States plan for pandemic flu

States rush, but some lag on bird flu

Saturday, July 08, 2006

By Kevin Freking, The Associated Press
WASHINGTON -- South Carolina is in. Utah and Alabama, too. Some states aren't waiting for an Aug. 1 deadline to seek help from the federal government in buying anti-bird-flu medicine for a possible pandemic. "We figure it is certainly better to do it, and move forward with the purchase and hope we never have to use it, than not and wish that we had," said Jim Beasley, spokesman for South Carolina's Department of Health and Environmental Control. As part of its pandemic preparations, the federal government is stockpiling Tamiflu and other anti-flu medications, which can reduce the symptoms associated with influenza. The Bush administration plans to buy enough to treat 44 million people. States can buy more if they want. The government is negotiating a price with Roche Laboratories, Inc., which makes Tamiflu, and will pay a quarter of the costs, up to a prescribed amount for each state. In all, states could use the subsidy to buy anti-flu medications for an additional 31 million people. The Department of Health and Human Services had initially set a July 1 deadline for states to indicate whether they would move forward with the purchase, but some states wanted more time, spokesman Bill Hall said. So the deadline was delayed until Aug. 1. Mr. Hall stressed that the deadline does not obligate states to a specific course of action. Rather, it serves as guidance to his department for its planning. Montana and Arizona want only a little extra help. Meanwhile, states such as Washington say they plan to take full advantage of the next few weeks to determine the right amount of drugs to purchase."There's a lot to sort out with antivirals," said Tim Church, spokesman for the Washington state Department of Health. "It's not a black-and-white decision." Oklahoma lawmakers this spring allocated $500,000 to buy anti-flu medications. That's enough to pay for enough medicine to treat about 35,000 of the state's 3.5 million people. But that's about 7 percent of the amount Health and Human Services estimates that the state could purchase through the federal subsidy."We're struggling with how much do we need," said the state's epidemiologist, Dr. Brett Cauthen. "How much insurance do you need? Nobody knows what the best number is." New Jersey has told the federal department that it wants enough to treat about 900,000 people. "We are authorized to buy as much as we can get by the governor," said Dr. Fred Jacobs, New Jersey's health commissioner. The amount Pennsylvania, with a population of 12.4 million, is planning to buy was unavailable yesterday, but the Health and Human Services Department shows it is eligible for a federal subsidy for 1,298,844 courses. Dr. William Schaffner, an infectious disease specialist at Vanderbilt University's medical school in Nashville, Tenn., recommends that states have some anti-flu medication stockpiled in case of a pandemic. But he said there's no right answer regarding just how much the states should have on hand. "These are all insurance policies we're buying," Dr. Schaffner said. How much insurance a state wants has to be weighed against other pressing matters, such as funding better education or roads, he said. Copyright 2006 Associated Press.

Pandemic flu: not if but when

Flu pandemic 'is inevitable'

EUROPEAN Union experts yesterday said a global influenza pandemic that could kill millions remains inevitable, although the immediate threat to human health from bird flu in Europe remained low.

"It's when and not if," Robert Madelin, director-general of the EU's health and consumer protection department, said in Brussels.

He cited scientists' predictions suggesting a pandemic could kill two million to seven million people worldwide, ten times the death rate from regular flu.

Thailand vigilant

PM calls for constant vigilance on bird flu

Prime Minister Thaksin Shinawatra Saturday urged concerned officials to step up vigilance against the deadly bird flu disease, especially now that the country is more impacted by the rainy season.

Speaking during his weekly radio program, Mr. Thaksin said the country had been free of avian influenza for more than 290 days due to good cooperation between the public and private sectors.

Denying rumors of a recent outbreak of a new round of the disease which had killed many chickens and birds, Mr. Thaksin said they died from an infection called "Newcastle disease" and not bird flu.

Despite a long absence of the disease, officials must keep a close watch especially in areas that were affected before, he added. (TNA)

Isolated case of avian flu in Spain?

Spanish Authorities Say Bird Flu Case Is Isolated One
Main Category: Bird Flu / Avian Flu News
Article Date: 08 Jul 2006 - 11:00am (PDT)


Agricultural authorities in Avala, Spain, say the H5N1 infected Great Crested Grebe is an isolated case and that people should not panic. They stressed it is just a ‘veterinary problem' and not one people should be unduly concerned about.

