Specialist and Deputy Representative.

QUALIFICATIONS/SPECIALIZED KNOWLEDGE/EXPERIENCE REQUIRED:
University degree in Education, Social Sciences, Behavioural Sciences and Communication ? two years professional experience in the area of communication, especially related to health, preferably with International organizations ? knowledge of and experience with communication for behavioural impact ? professional writing skills ? fluency in Tajik, Russian, and English ? familiarity with & knowledge of UNICEF context/priorities ? ability to learn quickly and apply procedures in an international organization

PERFORMANCE INDICATORS
Consultant?s performance will be evaluated against the following criteria: timeliness, responsibility, initiative, communication, accuracy, and quality of the products delivered.

ESTIMATED BUDGET AND PAYMENT ARRANGEMENTS
National Officer will be paid a monthly salary at NOA level taking into account the level of responsibilities and complexity of tasks and assignments.

HEALTH STATEMENT & CERTIFICATE
The Health Statement and certificate of Good Health will be received prior to signing the contract.

AI Research

Avian Influenza Outbreaks in Chickens, Bangladesh

11/25/08 CDC/EID--Volume 14, Number 12?December 2008 Dispatch [full text with graphics]

Paritosh K. Biswas, Comments to Author Jens P. Christensen, Syed S.U. Ahmed, Himel Barua, Ashutosh Das, Mohammed H. Rahman, Mohammad Giasuddin, Abu S.M.A. Hannan, Mohammad A. Habib, Abdul Ahad, Abu S.M.S. Rahman, Rayhan Faruque, and Nitish C. Debnath
Author affilations: Chittagong Veterinary and Animal Sciences University, Chittagong, Bangladesh (P.K. Biswas, S.S.U. Ahmed, H. Barua, A. Das, M.H. Rahman, A. Ahad, R. Faruque, N.C. Debnath); Copenhagen University, Copenhagen, Denmark (J.P. Christensen); Bangladesh Livestock Research Institute, Dhaka, Bangladesh (M. Giasuddin); Department of Livestock Services, Dhaka (A.S.M.A. Hannan, M.A. Habib); and Department of Livestock Services, Joypurhat, Bangladesh (A.S.M.S. Rahman)

Regional Reporting and Surveillance

China: Forum Members Discuss AI Outbreak Across Eastern Jiangsu Province

11/24/08 ARGUS--An industry forum included a posting dated November 24 by a Xuzhou farmer who posted a claim that in Hai?an and Taidong cities, a major outbreak of H5N1 Re-4 avian influenza (AI) has killed up to 10 million poultry birds. The farmer asked other forum members to verify the claim.

Another farmer from an unspecified region of Jiangsu Province said that there are indeed deaths due to AI but that they are neither massive nor uncommon. That farmer claimed that the fatality rate was between 10-20% and that egg production rates have fallen drastically. He also wrote that county-level authorities do not dare probe the matter and thus have not taken any action.

According to the posting, AI has reportedly circulated widely across various parts of the province, and has not been dealt with since February this year. One forum member from Taidong implied that he was not aware of the outbreak. No further information was provided.

Article URL(s)
http://bbs.jbzyw.com/read.php?tid-31992.html

Regional Reporting and Surveillance

Egypt: $10 Million Loan in Support of Avian Influenza Fight

11/26/08 ARGUS--An international source reported that the Islamic Development Bank has given the Egyptian government a $10 million loan to aid the fight against AI. The AI loan is meant to be used to combat the disease in Egypt and strengthen the capacity to reduce the risk of transmission of AI among animals and humans.

Article URL(s)
http://www.spa.gov.sa/details.php?id=611041

Regional Reporting and Surveillance

India: Avian flu help increased (Op/Ed)

11/26/08 Central Chronicle--With an extended burst of applause, representatives from more han 120 nations closed an international meeting whose focus was highly pathogenic H5N1 avian influenza and the need to control and then eradicate the virus in poultry and prepare the planet for a human pandemic.

The conference produced pledges of financial assistance from the United States, Japan and Norway of more than $350 million and offers of technical assistance from many countries to more vulnerable nations.

Newly developed international health mechanisms have resuled in a coordinated global approach to *(to avian flu and other infectitious disease threats), Paula, Under Secretary of state for democracy and global affairs and head of the US delegation, told attendees.

International focus on the twin threats, she added, both from the spread of avian influenza in domestic and migratory birds but also from a possible viral mutation that would cause a potentially devastating human pandemic, has led to action worldwide.

Officials addressing the conference were Egyptian Prime Minister Ahmad Nazif, Agriculture Minister Amin Abaza, Health Minister Hatem el-Gabalyaza and World Organization for Animal Health director Bernard Valat.

Our conference should spare no effort in enacting concrete and strong actions to combat the imminent threat of avian influenza. Following the example of Egypt, transparency should be the cornerstone of our strategy, el-Gabalyaza said.

Raising the citizens awareness by creating efficient communications and media coverage and pooling our resources are important measures to be embraced worldwide, he added. We need, more than ever before, strengthened partnerships among science, polycymakers, industry, the business community and civil society.

Also addressing the meeting were World Bank vice president Jeffrey Gutman, food and agriculture organiation dy DG Jim Butler, WHO, Dy DG Anarfi Asamoa-Baah and UN System Influenza Coordinator David Nabarro.

More than 350 conference participants- including 63 government ministers, senior officials who represented 120 countries and 26 international organizations, researchers, representatives of international and regional organizations, and non-governmental and private groups-addressed three main challenges:

Making sure the world is prepared to mitigate the effects of a flu pandemic or another public health catastrophe.

Sustaining efforts to control H5N1, especially in poultry, and eventually eradicate the H5N1 virus from domestic animals in countries that still suffer from it.

Initiating longer term action for responding to infectious diseases that emerge at the animal-human-ecosystem interface.

Pandemic Preparedness

Hospital pandemic drill reveals major supply challenges

11/25/08

CIDRAP

The 24-hour exercise in a British hospital also revealed various other challenges, including that hospital workers lacked confidence in their ability to follow infection control guidelines, felt uncomfortable wearing surgical masks, and felt that wearing personal protective equipment (PPE) hindered communication, according to the report, published online by the Journal of Infection Control.

"Healthcare in a pandemic situation is not simply a case of applying pandemic influenza infection control guidance to current practice; hospitals need to consider changing the way care and services are delivered," states the report by N. F. Phin of Cheshire and Merseyside Health Protection Unit, Chester, UK, and colleagues.

British health authorities issued infection control guidance for pandemic flu in October 2005, the report says. The guidelines call for healthcare workers (HCWs) to wear gloves, a plastic apron or gown, and a surgical mask when coming within 3 feet of pandemic flu patients. They recommend the use of an FFP3 respirator (equivalent to a US N-99 respirator, designed to stop 99% of small airborne particles) and eye protection during aerosol-generating procedures.

These guidelines "involve major changes to the way care is currently delivered and the use of infection control measures and PPE on a scale far beyond that experienced in the recent past," Phin and colleagues write. "Few currently employed healthcare workers have experience of a pandemic and the lack of a detailed operational data makes implementation of the current guidance challenging."

Basic PPE much more in demand
To assess the operational challenges, the researchers set up their 24-hour exercise on a 29-bed general medical ward that received mostly respiratory and gastrointestinal patients. The staff, including 14 nurses, 5 healthcare assistants, and 4 domestic workers, was briefed in advance on pandemic flu, infection control procedures to be used, and how to don and remove PPE, including FFP3 respirators.

