Friday, May 12, 2006

Who update Avian Flu in Africa


Avian influenza – situation in Djibouti

12 May 2006


The Ministry of Health in Djibouti has confirmed the country’s first case of human infection with the H5N1 avian influenza virus. The patient is 2-year-old girl from a small rural village near the border with Somalia. She developed symptoms on 23 April. She is presently in a stable condition with persistent symptoms.

Three tests conducted on 10 May by the Cairo-based US Naval Medical Research Unit 3 (NAMRU-3) confirmed the child’s infection with the H5N1 virus. She is the first case of human infection reported in the Horn of Africa.

Three of the child’s siblings are under investigation for possible infection and are also receiving care. Samples have been taken and are being sent to NAMRU-3 for testing.

Health authorities in Djibouti initiated surveillance for human cases following reports of a small number of chicken deaths in early April. NAMRU-3 has also confirmed the presence of H5N1 virus in samples from three birds.

Surveillance for additional human and animal cases is presently under way, but is hindered by the country’s lack of resources and of epidemiological and laboratory capacities. The search for human cases has been further complicated by a concurrent outbreak of dengue fever, which can mask the occurrence of other febrile illnesses with abrupt onset of symptoms, including H5N1 infection.

The situation in animals is poorly understood. Most of the country’s population is concentrated in the Djibouti district, where many households keep small numbers of poultry. Poultry production in other parts of the country is virtually non-existent. High mortality in poultry flocks has not been detected to date.

At the request of the Ministry of Health, WHO is arranging urgent support for the country’s investigation and response to the outbreak.

Thursday, May 11, 2006

Interesting story from New York Times Today


May 11, 2006
Migrating Birds Didn't Carry Flu
By ELISABETH ROSENTHAL

ROME, May 10 — Defying the dire predictions of health officials, the flocks of migratory birds that flew south to Africa last fall, then back over Europe in recent weeks did not carry the deadly bird flu virus or spread it during their annual journey, scientists have concluded.

International health officials had feared that the disease was likely to spread to Africa during the southward migration and return to Europe with a vengeance during the reverse migration this spring. That has not happened — a significant finding for Europe, because it is far easier to monitor a virus that exists domestically on farms but not in the wild. "It is quiet now in terms of cases, which is contrary to what many people had expected," said Ward Hagemeijer, a bird flu specialist with Wetlands International, an environmental group based in the Netherlands that studies migratory birds.

In thousands of samples collected in Africa this winter, the bird flu virus, A(H5N1), was not detected in a single wild bird, health officials and scientists said. In Europe, only a few cases have been detected in wild birds since April 1, at the height of the migration north.

The number of cases in Europe has fallen off so steeply compared with February, when dozens of new cases were found daily, that specialists contend that the northward spring migration played no role. The flu was found in one grebe in Denmark on April 28 — the last case discovered — and a falcon in Germany and a few swans in France, said the World Organization for Animal Health, based in Paris.

In response to the good news, agriculture officials in many European countries are lifting restrictions intended to protect valuable poultry from infected wild birds.

Last week, the Netherlands and Switzerland rescinded mandates that poultry be kept indoors. Austria has loosened similar regulations, and France is considering doing so. The cases in Europe in February were attributed to infected wild birds that traveled west to avoid severe cold in Russia and Central Asia but apparently never carried the virus to Africa. The international scientists who had issued the earlier warnings are perplexed, unsure if their precautions — like intensive surveillance and eliminating contact between poultry and wild birds — helped defuse a time bomb or if nature simply granted a reprieve.

"Is it like Y2K, where also nothing happened?" asked Juan Lubroth, a senior veterinary official at the United Nations Food and Agriculture Organization in Rome, referring to the expected computer failures that did not materialize as 1999 turned to 2000. "Perhaps it is because it was not as bad as we feared, or perhaps it is because people took the right measures."

Still, he and others say, the lack of wild bird cases in Europe only underscores how little is understood about the virus. And scientists warn that it could return to Europe.