The Spanish Ministry of Agriculture has implemented a 3 kilometre no poultry or bird hunting zone around the area where the dead bird was found. Heightened monitoring is also taking place within a ten mile radius of the area.

The bird was found nine days ago and no other infected cases have been identified - this is after extensive monitoring and testing of many samples, say authorities.

About the Great Crested Grebe

Called Podiceps Cristatus in Latin, the Great Crested Grebe is a water bird, a member of the grebe family. It is commonly found in marshes and freshwater lake areas throughout Europe and many parts of Asia. Where winters are more severe it will migrate, otherwise it is a resident bird.

Like all grebes, it has a formidable mating display. The bird nests on the banks of lakes or rivers. This is because it is not a good walker and needs to be near water. It is not uncommon to see the striped young being carried on the mother's or father's back. Two eggs are usually laid each season.

It has a wing span of about 60cm-70cm and is about 50cm long. It hunts for fish and other aquatic creatures and will often pursue its prey underwater.

The Great Crested Grebe is white in the winter and has beautiful head and neck decorations in the summer. It has a pink bill.

In the UK it was hunted for its head plumes in the 19th century and nearly became extinct as a result. The near-extinction of the Great Crested Grebe in the UK brought about the creation of the Royal Society for the Protection of Birds (RSPB).

It is of great concern to the RSPB and other bird protection organisations throughout the world that measures taken to protect humans from bird flu are thoughtfully balanced so that the well-being of wild and domestic birds are taken into account.

Written by: Christian Nordqvist
Editor: Medical News Today

AlaskaNews wire on stockpiling for pandemic flu

Alaska puts in early order for bird flu medicines

By MARY PEMBERTON, Associated Press Writer

Published: July 6, 2006
Last Modified: July 6, 2006 at 05:00 PM

ANCHORAGE, Alaska (AP) - Alaska is taking an aggressive stance against a possible outbreak of deadly human bird flu by placing its order early for medicines intended to slow the spread of a pandemic.

State officials will eventually order enough antiviral doses to cover about a fourth of Alaska residents. Officials are being bold since the state is a crossroads for migratory birds, which could be carrying the virus here from other parts of the world.

Currently, there is no vaccine to protect humans from H5N1 avian influenza - the deadly form of bird flu. If there is an outbreak, the government is relying on antivirals such as Tamiflu and Relenza to help slow its spread.

The virus, which commonly affects birds but has gone from birds to humans in a number of countries, has killed at least 130 people worldwide since it began showing up in Asian poultry stocks in late 2003. While it is now difficult for humans to catch, the fear is that bird flu could mutate into a form that could pass easily from human to human, sparking a human pandemic.

The U.S. Department of Health and Human Services is allocating antivirals - Tamiflu and Relenza, a flu drug that can be inhaled - based on each state's population.

The federal government is stockpiling enough antivirals this year to treat 20 million people. It plans to order another 24 million treatment courses for fiscal year 2007. An additional 31 million treatment courses will be available for states to purchase, according to the federal Department of Health and Human Services.

Alaska, with a population of about 650,000, is slated initially to get enough antivirals to treat 43,913 people. Another 52,695 treatment courses will be made available in fiscal year 2007. The federal government has made another 68,065 treatment courses available for Alaska to purchase. The total number of treatment courses available to Alaska is 164,673.

The first order of antivirals are expected to be available by the end of next March at the earliest. The state expects to place its order this week, Dr. Richard Mandsager, director of the state Division of Public Health, said Wednesday.

State health officials want to make sure, given the state's remoteness, that it has as much medicine on hand as possible if there is an outbreak. Antivirals should be given in about the first 12 hours to make a real difference, Mandsager said.

Alaska plans to take advantage of the option to buy some doses with a 25 percent federal subsidy so that one-quarter of the state's population would be provided with antivirals if there was an outbreak, Mandsager said.

"We plan to purchase the whole allotment," he said.

Mandsager said the initial purchase request will be for 80 percent Tamiflu and 20 percent Relenza.

"We are the only state that is placing an order right now in the Northwest," he said.

If there was a pandemic this fiscal year in Alaska, the state clearly would be short, Mandsager said. Next year looks better, he said.

"If we get to 2007, we will be on our road of having a reasonable supply," Mandsager said.

The state already has $552,000 to buy the drugs. The legislature will have to approve another $600,000 to buy the full allotment. Mandsager said he expected lawmakers to go along with the request.