During the exercise, conducted in November 2006, 17 infection control nurses (ICNs) monitored staff compliance with the infection control guidance, gave advice when needed, and recorded issues that arose.

A key finding was that HCWs used far greater than normal quantities of basic PPE during the exercise: about 1,200 pairs of gloves, 650 surgical masks, and 750 disposable aprons. This suggests that during the height of a pandemic, the use of aprons, gloves, and masks would increase 13-fold, 10-fold, and 450-fold, respectively, the report says.

On the other hand, it says the quantities of high-level PPE used were much lower than expected: 13 gowns, 13 FFP3 respirators, and 13 pairs of goggles. Expecting a much greater need, the team had ordered 500 respirators for the exercise.

On the basis of World Health Organization (WHO) guidance at the time, the investigators had expected a much smaller need for basic PPE and a greater need for high-level equipment. "WHO guidance overestimates the use of high-level specialist PPE and underestimates the amount of basic PPE required," they write.

Along with the surge in basic PPE used came a major increase in waste generated: 18 48-liter bags, versus four to six bags on a normal day, the report says.

The team also recorded traffic through the ward and found that at least 115 different workers made 167 visits during the exercise. "This level of traffic would be highly undesirable during a pandemic, and as a consequence of the exercise, operational assumptions and plans are to be reappraised in order to minimize unnecessary staff movement," they write.

Workers' perceptions
Twenty-one of the 23 ward staff members completed a questionnaire about the exercise. Among the results: Fourteen (67%) of them found it uncomfortable or very uncomfortable to wear a surgical mask; 17 (81%) said their duties took longer; and 9 (43%) felt that talking with others was more difficult. In addition, three workers reported that wearing a mask seemed to affect their hearing, very likely showing the importance of nonverbal cues in communication.

The ICNs on hand during the exercise found that compliance with the infection control guidelines was good, but they also noted plenty of concerns and areas of uncertainty. A few examples included problems with donning and removing PPE, patients being kept waiting while HCWs put on PPE, decontamination of ward equipment such as telephones and door handles, and hand hygiene after contact with inanimate objects.

Overall, the staff had a good grasp of basic infection control steps, but they were unsure about the extra measures recommended in a pandemic, the report says, adding, "Uncertainty was also evident in participating staff as ICN observers occasionally gave conflicting advice."

Supporting what some of the staff reported, the investigators also found that "many tasks and routine procedures took much longer than usual, despite the rostering of additional staff; this was particularly obvious at night when the drug round took twice as long as usual to complete."

Despite the challenges pointed up by the exercise, the staff felt that it increased their confidence about dealing with a flu pandemic, the researchers write. They conclude, "We believe that this is the first simulation of its kind in the UK, and that many hospitals would benefit from undertaking similar exercises in order to gain confidence and understanding of their own operational needs."

Study 'generalizable' to US hospitals
Marcia Patrick, RN, MSN, CIC, infection control director with the MultiCare Health System in Tacoma, Wash., called the study very interesting and said the big increase in usage of PPE impressed her as the most important finding.

"I believe it [the study] is generalizable to US facilities, particularly the increased amount of isolation supplies that would be needed in a pandemic," she told CIDRAP News.

"Where do you store all that?" Patrick asked. "Most hospitals, just like grocery stores, don't have big storerooms of supplies. A lot of places have gone from a 24-hour supply to 72 or 96 hours, but we don't have stocks and stocks of stuff."

"Another good point is that most of the masks and gloves and gowns are made in China or some of those other countries, and the likelihood of a supply shortage [in a pandemic] is enormous," she added.

The volume of trash is also a concern, said Patrick, who is a board member of the Association of Professionals in Infection Control and Epidemiology (APIC). She said hospitals might consider using trash compactors to deal with that, but compactors might cause aerosolization of pathogens, and heavier trash containers might increase injury risk for workers.

She said she wasn't surprised by the finding that many workers found the surgical masks uncomfortable. "It's difficult for staff not used to wearing the things to wear them all shift long," she said.

As for respirators, people who have asthma or other respiratory problems find it very difficult to wear them for more than a few minutes, she added. Because of that, her own healthcare system uses powered air-purifying respirators (PAPRs), which blow air through a HEPA filter and into a hood worn by the worker. The device has a clear face shield and does not require fit testing.

Patrick said the British guidelines differ in a couple of respects from those used in her institution. One was that the former do not call for eye protection for HCWs in close contact with infectious patients.

"I would want mask and eye protection to be linked?not just used for cough-inducing procedures," she said. "We have found that requiring masks with eye protection and providing the single-unit items has increased compliance."

Phin NF, Rylands AJ, Allan J, et al. Personal protective equipment in an influenza pandemic: a UK simulation exercise. J Hosp Infect 2008 (early online publication) [Abstract]

Regional Reporting and Surveillance

Indonesia says big market should spur drug makers to invest more

11/26/08 Reuters--Indonesia's huge market for prescription drugs should encourage foreign pharmaceutical firms to set up production plants in the country and comply with a new government decree, the health minister said on Wednesday.

The new rules, issued earlier this month, require foreign drug companies to set up production facilities in Indonesia in order to receive licences to sell their products there. Firms will have a two-year grace period to make the investments.

The decree, which also includes a provision on transfer of technology to Indonesia, is likely to affect foreign drug makers such as Merck Sharp & Dohme Corp, Johnson & Johnson (JNJ.N: Quote, Profile, Research, Stock Buzz) of the United States, AstraZeneca (AZN.L: Quote, Profile, Research, Stock Buzz) of Britain and Servier of France.

"Big pharmacy companies only need a small room and two workers (in a country), and then the whole profit is brought back to their countries. I want fairness," Siti Fadillah Supari said in an interview with Reuters and a local magazine.

"I am not against working with foreigners, but the deal should be fair ... I have the market, the biggest in ASEAN (Southeast Asian region)," she said.

Supari said 30 percent of the world's fourth most populous country of 226 million people are able to buy expensive drugs. The country's total drug market is worth more than 20 trillion rupiah ($1.66 billion) a year.

Indonesia still imports drugs for cancer and heart diseases. Currently, there are 208 pharmacy companies in Indonesia, of which 31 are foreign.

Supari, who has clashed with the international community and United States over her handling of health issues, also said the World Health Organization was close to agreeing on a fairer mechanism for sharing information on viruses, which could be agreed upon as early as next year.

Jakarta has refused to share bird flu samples, saying it wants guarantees from richer nations and drugmakers that poor countries would get access to affordable vaccines developed from their samples.

Indonesia has the highest bird flu toll of any nation. Some 112 people have died because of the disease.

International health experts say it is vital to have access to samples of the constantly mutating H5N1 virus, which they fear could change into a form easily transmissible among humans and sweep the world in months, killing millions of people.

Supari denied Indonesia was trying to hide the extent of the bird flu problem in the country by announcing death figures only once in six months and said the number of cases this year was about half the number last year.

"Why must we cover the cases, with the strain's virulency? Indonesia is not that bad compared to other countries with smaller areas and lesser populations," she said. ($1 = 12,050 rupiah) (Editing by Sugita Katyal & Kim Coghill)

Regional Reporting and Surveillance

Mayalsia: World's First Pandemic Logistics And Learning Exercise

11/26/08 Bernama--The world's first pandemic logistics and learning exercise, known as P2LX, is being held here to enhance readiness and response to a crisis situation triggered by the Avian Influenza or bird flu H5N 1 virus.