"Maybe we will be lucky and this virus will just die out in the wild," Mr. Lubroth said. "But maybe it will come back strong next year. We just don't have the answers."

The feared A(H5N1) bird flu virus does not now spread among humans, although scientists are worried it may acquire that ability through natural processes, setting off a worldwide pandemic. The less bird flu is present in nature and domestically on farms, the less likely it is for such an evolution to occur, they say.

Worldwide, bird flu has killed about 200 humans, almost all of whom were in extremely close contact with sick birds.

Specialists from Wetlands International, who were deputized by the Food and Agriculture Organization, sampled 7,500 African wild birds last winter in a search for the disease. They found no A(H5N1), Mr. Hagemeijer said, so it is not surprising that it did not return to Europe with the spring migration.

While bird flu has become a huge problem in poultry on farms in a few African countries, including Egypt, Nigeria and Sudan, specialists increasingly suspect that it was introduced in those countries through imported infected poultry and poultry products. Mr. Hagemeijer said the strength of the virus among wild birds possibly weakened as the southward migration season progressed, a trait he said was common in less dangerous bird flu viruses. That probably limited its spread in Africa, he said.

A(H5N1) is the most deadly of a large family of bird flu viruses, most of which produce only minor illness in birds.

Many bird flu viruses are picked up by migratory birds in their nesting places in northern lakes during the summer and fall breeding season. As the months pass, the viruses show a decreasing pattern of spread and contamination.

"So it tends to be mostly a north-to-south spread, and then it wanes," Mr. Hagemeijer said.

Still, this means that the cycle could start again this summer, if the virus — which can live for long periods in water — has persisted in those breeding areas. Many bird specialists contend that a small number of wetland lakes in Central Asia and Russia may harbor the virus all the time, serving as the origin of European and Central Asian infections.

Scientists still do not know which birds carry the virus silently and which die from it quickly, or how it typically spreads from wild bird to wild bird, or between wild birds and poultry.

Farm-based outbreaks of bird flu still occur constantly in a number of countries, although not in Europe. Ivory Coast had its first outbreak of bird flu, on a farm, last week.

But other countries, like Turkey, have made substantial progress in containing the disease among poultry, Mr. Lubroth said. He added that he hoped that quick measures to limit outbreaks had reduced the virus's spread in Africa.

After the virus was found on farms in Nigeria in January, many specialists expected it to spread rapidly among farms and into wild birds in the region. Apparently, it did not.

"Why didn't it sweep up the coast from Niger, to Benin and Senegal and back up through Europe? Why didn't it hit Africa's big lakes?" Mr. Lubroth asked.

"All we have are a few snapshots of the virus. What we need is a movie of its life cycle."

Tuesday, May 09, 2006

News update for avian flu



Archive Number 20060509.1338
Published Date 09-MAY-2006
Subject PRO/AH> Avian influenza, human - worldwide (61): GI trans.

AVIAN INFLUENZA, HUMAN - WORLDWIDE (61): GASTROINTESTINAL TRANSMISSION
**********************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Tue 9 May 2006
From: Mary Marshall
Source: Blomberg.com, Tue 9 May 2006 [edited]



Avian influenza may be capable of invading people through the gut,
not just the respiratory system, and diarrhea is sometimes the first
symptom, said virologist Menno de Jong, whose team observed 18 cases
in Viet Nam.

Particles of the lethal H5N1 virus contained in the meat and blood of
infected poultry may have been ingested by some patients, possibly
causing their infection, said De Jong, who is head of the Virology
Department at the Oxford University Clinical Research Unit in Ho Chi
Minh City. "In a number of patients the only exposure risk has been
drinking raw duck blood," De Jong said in a phone interview
yesterday. "That could imply that the gastrointestinal tract is also
a route of transmission or a route of first infection, and there are
experiments in animals" that suggest this.