The state has a small stash of 500 treatment courses in an Anchorage warehouse.

State health officials this summer will come up with a map for quickly distributing the drugs if there is an outbreak. The plan calls for moving some of the antivirals from Anchorage to cities and towns such as Bethel, Nome and Kotzebue, and eventually out to the villages.

"It won't do any good to have the medicine if we don't have a distribution plan to go," Mandsager said.

The virus has led to the death or slaughter of millions of birds in Asia, Europe and Africa.

Plans call for testing some 19,000 mostly live, wild and migratory birds in Alaska this year for bird flu. That's out of 75,000 to 100,000 birds the federal government hopes to test nationwide.

As of the end of June, about 5,000 samples had been taken from Alaska birds. The samples are being tested at various labs, said Lynda Giguere, spokeswoman for the Alaska Department of Environmental Conservation.

"We have not found the high-pathogen avian influenza virus, which is the H5N1 virus. We have not found any," Giguere said.

Given Alaska's low number of domestic birds compared to some other states, it is more likely that bird flu will show up elsewhere, Mandsager said, adding that only one case involving human deaths may have come from wild birds. But he said that doesn't let Alaska off the hook, particularly if already there was an outbreak in another state.

"The likelihood is that the federal supply will be used up and we better have some in-state," he said.

pandemic awareness

Planning for Avian Influenza
John G. Bartlett, MD

18 July 2006 | Volume 145 Issue 2

Avian influenza, or influenza A (H5N1), has 3 of the 4 properties necessary to cause a serious pandemic: It can infect people, nearly all people are immunologically naive, and it is highly lethal. The Achilles heel of the virus is the lack of sustained human–human transmission. Fortunately, among the 124 cases reported through 30 May 2006, nearly all were acquired by direct contact with poultry. Unfortunately, the capability for efficient human–human transmission requires only a single mutation by a virus that is notoriously genetically unstable, hence the need for a new vaccine each year for seasonal influenza. Influenza A (H5N1) is being compared to another avian strain, the agent of the "Spanish flu" of 1918–1919, which traversed the world in 3 months and caused an estimated 50 million deaths. The question is if we are ready for this type of pandemic, and the answer is probably no. The main problems are the lack of an effective vaccine, very poor surge capacity, a health care system that could not accommodate even a modest pandemic, and erratic regional planning. It's time to get ready, and in the process be ready for bioterrorism, natural disasters, and epidemics of other infectious diseases.

In May 1997, a child in Hong Kong died of influenza. The case, in retrospect, seems to have been the first known human infection with influenza A (H5N1), or avian influenza. After 18 cases and 6 deaths in Hong Kong, this virus appeared to be controlled and possibly eradicated by the end of 1997. But it returned in 2003, and it has subsequently continued to evolve and spread. By May 2006, this virus had caused the deaths, from culling or infection, of more than 140 million domesticated birds in 153 countries and infections in 218 patients, with 124 deaths—a mortality rate possibly as high as 55% (1). The poultry infections extended from Asia to Africa, the Near East, Europe, and Eurasia; the human infections have been primarily in Asia but also in Turkey, Egypt, Iraq, and Azerbaijan.

Influenza experts have consistently warned that pandemic influenza is inevitable and historically has occurred at intervals of 11 to 42 years. The worst pandemic in recorded medical history was Spanish flu (H1N1) in 1918 and 1919. The last pandemic was Hong Kong flu (H3N2) 37 years ago in 1968 and 1969. The question now is whether avian influenza will be that next pandemic. The missing link to pandemic spread is lack of sustained person-to-person transmission. The H5N1 influenza virus could acquire property by mutational adaptation of the avian strain, as with the Spanish influenza, or by reassortment through dual infection with human and avian strains as occurred in 1957 (Asian influenza) and 1968 (Hong Kong influenza) (2). Analysis of H5N1 shows that it is avian, and nearly all cases have resulted from direct contact with poultry; human-to-human transmission has been reported but is rare. Those who are skeptical about an H5N1 pandemic point out that genetic changes to facilitate efficient person-to-person transmission are unlikely to occur by either mechanism, since the virus has not acquired this property during 10 years of existence. If they are right, H5N1 will remain primarily an avian pathogen that sporadically causes disease in people, with most cases occurring in those who have close contact with sick poultry.

