Update Indonesian and Europe

In this update:
[1] Indonesia - Nurse no longer a suspected case
[2] ECDC Revised Risk Assessment

From Pro-Med:

Indonesia: Suspected Avian Influenza infected Nurse Tests Negative
-----------------------------------------------
Local tests have come back negative for an Indonesian nurse who fell
ill after treating 2 siblings infected with avian influenza amid a
surge in deaths from the virus. "Thank God, the result came back
negative," Hariadi Wibisono, a senior Health Ministry official said
on Sun 4 Jun 2006. He said specimens would be sent to a World Health
Organization-approved laboratory in Hong Kong for confirmation.

The 25-year-old nurse was isolated and given the antiviral drug
Tamiflu when she developed a fever and other flu-like symptoms. She
fell ill about 10 days after treating a 10-year-old girl and her
18-year-old brother from West Java province, who died hours apart
last month of bird flu. She is improving and will likely be released
this week after finishing the full course of Tamiflu, said Dr. Hadi
Jusuf of Hasan Sadikin Hospital in Bandung, where the nurse is being
treated. The nurse's case initially raised concerns that the H5N1
virus may have passed to her from the siblings, but Wibisono said it
now appears that she was instead suffering from a seasonal flu.

On Friday [2 Jun 2006], health officials said local tests found a
7-year-old girl from the outskirts of Jakarta had died from the
virus. Specimens have been sent to the WHO laboratory for
confirmation. The girl's 10-year-old brother died 3 days earlier with
similar symptoms, but no samples were taken before he was buried.

Last month [May 2006], 6 members of a family also died of bird flu,
and a 7th fell ill in the largest family cluster reported since the
virus began ripping through Asian poultry stocks in late 2003. An 8th
member of the family in the farming village of Kubu Simbelang in
North Sumatra province was buried before samples were collected, but
WHO considers her part of the cluster of cases. Experts have not
found any link between the relatives and infected birds, which has
led them to suspect human-to-human transmission. But no one outside
the group of blood relatives has fallen ill, and experts say the
virus has not mutated.

--
Joseph P. Dudley, Ph.D.
Chief Scientist,
Biosecurity and Bioinformatics
EAI Corporation
4301 North Fairfax Drive
Suite 200
Arlington, VA 22203
<jdudley@eaicorp.com>

[The failure to confirm avian influenza in this healthcare worker
reinforces the belief that so far "clusters" of cases of human
infections have been restricted to blood relatives. Readers are
referred to the ECDC Risk Assessment document described below for
more detailed discussion. - Mod.CP]

******
[2] ECDC Revised Risk Assessment
Date: Mon 5 Jun 2006
From: Angus Nicoll <angus.nicoll@ecdc.eu.int>
Source: Press release, European Centre for Disease Prevention and
Control (ECDC), 1 Jun 2006 [edited]
<http://www.ecdc.eu.int>


Revised ECDC Risk Assessment
-------------------------------------
[The attention of ProMED-mail readers is drawn to the Technical
Report entitled ECDC Risk Assessment, which has been recently
revised. The ECDC Technical Report is a 31-page document that can be
accessed at
<http://www.ecdc.eu.int>.
The ECDC risk Assessment provides a balanced and detailed account of
current understanding of the HPAI avian influenza outbreak in animals
and humans. The following summary intimates the release of a revision
of this document. - Mod.CP]

A revised risk assessment published today [1 Jun 2006] by the
European Centre for Disease Prevention and Control (ECDC) highlights
the need for governments to intensify preparations against a possible
influenza pandemic. While the assessment concludes that "bird flu,"
in its present form, presents only a low risk to humans, it expresses
concern about the spread of H5N1 among birds in Asia and Africa.
Developments in recent months mean that more humans than ever are
being exposed to the virus, increasing the possibilities for the
virus to adapt or mutate into a human pandemic virus.

Zsuzsanna Jakab, Director of ECDC has declared that: "The spread of
H5N1 across Africa and Asia means more people than ever are now being
exposed to it. We do not know for sure whether "bird flu" is going to
mutate into a human pandemic virus. However, we are getting nearer to
finding out. This underlines the need for Europe to move ahead with
its preparedness against a pandemic."

In May 2006, the ECDC, the European Commission and WHO Europe held a
meeting with senior public health officials from across Europe to
discuss preparedness against a possible influenza pandemic (see ECDC
press release of 17 May 2006). Today's risk assessment from ECDC
underlines the importance of reinforcing and accelerating Europe's
preparedness drive.

Details of risk assessment
--------------------------
ECDC's new risk assessment points out that, because of its occasional
presence in wild birds, Europeans may have to adapt to the fact that
H5N1 will remain one of the zoonoses (animal diseases capable of
passing to humans) present on our continent. It finds no evidence
that H5N1 has become any better adapted to humans than it was in
1997, when the virus 1st emerged. The few humans who become infected
do so only when exposed to high doses of the virus.

People who keep poultry near where they live need to be aware of the
risk from H5N1 and how to protect themselves. In addition, some
precautions need to be taken to protect people such as vets and
poultry farm workers. However, the overall level of risk to the
public in Europe from "bird flu" in its current form is lower than
for many other infections that can pass from animals to humans, for
example, salmonella, campylobacter and the zoonotic strains of
_Escherichia coli_ (EHEC). As of yet, there have been no human cases
of H5N1 in the European Union, compared with thousands of infections
each year from other zoonoses.

The major cause for concern about H5N1 "bird flu" is its potential to
mutate or adapt into a human pandemic virus. There is no way of
knowing whether or when this might happen. However, the increased
exposure of humans to H5N1 resulting from its spread across Africa
and Asia multiplies the opportunities for it to adapt or mutate, if
it has that capability.

This increased exposure raises the importance of preparing for a
pandemic. Even if a pandemic caused by "bird flu" never occurs, the
same preparations will protect against other pandemics. Three
influenza pandemics occurred in the 20th century: in 1918-1920, in
1957 and 1968. It is highly likely that another pandemic will occur
at some point in the coming years.

The full text of the revised risk assessment can be found at:
<http://www.ecdc.eu.int>.

--
Prof Angus Nicoll CBE
Influenza Coordination
European Centre for Disease Prevention and Control (ECDC)
Stockholm, SWEDEN