Scientists are studying H5N1 patients to improve their understanding
and treatment of the virus, which has the potential to mutate into a
pandemic form that may kill millions of people. If live virus
particles are carried outside the lungs and surrounding tissues to
other parts of the body, some antiviral treatments such as inhaled
zanamivir, marketed by GlaxoSmithKline Plc as Relenza, may not be
effective treatments, De Jong said.

The infection rate in humans is increasing after more than 30
countries across three continents reported initial outbreaks in birds
so far in 2006. H5N1 has killed at least 115 of the 207 people known
to have been infected since late 2003, according to the World Health
Organization. [A complete breakdown of the figures of
laboratory-confirmed human cases of avian influenza by country and
year since 2003 up to 8 May 2006 is available at
.
- Mod.CP]

This year, 39 fatalities have been reported, almost as many as the 41
deaths recorded in the whole of 2005. Viet Nam accounts for 93 cases
and 42 deaths [since 2003 - Mod.CP]. Nonetheless, the Southeast Asian
nation hasn't reported any new infections in [the last] 6 months. In
almost all human H5N1 cases, infection was caused by close contact
with sick or dead birds, such as children playing with them, or
adults butchering them or taking off the feathers, according to the
Geneva-based WHO. Proper cooking of meat and eggs kills the virus.

In uncomplicated cases of seasonal influenza, disease is limited to
infection in the nose, throat and lungs. In contrast, H5N1 was
observed to have caused encephalitis, or swelling of the brain, in
one patient in Viet Nam, De Jong said. Virus particles collected from
numerous sites could be cultured, including from the throat, rectum,
blood and cerebralspinal fluid, he said. De Jong said it is possible
H5N1 may be replicating in the gastrointestinal tract after the virus
was cultured from a rectal swab in a patient who had diarrhea. For
some patients, the gastrointestinal tract may have been the initial
site of infection, possibly after the consumption of raw chicken or
raw duck products, he said.

Some scientists said survival of flu particles in the gut would be
difficult because of enzymes and bile that break down fats in the
process of food digestion. Flu particles are enveloped by a layer of
lipids or fats. "It's difficult to understand how the virus could
survive passage through the stomach and intestines," said Lorena
Brown, an associate professor in the Department of Microbiology and
Immunology at the University of Melbourne. The acid environment of
the stomach would denature protein-based components of the virus, she
said.

The systemic nature of illness caused by H5N1 poses challenges for
treating infected patients because, if the virus is spreading through
the blood, so too must drugs that aim to combat the infection. Roche
Holding AG's Tamiflu and GlaxoSmithKline's Relenza have shown signs
of fighting H5N1. Some studies have shown the virus binds
preferentially to human cells in the lower respiratory tract, whereas
the highest concentration of orally inhaled Relenza is found in the
upper respiratory tract.

"With the current data and with the current case reports, we should
assume that you should seek systemic coverage with drugs," De Jong
said. "I think, for instance, that the current formulation of
zanamivir isn't going to be of any use in the current avian flu. If a
pandemic strain evolves, we have to reconsider it because we won't
know if the change in the virus will also have changed the illness."

GlaxoSmithKline, Europe's biggest drugmaker, is developing an
intravenous form of Relenza, Nancy Pekarek, a U.S. spokeswoman for
the London-based company, said yesterday. Scientists are still
formulating the compound, and testing in people hasn't started, she
said.

--
Mary Marshall


[While it is reasonable to suggest that human infection has been
associated with a gastrointestinal route of infection in Viet Nam
because of the practice of consuming raw duck blood, it is a less
satisfactory explanation for the variable mortalities recorded
elsewhere. As of 8 May 2006, the percentage mortalities observed in
all 8 countries recording human cases of avian influenza is as
follows: Azerbaijan 63 percent (8 cases and 5 deaths); Cambodia 100
percent (6 / 6); China 67 percent (18 / 12); Egypt 39 percent (13 /
5); Indonesia 76 percent (33 / 25); Iraq 100 percent (2 / 2);
Thailand 64 percent (22 / 14); Turkey 33 percent (12 / 4); and Viet
Nam 45 percent (93 / 42 deaths); giving an overall mortality of 56
percent (207 cases, 115 deaths). - Mod.CP]

Brief notes on ABC Movie on avian flu pandemic


I am not a big fan of television in general. Normally I would rather read than watch TV. However, since this movie tonight on ABC Fatal Outbreak (I think it was called) is about a subject I am slightly obsessed with, I tuned in at 8PM to watch. I really tried to watch it too, but I only made it to nine pm. Then I started channel flipping and decided that House was better viewing material for me.