Should we base our planning on this optimistic scenario? The problem for planners is that a pandemic like that of 1918 has unimaginable consequences, and yet we can't calculate its probability. Most people feel that we should plan for the worst. Complacency is not acceptable. Furthermore, if H5N1 proves to have a limited impact, the planning will improve our preparedness for a future pandemic influenza strain or even another public health disaster, such as SARS (severe acute respiratory syndrome), smallpox, or anthrax.

The experience with the 1918 pandemic influenza is the basis for planning for pandemic avian influenza. The rationale for this strategy is the clinical and virologic similarities between the 2 strains. The 1918 strain traversed the globe in 3 waves and caused an estimated 50 million deaths, including 675 000 in the United States. An unusual feature of the infection was the high mortality rate in healthy persons 15 to 35 years of age (1, 2). By contrast, the annual death toll in the United States for seasonal influenza is about 36 000, and most deaths occur in persons older than 85 years of age. Although some victims of the 1918 pandemic had bacterial pneumonia, most appeared to die of respiratory failure with a characteristic hemorrhagic alveolitis. Dr. Isaac Starr's graphic account of the typical 1918 case is reprinted in this issue: "As their lungs filled with rales the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth" (3). This course with respiratory failure in young adults sounds similar to the Asian cases of avian influenza, except that many of the patients with avian influenza died despite access to antibacterial agents, antiviral agents, and ventilatory support (4, 5). Despite modern intensive care, the mortality rate for avian influenza is about 20-fold higher than that for the influenza of 1918. The 1918 pandemic and avian influenza also have virologic similarities. Analysis of the reconstructed 1918 pandemic influenza strain shows unusual similarities with H5N1, including the fact that both strains have genes of avian influenza viruses (2, 6, 7).

This issue contains 2 relevant articles on this topic. The first is a summary of the policy monograph of the American College of Physicians addressing the health care response to pandemic influenza (8). The second, quoted in the preceding paragraph, was originally published in Annals by Isaac Starr and is a riveting account of his experience as a medical student at the University of Pennsylvania working as a nurse during the 1918 pandemic (3). In this editorial, I describe some of the most important issues about planning for pandemic influenza and appraise the prospects for preparedness (3, 8).

Current planning assumptions are based largely on the anticipated experience if a virus comparable to the 1918 flu strain were to cause a pandemic now. The medical consequences would include the following: 1) The attack rate in the United States would be 30%, causing 90 million cases; 2) of those infected, about 50% would seek medical care; 3) the excess mortality would be 209 000 to 1 903 000 deaths; and 4) the outbreak in a community would last about 6 to 8 weeks.


What Could Be Done To Lessen the Impact of the Disease?

Aside from agricultural intervention to reduce the number of infected birds, the 3 major weapons for controlling person-to-person spread are vaccines, antiviral agents, and social distancing. The College's plan calls for an effective pandemic influenza vaccine (Positions 6 and 7), but several important obstacles stand in the way of success. We will need a vaccine that has a good antigenic match with the epidemic strain and a substantial increase in our vaccine production capacity. The initial attempt with an H5N1 vaccine ("1203 vaccine") required two 90-µg doses to produce a serologic response in about 50% of healthy adults (9). This inoculum is 12-fold greater than the dose for seasonal influenza, which indicates the extent of the challenge to our influenza vaccine production capacity. The worldwide production capacity for this vaccine would be enough to vaccinate a total of 75 million people, which is about one fourth of the U.S. population or 1.25% of the world population (10). Furthermore, using the current H5N1 vaccine as an example, only half of vaccinated healthy persons might be protected against the target virus. Finally, the target virus has already undergone antigenic change to a new clade (10). The College's recommendations for a vaccine supply adequate for the entire U.S. population are clearly not feasible now. The good news is that vaccine producers are pursuing promising new technologies. High-priority research developments include attempts to improve the volume of production with cell cultures, to reduce inoculum size with intradermal injections and use of adjuvants, and to use live attenuated viruses to get a better antigenic response. Thus, the vaccine gap, while large, may be temporary. However, we cannot predict when we will close this gap, nor do we know when we will need a vaccine against pandemic influenza.