Mercy Malaysia president Datuk Dr Jemilah Mahmood said the seven-day exercise beginning Monday, would among others, identify areas needing improvement in the logistics operation and management practices of senior logistics staff in pandemic situations.

The exercise is organised by Mercy, World Food Program (WFP) and the World Health Organisation (WHO).

"The P2LX is a simulation exercise geared at responding to a crisis situation triggered by a pandemic, such as the Avian Influenza or bird flu H5N 1 virus, in a controlled simulation environment.

"P2LX learning exercise is important to us as a nation because of the involvement of all the different non-governmental organisations (NGOs) and the corporate sector which are also assisting us in these programmes," she told Bernama here Wednesday.

Dr Jemilah said 158 local participants from Mercy and Red Crescent Malaysia were participating in the exercise.

She said the simulation exercise was intended to act as a learning tool, allowing experienced logisticians who participate to apply their skills and knowledge.

"The P2LX enabled participants to gain a clearer understanding of their role in the logistics inter-agency mechanism to highlight areas of response in a pandemic situation.

"This is the first time in the world that we are teaming up for such training," she said.

Dr Jemilah said many international communities, such as the United Nations(UN), could learn from the experiences of Malaysian Government agencies in handling pandemic cases.

She said Malaysia was chosen for this exercise due to the big support from the government.

Meanwhile, Avian and Pandemic Task Force World Food Program (WFP) chief Peter Scott Bowden said in early 2006, virus like SARS Influenza had spread across three continents and had proved an aptitude to infect and kill humans.

"Based on history, there is a recycle in every 40 years for a new virus to spread, and no one can guarantee that it will not recur.

"Its ability to mutate and transmit from one person to another has triggered a global human influenza pandemic.

"(Thus) the objective of this exercise is to operationalise the plans, guidelines and idea on how we can operate in such situations," he said.

The P2LX training, divided into theoretical and practical, is being held at the Kuala Kubu Baru fire and rescue department training centre.

Regional Reporting and Surveillance

Malaysia: Stringent checks on poultry smuggling

11/25/08 Straits Times--The state Veterinary Services Department is stepping up checks to curb the smuggling of poultry from Thailand following the outbreak of bird flu there.
The checks will target commercial vehicles passing through the checkpoints along the Malaysian-Thai border for frozen chicken.

Director Dr Mohd Zairi Serlan said the checks were conducted jointly with help from the General Operations Force and the state's Anti-Smuggling Unit.

"We are keeping a close eye on the traffic movement at border checkpoints as we suspect that farm operators in Thailand may dump the chickens here. The ban on poulty imported from Thailand is still on and we are constantly on the alert to prevent the disease from speading here."

Regional Reporting and Surveillance

Pakistan: Isolation units for bird flu patients still awaited

11/25/08 Dawn--The provincial health department has failed to establish respiratory isolation units for bird flu patients despite the lapse of one year, sources said. After confirmation of the first case of human-to-human transmission of avian influenza in Peshawar last year, the health department had planned to establish two respiratory isolation units (RIUs), one each in the Khyber Teaching Hospital in Peshawar and the Ayub Teaching Hospital in Abbottabad, to help treat patients suspected of carrying the H5N1 strain of virus.

However, after one year, there are no signs of any development regarding establishment of the wards. The World Health Organisation had confirmed last year the deaths of some members of a family in Peshawar due to bird flu virus.

Sources in the health department said the WHO had also agreed to provide $500,000 for the two wards, but it wanted the government to bear some expenditure. The world health agency had also sent a feasibility report to the government to pave the way for setting up the units.

The WHO wanted the government to play lead role in the project, but the latter dragged feet on it and the two units are yet to be established. The former caretaker government had directed the health department to prepare PC-1 for setting up the units, but the directives were not carried out.

Genetic sequencing tests performed by WHO laboratories in Egypt and the US on samples collected from three of the four brothers had established human-to-human transmission of the virus. Serum taken from the three was found to have been infected by the H5N1 avian influenza virus.

A WHO report had confirmed limited human-to-human transmission.

Sources said the federal government?s plan to devise PC-1 for the entire country, at a cost of about Rs2.5 billion, had not materialised despite WHO?s warning to put in place measures, especially in the NWFP.

Sources said the government had temporarily allocated 10 beds in private rooms of the KTH last year that served as makeshift RIUs for suspected bird flu patients. Last year, more than a dozens suspected patients were admitted to these RIUs.

Regional Reporting and Surveillance

India: Project to study role of birds in avian flu

11/24/08 The Hindu--A project, to be funded by the Food and Agriculture Organisation, will study the role of migratory birds in the spread of avian influenza, using tracking devices in three bird sanctuaries later this year, K. Balachandran, Indian co-ordinator of the project, has said.

The bird flu scare caused a major culling operation in West Bengal and Tripura earlier this year. While the Highly Pathogenic Avian Influenza (HPAI) H5N1 mainly attacks poultry, the role of migratory birds in spreading the virus has not been ruled out. A global study commissioned by the FAO has found incidence of the HPAI H5N1 in migratory birds in various parts of the world. Though the latest report (up to September 2008) by the FAO suggests that only Indonesia and Egypt are critical, the incidence of avian flu in migratory geese and ducks, especially in the Qinghai Lake in China in 2005, has put India on alert. To prevent a situation similar to the one in West Bengal, the Bombay Natural History Society (BNHS) has been actively monitoring wild bird populations, Dr. Balachandran said.

Using bird-ringing, the BNHS has been trying for a basic study of the behaviour of migratory birds. Speaking to The Hindu, he said: ?We collected 397 samples from the Chilka Lake [in Orissa] and studied the symptoms, but the High Security Animal Disease Laboratory (HSADL), Bhopal, ruled out avian flu as a cause of death. Now we will study the birds during the current migratory season, using the FAO project.?

Thirty birds in each of the sanctuaries will be fitted with a Platform Transmitter Terminal (PTT), which will track the birds along their migratory path. Each of the PTTs, costing Rs. 5 lakh, will be tracked every four hours through satellites to locate the birds within a resolution of 100-200 m.

Regional Reporting and Surveillance

USA: National Avian Influenza Surveillance Information

November 25, 2008
Samples Tested and Reported into HEDDS

* Nov 25, 2008: 307 samples and tests were added to HEDDS for 2008. Total is now 64,182.
* Nov 24, 2008: 1,842 samples and tests were added to HEDDS for 2008. Total is now 63,875.
* Nov 22, 2008: 1,080 samples and tests were added to HEDDS for 2008. Total is now 62,033.

* * Highly pathogenic H5N1 avian influenza virus has NOT been detected in these samples * *

AI Research

Avian Flu Virus Freed From Immune Recognition By Protein 'Tubules'

11/6/08 Medical News Today--A protein found in the virulent avian influenza virus strain called H5N1 forms tiny tubules in which it "hides" the pieces of double-stranded RNA formed during viral infection, which otherwise would prompt an antiviral immune response from infected cells, said Baylor College of Medicine researchers in an online report in the journal Nature.

Two domains or portions of the protein NS1 combine to form tiny tubules where double-stranded RNA is hidden from the immune system, said Dr. B. V. Venkataram Prasad, professor of biochemistry and molecular biology, molecular virology and microbiology at BCM and his student, Dr. Zachary A. Bornholdt (now of the Scripps Research Institute in La Jolla, California).