Hopefully the program will encourage people to learn the facts. I don't believe that many will take it too seriously. I missed the last hour so perhaps it became better acted and the plotline improved. See below for the government response to the show from PandemicFlu.gov.

From PandemicFlu.gov


ABC TV Movie: Fatal Contact: Bird Flu in America

On Tuesday, May 9 at 8 p.m., the ABC television network will air a made-for-TV movie titled "Fatal Contact: Bird Flu in America." The movie follows an outbreak of the H5N1 avian flu virus from its origins in a Hong Kong market through its mutation into a pandemic virus that becomes easily transmittable from human to human and spreads rapidly around the world.

The Department of Health and Human Services has prepared a Viewer's Guide and some anticipated Questions and Answers to provide factual information for viewers of the movie.


The ABC Movie "Fatal Contact: Bird Flu in America" is a movie, not a documentary. It is a work of fiction designed to entertain and not a factual accounting of a real world event.

There is no influenza pandemic in the world at this time.

Also, it is important to remember that H5N1 avian influenza is almost exclusively a disease of birds. The H5N1 virus has not yet appeared in the U.S.

Should the H5N1 virus appear in the U.S., it does not mean the start of a pandemic.

An additional point to remember is that the next influenza pandemic could be substantially less severe than what the movie depicts or that occurred in 1918. For example, the influenza pandemics of 1957/58 and 1968/69 caused so much less illness and death than did the 1918/19 pandemic that many Americans at that time did not distinguish them from seasonal influenza and were unaware that a pandemic was underway.

While the movie does serve to raise awareness about avian and pandemic flu, we hope it will inspire preparation - not panic. There are steps individuals, families and communities can take to prepare. You can keep a supply of food and medicines on hand in case you have to stay home, you can practice good public health measures like frequent hand washing and staying home when sick. There is good information available on www.pandemicflu.gov.

The film does depict scenarios that could unfold should a severe pandemic ever develop, including limited availability of antivirals and vaccines as well as the potential for disruption of supplies, medicines and other essential services.

The film also illustrates the expected months-long delay in developing an effective vaccine against a pandemic strain of influenza once it emerges. This is why, at the President's request, the Congress approved funding for the Department of Health and Human Services to make significant financial investments to improve the technology for vaccine development and to build up our domestic vaccine production capacity, to ensure more rapid availability of vaccine for the population in a pandemic.

The film highlights an important aspect of planning - individual and community planning and cooperation that will be so vital to sustaining communities and neighborhoods during an extended wave of an influenza pandemic. HHS has developed an extensive set of planning documents, including planning checklists for businesses, schools, health care providers, community organizations and states as well as an individual and family planning guide. All of these materials are available at www.pandemicflu.gov.

While the H5N1 virus has not yet appeared in the U.S., and there is no influenza pandemic in the world at this time, it is important for all Americans to be informed about this potential public health threat and some of the steps individual Americans can take to protect themselves and their families in the event of a pandemic.

Monday, May 08, 2006

WHO Avian Flu Update: Indonesia



Avian influenza – situation in Indonesia – update 11

8 May 2006

The Ministry of Health in Indonesia has confirmed the country’s 33rd case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 30-year-old man from Greater Jakarta. He developed symptoms on 17 April, was hospitalized on 21 April, and died on 26 April.

An investigation to determine the source of his infection is continuing. He lived in close proximity to pens where animals, including poultry, were kept.

Of the 33 laboratory-confirmed cases in Indonesia, 25 have been fatal.