Prophylaxis and treatment with neuraminidase inhibitors is another strategy to control pandemic influenza. Oseltamivir and zanamivir are about 60% effective in preventing seasonal influenza, but their effectiveness for preventing pandemic influenza is unknown (11). Clinical trials of neuraminidase inhibitors to treat seasonal influenza have shown modest benefit if therapy is started within the first 48 hours of symptoms (the earlier the start, the greater the benefit). Effectiveness against pandemic influenza is essentially unknown. Oseltamivir had no clear effect on reported avian influenza cases, but the evidence was not strong enough to draw any conclusions, especially since therapy was started late and the dose and duration of the standard treatment regimen may be inadequate for a pandemic strain (5). Despite concern about oseltamivir resistance, which has occurred with both seasonal influenza and avian influenza (12), oseltamivir-resistant strains are infrequent and are generally susceptible to zanamivir. In addition, oseltamivir-resistant strains show reduced fitness for both transmission and pathogenicity in mammalian models (13). The College calls for stockpiling anti-influenza agents in sufficient quantities for 25% of the population (Position 7), although the actual amount necessary could vary substantially depending on use (prophylaxis or therapy) and the dose and duration advocated. The good news is that the drugs' shelf life is 10 years; assuming that the virus remains sensitive, this supply should be good until 2016.

Social distancing appears to be paramount but is not completely understood. A recent model—based on analysis of the 1918–1919 influenza pandemic—estimates that in the United States, one third of transmissions will occur in the household, one third in workplaces and schools, and one third in the general community (14). The largest risk is having a household member with influenza, and one of the most effective containment strategies is early antiviral treatment of the index case and confinement to the home. Therefore, an important containment strategy in an influenza pandemic would use targeted antiviral agents combined with school and business closings (14). The highest priority would be rapid institution of antiviral treatment, preferably within 1 day of symptom onset, and administration of antiviral prophylaxis to exposed persons, especially household members. The antiviral component of this strategy would be vulnerable to infection with drug-resistant strains that retain transmissibility, similar to that of wild-type virus; to date, these strains have not been detected (14).


How Can Hospitals Prepare?

The U.S. health care system is fragmented, is financially distressed, operates with "just-in-time" supplies, and has minimal surge capacity. According to the American Hospital Association, the average proportion of open beds is 4% to 6% of total bed capacity (15), which means that a pandemic will quickly overwhelm hospitals, intensive care units, and emergency departments. A review of hospital preparedness for pandemic influenza by Dr. Thomas Inglesby of the University of Pittsburgh Medical Center for Biosecurity indicated that at its peak, an epidemic comparable to that of 1918 would require 197% of hospital beds, 461% of intensive care unit beds, and 198% of all available respirators (16, 17). The gap between our need for surge capacity in urban areas and our current resources is staggering. Planning to close the gap should occur at the regional level by local providers and public health authorities. The College endorses this strategy (Positions 1 and 8), and it is included in the U.S. Department of Health and Human Services's Pandemic Influenza Plan (18). However, federal funding is woefully inadequate.

Local planners must solve major logistical problems. Requirements include substantial increases in staffed bed capacity, protection for health care personnel, isolation rooms, ventilators, and pharmaceutical caches. Particularly important will be the plans for coordination of activities between hospitals: distribution of resources and patients, enhancement of surge capacity, and creation of a credible communication system for health care workers and the public. The challenge here is collaboration within health care systems and hospitals that are largely private, financially stressed, and historical competitors. Most regions have no administrative structure to plan, to raise money, or to require hospitals to do their share of capacity building.

Health care personnel issues are particularly important. A pandemic may require efficient methods of credentialing and providing liability protection for personnel imported from other states or recalled from retirement. It will also mean foresight in assembling the right mix of expertise. In his review of the 1918 pandemic, Dr. Starr noted a laryngologist "who seeing herpes labialis on a gasping cyanotic patient was much interested in it and prescribed application of guaiac" (3). The greatest need will be providers skilled in primary care, infection control, emergency medicine, pulmonary–critical care, and infectious diseases; nurses; respiratory therapists; pharmacists; and support personnel. However, as in 1918, it may be necessary to take anyone with medical training, including students and retired physicians.

The College's position paper appropriately emphasizes the need to spare hospitals and emergency departments from demands that other organizations could fulfill. Planners must make maximum use of nonhospital resources (such as shelters, schools, nursing homes, hotels, and civic centers) to deliver vaccine and antiviral agents and provide "fever clinics" and resources to deal with other outpatient medical care issues, as in New York City, which established a model program for rapid and efficient delivery of prophylactic antibiotics during the anthrax incident in 2001 (19).