"Once we confirm the importance of this structural information, we should be able to design drugs to block this action," said Prasad. "There are other things the protein could do to interfere with different immune mechanisms. We don't know if this is the only mechanism or if there are others that also come into play during influenza virus infection."

The two researchers had already recognized the importance of the protein NS1 in the virulence of influenza viruses and particularly, H5N1, a form of avian flu associated with more than half the deaths in a 2004 "bird flu" outbreak that resulted in 50 human cases and 36 deaths in Vietnam, China and Thailand. In all but one case, experts ruled out human-to-human spread of the virus. In a previous report, Prasad and Bornholdt described the structure of an area of the protein called the effector domain. In this report, a series of elegant experiments designed and carried out over eight months by Bornholdt allowed the two scientists to "crystallize" the entire protein.

By doing this, they were able to determine its structure using a technique called X-ray crystallography. This technique enables scientists to determine the three-dimensional structure of proteins and other bio-molecules by scattering X-rays through a crystal of the molecule. They substantiated their structure with cryo-electron microscopy, which makes images of tiny frozen structures using an extremely powerful electron microscope.

That structure revealed a previously unsuspected idiosyncrasy of NS1 in H5N1 that could explain the virus' virulence. In most cases, when an infected cell is exposed to a virus, double-stranded RNA molecules are formed triggering a potent anti-viral response that involves production of interferon.

However, the two domains of NS1 in this H5N1 interact to form tiny tubules. The double-stranded RNA is hidden or sequestered in these structures. The cell never sees a significant length of the RNA and does not marshal its immune forces to the fight the virus. Prasad and Bornholdt believe also that cellular factor binding sites found on the surface of the tubules also play a role in fooling the immune system.

"This is only one structure," said Prasad. "We need to see if this holds up with other NS1 structures from other influenza viruses."

Bornholdt's technique for crystallizing the protein will prove valuable in pursuing this work, said Prasad.

"Is this a common mechanism for eluding the immune system?" he said. He said hopes to build a library to NS1 structures to facilitate future studies designed to fight influenza worldwide.

While H5N1 is not usually transmitted from human-to-human at this point, a small change in its genetic structure - perhaps an exchange of genes with a more easily transmitted flu virus - could change that, he said. Developing drugs to fight the virus could prove life-saving in a pandemic.

Funding for this work came from the National Institutes of Health and the Robert Welch Foundation.

The full article is available at http://www.nature.com.

For more science news from Baylor College of Medicine, go to http://www.bcm.edu/fromthelab

Regional Reporting and Surveillance

Record-level US Support For Bird Flu Program - Indonesia, Viet Nam And Egypt Among Major Beneficiary Countries

11/14/08 Medical News Today--The United States will provide an additional $44.4 million in support of FAO's avian influenza control and prevention campaign, FAO announced today.

With the new funding from the United States Agency for International Development (USAID), US support to the FAO avian influenza program has reached a total of $112.8 million. The United States remains the largest donor to FAO's bird flu control activities implemented in more than 96 countries.

The funds are mainly earmarked for avian influenza control in Afghanistan, Bangladesh, Cambodia, China, Egypt, India, Indonesia, Lao PDR, Myanmar, Nepal, Pakistan, South Asia, West and Central Africa and Viet Nam, as well as global efforts. Indonesia, Viet Nam and Egypt will be the top beneficiaries.

"Although many countries have successfully managed to get avian influenza under control, the virus remains present in ten countries and is mainly entrenched in countries like Egypt, Indonesia and Viet Nam. The additional US funds will enable FAO to continue its work in support of countries that are still struggling to get the virus under control," said FAO's Chief Veterinary Officer Joseph Domenech.

"The strong partnership with FAO is an integral component of our international efforts to contain and control Highly Pathogenic Avian Influenza at its animal source," said Ambassador Gaddi Vasquez of the US Mission to FAO.

The main donors to FAO's avian influenza program, which currently amounts to around $282.7 million, are: the United States, Sweden, Australia, Japan, the European Commission, the United Kingdom, Canada, Germany, the World Bank, UN Development Program, the Asian Development Bank and France. The program is also supported by funds from FAO's Technical Cooperation Program.

AI Research

A New Way To Predict Outbreaks: Replikin Peptide Concentration In H5N1 Influenza Virus Genome As A Marker For Lethal Outbreaks

11/13/08 Medical News Today--WHO and CDC have stated that the predictive accuracy of their annual formulations for human influenza vaccines is "suboptimal" -- often correct less than 50% of the time, especially for seniors. Perhaps in part because we are not yet accurate in our predictions of upcoming influenza strains, approximately 36,000 people die each year of flu in the United States alone.

As in the case of hurricanes, early warning of the location and intensity of virus outbreaks would allow us more rapidly and effectively to defend ourselves with strain-specific vaccines. This is now possible.

To provide this vital knowledge, Drs. Samuel and Elenore Bogoch of the Foundation for Research on the Nervous System and Replikins Ltd. of Boston ("Replikins") are presenting new technology at the 7th International Bird Flu Summit in Las Vegas November 13-14, 2008 that can accurately predict which viral strains are poised to attack human populations, and reveal the location from which this viral strain is going to strike. This service is being offered to WHO and CDC.

The key to this predictive technology is a new class of structural virus peptides that have been shown to be involved in the chemistry of rapid replication. The Drs. Bogoch called them "Replikins," and they are strictly defined by the concentration of lysine and histidine residues and the spacing between them. To demonstrate the correlation between the concentration of replikins and the lethality of influenza virus outbreaks, Replikins Ltd. has developed software called FluForecast(R), which counts the number of replikins in the sequences of each strain of flu virus across the years -- and thanks to the data in public databases like PubMed, we now can track as far as 90 years back.

What Replikins have found is that there's a strong correlation between the concentration of replikins and the lethality of an influenza virus outbreak. This allows us to determine in advance, using newly designed software, which viruses have the highest replikin concentrations -- and are thus poised to become the most lethal outbreak.

Replikin peptides are not distributed equally throughout the virus genome, but are concentrated in a specific area of the genome designated the Replikin Peak Gene (RPGene). When the replikin counts for certain viral strains are elevated, we see pandemics -- in which one to 50 million people die. Note that the replikins, like the pandemics, are strain-specific.

From its observations Replikins were able to predict an impending increase in human H5N1 mortality rate. In each host group -- goose, duck, chicken and human -- levels stayed low through 2004. But then Replikins saw a sudden spike in replikins particularly in chicken and human populations in 2005-06, which corresponded with increased epidemics in Asian countries. Which countries? Here again, Replikins looked at H5N1 replikin counts per country. Low levels - - below 4 -- were observed in each country until 2005-06, when it spiked most dramatically in Indonesia. Replikins thus predicted that Indonesia would be the first country to experience an H5N1 outbreak with higher human mortality, and this was proven to be correct in 2006-07.

So Replikins have demonstrated that tracking replikin counts not only works historically, but it can predict impending human mortality. Sequence the virus and you can tell whether it's relatively benign or likely to cause a pandemic -- the first time this has been possible.

Replikins is offering its FluForecast(R) service to WHO and CDC as a powerful new tool for tracking the appearance and lethality of new flu strains. By performing prompt replikin analysis of all human influenza sequences as they emerge, we can have advance warning of the intensity and location of future human influenza outbreaks. This will increase the accuracy of annual formulations for influenza vaccines, and will thereby hopefully reduce annual human influenza mortality rates. It is hoped that tracking replikins will save lives.

Beyond prediction, this new replikin-based technology also can be applied to combat influenza -- and to develop new vaccines that are more accurate and effective than current technology provides. Replikins have successfully demonstrated this capability when used against a virus in shrimp, which are susceptible to several devastating viral diseases. The replikin-based vaccine developed by Replikins to combat Taura Syndrome virus had a stunning result on the test population, protecting 91% of the shrimp against this deadly virus. Replikin vaccines work orally -- and can be synthesized far more quickly than conventional viral vaccines. The vaccine used to save the shrimp was manufactured in seven days. You can imagine what this type of rapid lead time would allow for making on-demand strain-specific influenza vaccines, which with traditional methods must be prepared nine months up to a year in advance.

Replikins is working to expand the capabilities of this vaccine technology and looks forward to making significant inroads to control H5N1 and other influenza populations.

Replikins are the viral tool of the future -- making accurate predictions in humans and animals now, through the FluForecast(R) service, and hopefully becoming a front-line weapon to stop viral pandemics in the future.

AI Research

New Centre To Fight Infectious Diseases - China-Australia Centre For Phenomics Research

11/24/08 Medical News Today--The fight against infectious diseases such as Avian influenza will receive a boost today with the official opening of the China-Australia Centre for Phenomics Research at The Australian National University.

The centre will be opened by ANU Vice-Chancellor Professor Ian Chubb and Professor Lu Yongxiang, President of the Chinese Academy of Sciences. The centre, funded by the Chinese and Australian Governments, will be located in the John Curtin School for Medical Research at the ANU. The opening will be marked by a plaque unveiling and speeches from Professor Chubb, Professor Lu, His Excellency Ambassador Zhang Junsai, Chinese Ambassador to Australia and Professor Frances Shannon, Director of the ANU John Curtin School of Medical Research.

"The centre will study alterations in the genome code that lead to increased resistance or susceptibility to a range of infectious diseases including Avian Influenza," said Dr Edward Bertram, the University's Program Manager for the China-Australia Centre for Phenomics Research. "It's hoped that this work will help us to identify targets for designing new treatments to boost the immune system against these diseases."

The centre brings together some of Australia and China's high performing immunologists and virologists to work towards new discoveries in this field of research. The Australian program will be lead by ANU researchers Dr Edward Bertram, Professor Chris Goodnow and Dr Steve Winslade, but will also involve some of Australia's top immunologists including Nobel Prize winner Professor Peter Doherty, Dr Stephen Turner from the University of Melbourne, Professor Doug Hilton from The Walter and Eliza Hall Institute of Medical Research and Professor Paul Hertzog from Monash Institute of Medical Research.

The Chinese team will be led by Professor Hong Tang, Director of the Centre for Infection and Immunity, Institute of Biophysics, Chinese Academy of Sciences in Beijing.

Conferences and Training

The 7th Annual ASM Biodefense and Emerging Diseases Research Meeting is scheduled for February 22-25, 2009 in Baltimore, MD

11/25/08 American Society for Microbiology--The 7th Annual ASM Biodefense and Emerging Diseases Research Meeting is scheduled for February 22-25, 2009 in Baltimore, MD.

The purpose of this meeting is to bring together individuals who are carrying out research to defend against the growing threat of bioterrorism and decision makers shaping the future biodefense research agenda, recognizing that emerging infectious diseases serve as a paradigm for handling the public threat of bioterrorism.

What's New for this Meeting

11/18/08
The Abstract Submission System is closed for new submissions
All complete abstracts will be forwarded to the Program Committee for review and acceptance. Incomplete abstracts must be completed by today to ensure they are reviewed by the committee. All Abstract Presenters will be notified by email from asmbiodefense@abstractsonline.com in mid-December with the results.

11/14/08
Abstract submissions remain open
You may continue to submit your abstracts until midnight on November 17. Abstracts submissions that have established a tracking number in the OASIS system but are incomplete must be completed by November 18. Abstracts that remain incomplete after November 18 will not be reviewed for acceptance by the Program Committee.

11/14/08
Registration
Registration information has been posted to the website and the registration site is now open. Registration will close on January 23, 2009.

Vaccines

New Vaccines Protect Against Asian H5N1 Influenza A Viruses in Domestic Ducks

11/25/08 American Society for Microbiology--Scientists are looking at a novel strategy to prevent the spread of pandemic avian influenza. They have developed a vaccine that protects ducks, a known natural reservoir for the virus. They report their findings in the November 2008 issue of the Journal of Virology

Waterfowl are considered to be the natural reservoir of influenza A viruses due to the isolation of all subtypes from these hosts. Current research indicates that influenza A viruses are continuously evolving within their natural environment and can be transmitted to a variety of animals, including humans. H5N1 avian influenza A viruses are now endemic in domestic poultry in many Asian countries and ducks are believed to be the primary source of infection. Reducing the spread of H5N1 in ducks could play a key role in minimizing the risk of a pandemic outbreak.

In the study researchers first identified dominant pathogenic strains of H5N1 influenza A viruses circulating in Asian poultry and found that four caused symptomatic illness in domestic ducks, but not all were lethal. In addition the researchers reversed the genetics of the viruses in domestic ducks to develop three different inactivated oil emulsion whole-virus H5 influenza vaccines. Following one round of inoculation with the vaccines ducks were completely protected when challenged with a lethal dose of the H5N1 virus.

"The vaccines provided complete protection against the lethal challenge of the homologous and heterologous H5N1 avian influenza A virus with no evidence of morbidity, mortality, or shedding of the challenge virus," say the researchers. "The complete protection offered by these vaccines will be useful for reducing the shedding of H5N1 avian influenza A viruses among vaccinated agricultural avian populations."

(J.K. Kim, P. Seiler, H.L. Forrest, A.M. Khalenkov, J. Franks, M. Kumar, W.B. Karesh, M. Gilbert, R. Sodnomdarjaa, B. Douangngeun, E.A. Govorkova, R.G. Webster. 2008. Pathogenicity and vaccine efficacy of different clades of Asian H5N1 avian influenza A viruses in domestic ducks. Journal of Virology, 82. 22: 11374-11382.)

AI Research

Highly Pathogenic Avian Influenza Virus (H5N1) Infection in Red Foxes Fed Infected Bird Carcasses

11/08 CDC/EID [link to full text pdf]
Leslie A. Reperant, Geert van Amerongen, Marco W.G. van de Bildt, Guus F. Rimmelzwaan, Andrew P. Dobson, Albert D.M.E. Osterhaus, and Thijs Kuiken

Author affiliations: Princeton University, Princeton, New Jersey, USA (L.A. Reperant, A.P. Dobson); and Erasmus Medical Centre, Rotterdam, the Netherlands (G. van Amerongen, M.W.G. van de Bildt, G.F. Rimmelzwaan, A.D.M.E. Osterhaus, T. Kuiken)