What Are the Risks to Health Care Workers?

Caring for victims of an influenza pandemic will endanger health care workers. The risks involve exposure to H5N1, a virus to which unvaccinated people are considered universally immunologically naive. Health care workers and their families need to receive the highest priority for vaccination, assuming a vaccine exists, and for access to antiviral agents that are active against the epidemic strain. Health care workers should expect hospitals to provide optimal protection, and someone needs to take the lead to resolve the current controversy about the need for negative-pressure rooms and N95 masks or powered air-purifying respirators versus surgical masks.

What are the obligations of health care professionals to care for the sick at great risk to themselves? Historical experience on this point is varied. The Hippocratic Oath is silent on whether physicians are obliged to care for the sick. Many physicians, including Galen and Sydenham, are said to have fled patients with contagious epidemic diseases. But AIDS, SARS, and smallpox have focused attention on the duty to serve, and a consensus has emerged. The American Medical Association Code of Medical Ethics states "that a duty to serve overrides autonomy rights in societal emergencies, even in cases that involve personal risk to physicians" (20). Some states regard the obligation to treat during an emergency as a legal duty punishable by criminal sanctions for failure to act or for abandonment of patients. Some health care contracts specify that health care workers are required to provide services in emergencies. The moral obligation to treat seems obvious, but it has a possibly less obvious reciprocal obligation for institutions to provide maximum available protection, including antiviral agents, vaccines, personal protective equipment, and liability protection.

SARS was a recent prototypic example of an infection that had a high mortality rate and high risk for health care workers, who accounted for more than 20% of cases (21). The health care professions rose to this occasion, and few if any reports of failure to serve exist. A survey of 10 511 health care workers in Singapore during the SARS outbreak confirms this judgment: Seventy-six percent of respondents said that caring for patients with SARS involved great personal risk but was also simply part of their job. Forty-nine percent reported social stigmatization, and 31% reported ostracism by family members (22). The experience in Toronto indicated good participation by health care workers but also a substantial psychological impact (23).


Conclusions

The pandemic influenza of 1918–1919 was a punishing chapter in medical history, with a death toll higher than that of World War I. The potential effect of an avian influenza pandemic has been equated to that of a global tsunami. The United States is leading in the scientific effort to contain pandemic influenza with a vaccine and antiviral agents, although the initial efforts have been disappointing. The federal government has presented a public health plan, which the College has endorsed in general terms. The federal plan is quite similar to European plans in terms of surveillance, use of vaccines and antiviral agents, and implementation of travel restrictions and social distancing (24). One major difference is that the European plans are largely national, in contrast to the U.S. strategy of making operational planning a regional responsibility. The challenge in the United States will be to achieve a coordinated plan in a health care system that is unique among nations in the independence of each unit of service, has an incredibly large shortfall in surge capacity, and currently could not begin to manage the magnitude of the 1918 epidemic in Philadelphia as described by Isaac Starr.

The needs for pandemic influenza preparedness are extensive and expensive. Preparing to meet them will require a major scientific effort to modernize vaccine development, substantial expansion of in-country production capacity for development of antiviral agents and vaccines, effective surveillance systems in agriculture and people, and regional planning for catastrophic health crises. The part of this plan that appears most deficient is the last: regional planning that includes local leadership, surveillance, effective communication systems, methods to expand surge capacity, plans to maintain essential services, identification of health care priorities, and guidelines for care. Most communities haven't begun this work, at least not with an integrated regional plan. For this, there needs to be financial support, a timeline, and public accountability for meeting deadlines. Preevent planning is critical. Once pandemic flu strikes a community, it is likely to be over in 3 to 4 months.


Author and Article Information
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Author & Article Info
References

From John Hopkins University School of Medicine, Baltimore, Maryland.

See also: The Health Care Response to Pandemic Influenza by the American College of Physicians and Influenza in 1918: Recollections of the Epidemic in Philadelphia by I. Starr.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: John G. Bartlett, MD, John Hopkins University School of Medicine, 1830 East Monument Street, Room 439, Baltimore, MD 21205; e-mail, jb@jhmi.edu.