Eating infected wild birds may put wild carnivores at high risk for infection with highly pathogenic avian influenza (HPAI) virus (H5N1). To determine whether red foxes (Vulpes vulpes) are susceptible to infection with HPAI virus (H5N1), we infected 3 foxes intratracheally. They excreted virus pharyngeally for 3?7 days at peak titers of 103.5?105.2 median tissue culture infective dose (TCID50) per mL; they became ill with severe pneumonia, myocarditis, and encephalitis. To determine whether foxes can become infected by the presumed natural route, we fed infected bird carcasses to 3 other red foxes. These foxes excreted virus pharyngeally for 3?5 days at peak titers of 104.2?104.5 TCID50/mL, but only mild or no pneumonia developed. This study demonstrates that red foxes fed bird carcasses infected with HPAI virus (H5N1) can excrete virus while remaining free of severe disease, thereby potentially playing a role in virus dispersal.
Influenza A viruses rarely infect species of the order Carnivora. However, since 2003, highly pathogenic avian influenza (HPAI) viruses of subtype H5N1 have infected a wide range of carnivore species. Within the past 30 years, and before the emergence of HPAI viruses (H5N1), 5 documented outbreaks of influenza virus infections occurred in 2 carnivore species?the harbor seal (Phoca vitulina) (1?4), and the American mink (Mustela vison) (5). In both species, the infection resulted in respiratory disease. In addition, influenza virus infection has been detected by virus culture or serologic examination in other carnivores, namely, domestic dogs (Canis lupus familiaris) (6,7), domestic cats (Felis catus) (8,9), and bears kept in captivity (species not stated) (9); however, these animals did not show clinical signs of disease. Also, recent outbreaks of equine influenza virus (H3N8) infections resulted in respiratory disease in domestic dogs (10,11). In contrast, within the past 5 years, HPAI viruses (H5N1) have infected and killed carnivores belonging to 7 species: captive tigers (Panthera tigris) and leopards (P. pardus) (12,13); domestic cats (14?17); captive Owston?s palm civets (Chrotogale owstoni) (18); a domestic dog (19); a free-living stone marten (Martes foina) (20); and a free-living American mink (21). In these species, the infection resulted in both respiratory and extrarespiratory lesions, demonstrating systemic infection beyond the respiratory system. The most frequently reported clinical signs for all species were respiratory distress, neurologic signs, or both.

Pandemic Preparedness

Book Review: David Swayne (2008) Avian Influenza

November 2008 Contributed by Mike Nunn, in Australia (Thanks Mike)

Journal of Wildlife Diseases, October 2008

http://www.jwildlifedis.org/cgi/content/full/44/4/1056

Book review, Journal of Wildlife Diseases, 44(4), 2008, pp. 1056-1058
By: Steven Schwarzbach, Sabir Muzzafar and John Takekawa, Western Ecological Research Center, US Geological Survey, 3020 State University Drive, Sacramento, California 95819, USA. (steven_schwarzbach@usgs.gov).

Avian Influenza. By David E. Swayne, Blackwell Publishing Ltd., Oxford, UK. 2008. 605 pp. ISBN-13 978-0-8138-2047-7/2008. US $149.99 (hardback).

Wildlife diseases have become a more prominent feature of ecological studies relatively recently, particularly in the face of increased contact between humans, domestic animals, and wildlife (Daszak et al., 2000). Highly pathogenic avian influenza (HPAI) of the H5N1 subtype, in particular, has drawn much public interest in just the last several years, with the infections of 383 humans with 241 deaths as of May 2008. It has also attracted new wildlife scientists to the problem because of the increasing involvement of wild bird species. HPAI H5N1, however, remains primarily a disease of domestic poultry, and in fact has been present in Eurasia for over 11 yr. As outbreaks of H5N1 continue to occur in wild birds, poultry farms, and humans, significant scientific questions remain.

For scientists seeking to pursue these questions and for policymakers concerned with the ongoing panzootic and threat of a potential pandemic, David Swayne?s book Avian Influenza is both timely and important. David Swayne assembles a remarkable ensemble of researchers, veterinarians, medical professionals, and government officials working in this field to provide a comprehensive review of the many dimensions of what we know about avian influenza and what we need to know and do. The issues are complex and technical, but the writing is accessible to the educated layman as well as the scientist seeking to work in a cross-disciplinary context. The book is ambitious in its scope, with chapters on the origin and evolution of fowl plague in the 1920s, the ecology of avian influenza in wild birds and man-made systems, the range of molecular complexity of viral subtypes, clinical signs and pathobiology of the disease, control measures at local to regional to global levels, and the future proactive strategies needed to adapt to and minimize this problem in human and animal health.

Although there has been significant research in all aspects of avian influenza during the last several years, we continue to grapple with some basic aspects of the disease. We do not know what causes low-pathogenic avian influenza (LPAI) subtypes to mutate to HPAIs, we are unclear about what role different kinds of poultry play in maintaining the disease, and we are unclear about the role of wild birds in spreading the virus. In the opening chapter David Suarez provides a very concise overview of what the book is about, touching on viral classification and systematics, influenza ecology in wild and domestic birds, genetic properties of the virus, and aspects of pathobiology. The pathogenicity of the virus?the characteristics that make it of such global significance?is dealt with in the second chapter (M. Perdue), as well as in Chapter 4 (Swayne), which highlights molecular determinants of pathogenicity. Examining pathogenicity helps us understand the bigger picture of adaptation, evolution, and spread of the virus in "novel" hosts, and the molecular changes that make LPAI viruses pathogenic (HPAI).

The greatest obstacle that any virus faces is that of the host barrier, a complex series of factors that prevent the virus from infiltrating into a novel system. The Asian lineage of HPAI H5N1 has managed to do this exceptionally well, as is illustrated in other chapters on the emergence and spread of HPAI H5N1 at regional and continental scales (Swayne, Chapters 4 and 6; Sims and Brown, Chapter 11), making it a particularly difficult problem in animal health. Wild birds seemingly have been partially spared from this problem for a number of reasons. First, the disease and its history indicate that it is primarily a disease in domestic poultry, having evolved from LPAI precursors from wild waterfowl. Conventionally HPAI outbreaks in poultry were considered a result of LPAI viruses spreading form wild-bird reservoirs to poultry. Alexander et al. (Chapter 9) point out, however, that recent outbreaks of H5N1 in Europe and Africa fail to conform to the dogma of LPAI spread from wild birds to poultry with subsequent mutation in domestic birds to HPAI. Second, adaptation of HPAI to wild waterfowl has historically been rare. In most cases, sporadic wild bird infections have, in fact, been spillover events from outbreaks at nearby poultry operations. In spite of their rarity in the wild, HPAI viruses have managed to kill thousands of wild birds on some occasions (the South African outbreak in 1961 and the Qinghai Lake, China, outbreak in 2005 are two examples of large wild bird die-offs). Additionally, the South African outbreak and the Qinghai Lake outbreak occurred in the absence of nearby poultry operations, raising the significant question of whether HPAI viruses can evolve in wild birds and if so, how frequently they may do so.

Swayne?s book has several chapters that provide a historical perspective on the disease that gives insight to these questions. Kaleta et al. (Chapter 7), Alexander et al. (Chapter 9), and Sims and Brown (Chapter 11) draw on the vast body of historical literature to provide a very thorough review of outbreaks and synopses for each case, synthesizing the information to help the reader draw his or her own conclusions on the history of avian influenza epidemiology in relation to man-made and wild systems. Evidently, LPAI viruses mutated to HPAI in poultry across the world, and although LPAI viruses are all of waterbird origin, their maintenance and enhancement in poultry operations has resulted in HPAI outbreaks. Experimental studies have alluded to the relative abilities of some wild birds to remain asymptomatic (Sturm-Ramirez et al., 2004; Brown et al. 2006), but as yet, no wild reservoirs of HPAI have been found. It can be argued that some wild birds may have survived in the wild after infection with HPAI H5N1 (Chen et al., 2006). Whether this resulted in adaptation in the virus to cause prolonged persistence in waterbirds?as suggested by some (Liu et al., 2005)?is not known, and this remains an important question in HPAI H5N1 ecology.

The latter half of the book (Chapters 12?25) considers control methods, biosecurity measures, vaccination strategies, and policy aspects necessary in HPAI H5N1 management. Multiple chapters demonstrate that mass depopulation of poultry has been the most effective tool in controlling and containing HPAI viruses since the earliest epidemics. Multiple authors conclude from various perspectives that control strategies should be part of a comprehensive package including high biosecurity measures, diagnostics and surveillance, and education, in addition to controlled depopulation when faced with an epidemic. The context in Asia is very complex, however, because poultry operations have minimal to low biosecurity, and live bird (and other animal) markets provide ample mutation opportunities for avian influenza strains as wild and domestic animals are in frequent close contact. Under these circumstances, alternative methods, such as gradual shifts toward more biosecure farming practices, are proposed, although the duration of time necessary to achieve some of these options is likely very long. The economics of instituting such changes and dealing with outbreaks as they occur is also expected to be costly, as highlighted by McLeod (Chapter 24). Swayne and Kapczynski (Chapter 19) aptly warn about the futility of using vaccination as a strategy when biosecurity and other measures are not in place. Lubroth et al., in the last chapter, advocate comprehensive, structural, and proactive approaches for an effective global strategy to address the multiple threats of avian influenza. The problems of poultry-rearing practices in Asia are likely to remain for years to come, as "backyard" poultry operations are an important means of meeting protein and basic economic demands of the rural poor. Adaptive strategies to minimize losses and create incentives to help governments in the region cope with and improve on existing systems are currently the best options, but a solution to globally eliminate HPAI from poultry is not immediately forthcoming.

Wildlife disease ecology has been studied from different perspectives. The emerging need for understanding transboundary zoonotics, as this book demonstrates, is for a science that achieves an interdisciplinary approach in wildlife ecology. The book provides a clear example of how a disease of significance to wildlife can be studied from different perspectives to produce a unifying picture of disease ecology and wildlife and human health. It is also an exceptionally informative reference for wildlife researchers, veterinarians, and policymakers. Each chapter, however, stands on its own, and as a result readers can quickly focus on the information they need in the specific chapters. The book will stimulate readers to consider how to enhance our understanding of diseases of wildlife significance in changing, human-influenced ecosystems. We still need to know if wild ducks, geese, swans, and other waterbirds, that are central to LPAI epidemiology in the wild, are capable of maintaining HPAI H5N1 in endemic cycles. Suarez (Chapter 1), Stallknecht and Brown (Chapter 3), Swayne (Chapter 4), and several others mention the importance of learning more about migratory bird movements in conjunction with virological studies to help piece together the HPAI H5N1 puzzle. Examining these areas is central not only to the ecology of HPAI in Asia, but also to the very discipline of wildlife disease epidemiology in the modern world. Ultimately this book demonstrates that as wild bird scientists we need to expand our understanding of diseases in relation to wildlife population dynamics and migration as well as virology, genetics, and human system interactions, not only just for the health of wild birds and the conservation of wild bird populations, but also for our own well being.

LITERATURE CITED
BROWN, J. D., D. E. STALLKNECHT, J. R. BECK, D. L. SUAREZ, AND D. E. SWAYNE. 2006. Susceptibility of North American ducks and gulls to HSNI highly pathogenic avian influenza viruses. Emerging Infectious Diseases 12: 1663?1670. [http://www.cdc.gov/Ncidod/EID/vol12no11/pdfs/06-0652.pdf]

CHEN, H., Y. LI, Z. LI, J. SHI, K. SHINYA, G. DENG, Q. QI, G. TIAN, S. FAN, H. ZHAO, Y. SUN, AND Y. KAWAOKA. 2006. Properties and dissemination of H5N1 viruses isolated during an influenza outbreak in migratory waterfowl in Western China. Journal of Virology 80: 5976?5983. [http://jvi.asm.org/cgi/content/abstract/80/12/5976?ijkey=46a83bddb3d2ba586e855a88ce76ade0cc49180a&keytype2=tf_ipsecsha]

DASZAK, P., A. A. CUNNINGHAM, AND A. D. HYATT. 2000. Emerging infectious diseases of wildlife: Threats to biodiversity and human health. Science 287: 443?449.[http://www.sciencemag.org/cgi/content/full/287/5452/443?ijkey=a2139bd46ec389c69906e61f6c69ea48e70e3057]

LIU, J., H. XIAO, F. LEI, Q. ZHU, K. QIN, X. W. ZHANG, X. L. ZHANG, D. ZHAO, G. WANG, Y. FENG, J. MA, W. LIU, J. WANG, AND G. F. GAO. 2005. Highly pathogenic H5N1 influenza virus infection in migratory birds. Science 309: 1206. [http://www.sciencemag.org/cgi/content/full/309/5738/1206?ijkey=49c563d3f67dc123784e101fe6d5b17495eacd71]

STURM-RAMIREZ, K. M., T. ELLIS, B. BOUSEFIELD, L. BISSETT, K. DYRTING, J. E. REHG, L. POON, Y. GUAN, M. PEIRIS, AND R. G. WEBSTER. 2004. Reemerging H5N1 influenza viruses in Hong Kong in 2002 are highly pathogenic to ducks. Journal of Virology 78: 4892?4901. [http://jvi.asm.org/cgi/reprint/78/9/4892?ijkey=fcce3249d6c09a044d40e9c19c01d31781de3ccc]

Conferences and Training

FAO: Avian Influenza Upcoming conferences

2008

1-3 December 2008
California, USA
Epidemics conference on infectious disease dynamics
Organiser: Elsevier Limited
Inaugural conference on infectious disease dynamics, including keynote presentation on zoonoses and emerging infections, plus presentations on HPAI.

2009

10-13 March 2009
Taba, Egypt
5th World Poultry Conference
Organisers: World Poultry Science Association (WPSA); Egyptian Poultry Science Association (EPSA)

5-8 April 2009
Athens, Georgia, USA
7th International Symposium on Avian Influenza
Organiser: The University of Georgia

22-26 September 2009
Marrakesch, Morocco
XVI Congress of the World Veterinary Poultry Association
Organiser: World Veterinary Poultry Association (WVPA)

Regional Reporting and Surveillance

One World, One Health edging onto a global agenda International community to draw on lessons from bird flu fight

11/24/08 FAO--A fresh input of US$ 350 million to the international fight against highly pathogenic avian influenza (HPAI) made the news when it was announced in Sharm El-Sheikh just over three weeks ago. Less coverage was given to endorsement of an ambitious new strategy to look at HPAI and other existing and emerging infectious diseases at the points where the animal, human and ecosystem domains meet.

The Sharm El-Sheikh meeting, the sixth in a series of high-level inter-ministerial conferences on avian and pandemic influenza, took place from 24 to 26 October and was attended by 530 participants from over 120 countries and 26 regional and international organizations.

A mix of technical and policy sessions, the conference focused on what is now known about HPAI and what has been achieved and learned since the latest wave of the disease broke out in later 2003 and subsequently spread throughout Asia and into Africa and Europe.

Delegates called for political commitment to and continued investment in strategies, approaches and activities to prevent and control HPAI. They stressed the importance of taking a long-term view of the issue, adopting a socio-economic approach and forging public-private partnerships to help combat HPAI. Communication was identified as a key component to respond to outbreaks before and once they spread.

In the almost five years that have passed since HPAI hit the scene in eastern and southeastern Asia, realisation of the need for close cooperation between the animal and public health sectors in the fight against HPAI and other existing or emerging infectious diseases (EIDs) has been growing steadily; in Sharm El-Sheikh the first concrete steps were taken to give shape to this cooperation.

Under the banner of One World, One Health, FAO, OIE, WHO and UNICEF (together with the World Bank and the UN System Influenza Coordinator (UNSIC), have agreed that a better understanding of the global emergence, spread and impact of EIDs is both urgent and important, and that because of the complexities of novel disease flare-ups, broad multidisciplinary and multisectoral cooperation across the animal-human-ecosystems interface should be put in place.

Presenting a first strategy paper on behalf of all the agencies involved, FAO explained that the thrust of the One World, One Health concept is to diminish the risk and minimize the global impact of epidemics and pandemics due to EIDs by enhancing livestock and wildlife disease intelligence, surveillance and emergency response systems at national, regional and international levels, and by supporting them through strong and stable public and animal health services and effective national communication strategies. Priorities will be identified on the basis of known areas of risk (?hotspots?) for disease emergence and on research findings that point to new risks.

Delegates to the Sharm El-Sheikh meeting welcomed the approach as a starting point for future action and called for further elaboration of the concept and clear indications of the roles of all "stakeholders" in the process. These stakeholders range from local communities to national governments, technical regional and international organisations, and to finance and development agencies and NGOs.

Expressing enthusiasm for One World, One Health, the Canadian government offered to organise a technical meeting in Winnipeg at the beginning of 2009 to continue discussion of the issue. On this basis, the agencies involved in formulation of the One World, One Health strategy are expected to decide on the next steps. These include ways of implementing the strategy, costing options and how to ensure that stakeholder "buy-in" to the strategy is as widespread as possible.

Timely implementation will contribute significantly to the overall goal of improving public health, food safety and security, and the livelihoods of poor farming communities, as well as protecting the health of ecosystems.

FAO has started to work with its partners to further develop the One World, One Health strategy, to share it with stakeholders particularly at country and regional levels, and to develop clearly defined options for its implementation.

Click here for the strategy paper on One World, One Health.

Click here for other material presented in Sharm El-Sheikh.

Regional Reporting and Surveillance

EMPRES Transboundary Animal Disease Bulletin 31

November 2008 FAO[link to full text pdf English]

Table of contents

Participatory Disease Surveillance in the Republic of Sudan as of August 2007

Porcine reproductive and respiratory syndrome (PRRS)

Capacity building for disease surveillance in wild birds

FAO in action

Workshops

Meetings: recommendations

Avian Influenza and Wildlife Regional Surveillance and Research Priorities for Asia International Meeting ? Bangkok, Thailand, 3?5 September 2007

News

Contributions from FAO Reference Centres

Stop the press

EMPRES address list

Regional Reporting and Surveillance

S. Korean gov't issues bird flu warning

11/12/08 Yonhap News, contributed by email--The South Korean government on Wednesday issued a nationwide bird flu alert as migratory birds started arriving in the country for winter.

The precautionary alert calls for poultry farmers and butchering facilities to carefully monitor birds they handle, and for quarantine authorities to check for sick travellers arriving from countries that have reported bird flu outbreaks, the Ministry for Food, Agriculture, Forestry and Fisheries said.

Thailand reported a virulent outbreak of the avian influenza on Monday.The ministry said inspectors will visit bird sanctuaries and rookeries where migratory birds gather in large numbers and conduct regular visits to bird farms across the country. Large poultry farms and vehicles used to move birds must be decontaminated on a regular basis.

Past outbreaks in the country have been associated with migratory birds that transmit the disease to domestic birds. Authorities said that if an outbreak takes place, all actions will be taken to prevent the disease from spreading.

The country has been hit three times with avian influenza, with the latest outbreak occurring in April and resulting in a record 8.46 million birds being culled at the cost of around 264 billion won (US$195 million).
The previous outbreaks took place in the winter months of 2003-2004 and 2006-2007.
No cases of human infection were reported in the latest outbreak, although the government said 10 South Koreans were infected in the two previous outbreaks without developing any symptoms.
Worldwide, 245 human deaths have been reported in 48 countries.

Vaccines

Cuba working on bird-flu vaccine

11/11/08 EFE, contributed by email--Cuba will present its first results in its effort to obtain a vaccine against bird flu during the Nov. 30-Dec. 5 Biotecnologia Habana 2008 conference, the Genetic Engineering and Biotechnology Center, or CGIB, announced here Tuesday. The head of the CGIB's Animal Biotechnology division, Mario Pablo Estrada, said at a press conference that his agency was working "to achieve an effective vaccine against bird flu." The scientist said that "at this time they're performing some tests at the laboratory level on birds" with the two experimental vaccines the communist island has in hand.

He explained that the current phase of the experiments constitutes the initial steps toward showing that this preliminary vaccine "can produce an interesting response in the immune system of birds," and therefore what will be presented at the conference are the "first results" in obtaining a vaccine.

In addition, Cuba will take to the congress new experimental vaccines to control ticks in dogs and hemorrhagic fever in rabbits, as well as "very convincing results" of a new product against classic swine fever, Estrada added.

CIGB researchers are working to eradicate the latter disease, which is considered "the most important" of those affecting the Cuban hog population, and at the end of November they will begin a massive trial of the new product on local farms.

Among its already patented products, the CIGB will also present the results obtained around the country with the use of Gavac, a vaccine against sheep ticks that currently is being marketed in countries like Mexico, Colombia, Venezuela and Brazil and which is saving the island $9 million per year on tick-killing products.

Government sources have said that Cuba's income from pharmaceutical sales during 2007 amounted to $350 million.

Regional Reporting and Surveillance

Syria: Launch of Avian Influenza Preparedness Project

11/19/08 ARGUS--A local source reported that the Ministry of Agriculture and Land Reform, in cooperation with the Food and Agriculture Organization?s (FAO) Regional Animal Health Center (RAHC) for the Middle East, has launched an Avian Influenza Preparedness project in Syria. The director of RAHC indicated that the implementation of the preparedness project in Syria is part of the initiative for implementing 9 projects in different countries of the region. He affirmed the FAO?s keenness to control the disease and prevention of its spread across continents. He also expressed the FAO?s willingness to provide, through special mechanisms, everything that would enable eradication of the disease.

Article URL(s)
http://alwatan.sy/newsd.php?idn=45806

Regional Reporting and Surveillance

Nigerian Government Compensates Farmers for AI-Related Poultry Losses

October 2008 This Day--(article was originally published early November when AI Digest was offline)--A national source reported that the Nigerian Federal government and the World Bank provided N630.9 million [US$5,354,264] to 3,037 farmers as
compensation between February 2006 and 31 October this year for avian influenza (AI) related losses. According to an official [charged with the control of AI], 1,264,191 birds were depopulated in 97 local
government areas across 26 states, and the latest WHO report on human H5N1 cases states there has been one confirmed AI-related death in Nigeria since 2003.

AI Research

Modeling Drug Resistant Influenza

11/25/08 Clinicians Biosecurity Network (republished with proper attribution)

By Amesh A. Adalja, M.D., November 21, 2008

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.

Avian/Pandemic Influenza Daily Digest

Nov 26, 2008

DNI Avian Influenza Daily Digest

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Avian Influenza Daily Digest

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Quid Novi

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