Protective fashions for bird flu

France : IFTH offers protective clothing expertise in managing Avian Flu July 7, 2006

Growing concerns for the risk created by the spread of the Asian Flu virus, rescue teams or professionals caring for animals are asking themselves the question on the choice of a protective garment adapted to the different activities that may bring them into contact with the virus: removal of dead animals, contact with droppings of infected birds, etc. For some punctual operations, choosing a disposable suit may be sufficient. But caution must be exercised in choosing equipment that offers suitable protection, because it may be dangerous to opt for a type 5 or 6 chemical protection suit. The qualification of this type of equipment does not allow verifying the barrier offered against exposure to infectious agents. It is thus recommended to apply the EN 14126 “Effectiveness requirements and test methods for protective clothing against infectious agents” reference database and to choose the type of contamination the garment will protect against: contamination by liquids and/or aerosols, and/or dust particles. IFTH, an organisation certified (no. 0072) for protective clothing, can assist manufacturers in their EC marking approach. Propose a technical analysis of test reports making it possible to qualify materials, a complete report on all controlled elements, followed by an assessment of possible additional tests to be carried out in order to obtain EC markings for the suits. IFTH, the essential partner in the technological evolution of Textile and Apparel. The Institut Français Textile-Habillement (French Textile and Apparel Institute) carries out general interest missions and provides private services. Prospecting for innovations, promoting and training in new technologies, IFTH guarantees quality and plays a role of consultant and expert among industrial companies, distributors, government agencies and consumers.

Institut Français du Textile et de l'Habillement

Bird flu summary

U.K.'s Bird Flu Risk May Increase From Next Month (Update2)

July 7 (Bloomberg) -- The risk of bird flu re-entering the U.K. will be higher between August and November, when wild fowl typically fly through the country during winter migration, a government report said.

Outbreaks of the lethal H5N1 avian influenza strain in countries along flyways that overlap the U.K. would also increase the probability of infection, the Department for Environment, Food and Rural Affairs, known as Defra, said yesterday.

Governments and international health authorities are monitoring for H5N1, which has the potential to mutate into a pandemic form that may kill millions of people. Poultry deaths in Romania, scheduled to join the European Union in 2007, are raising concern that the virus is lingering in domestic and wild bird populations, Defra said on its Web site.

``The virus may continue to be introduced in some parts of the EU and eventually arrive in the U.K. because of the potential for limited mixing at some contact points between the existing wild water-bird populations from Eastern Europe with the populations in the EU,'' Defra said.

A flu outbreak killing 70 million people worldwide may cause global economic losses of as much as $2 trillion, the World Bank said last week. Since late 2003, H5N1 is known to have infected at least 229 people, mainly in Asia, killing 131 of them, the Geneva-based World Health Organization said on July 4.

Seasonal Pattern

Reports of human cases have tended to be highest during the cooler periods in the Northern Hemisphere, the WHO said in its June 30 issue of the Weekly Epidemiological Record. If this pattern continues, an increase in cases could be anticipated starting in late 2006 or early 2007, the report said.

``We have to get used to a seasonal pattern of avian influenza in the coming months and years,'' said Zsuzsanna Jakab, director of the European Center for Disease Prevention and Control, at a press conference in Brussels today. ``As long as the virus is endemic in Asia and parts of Africa, it's quite likely it will reappear in Europe.''

In Egypt, a seventh person died of H5N1, Cairo's Al-Wafd newspaper reported on its Web site yesterday. An 18-year-old woman died at the general hospital of Qena, in southern Egypt, several days after her hospitalization, the newspaper said, citing Ahmed Farrag, a regional legal official who authorized the woman's burial. The report didn't say when the woman died.

Indonesia

Indonesia may have recorded its 41st H5N1 fatality after a 3-year-old girl who died yesterday tested positive for the virus at a local laboratory, I Nyoman Kandun, director general of disease control and environment at the Ministry of Health, said in a phone interview today.

More birds are dying from avian flu in Indonesia because of poor vaccination particularly in the small-scale and backyard farms, the country's Agriculture Ministry said in a statement, citing Mathur Riady, director-general of livestock production.

One million fowl, half them of quail, died of bird flu in the first three months of this year, compared with a total of 1.2 million in 2005. Cases in fowl may have been under-reported last year, the ministry said. The virus is endemic in about 80 percent of 33 provinces in the Southeast Asian nation.

Denmark said yesterday that a low-pathogenic strain of an H5 avian flu subtype infected fowl on a farm with 25,000 mallards, pheasants, ducks, geese and ornamental birds at Loevel in Viborg county. The outbreak began on July 5, almost a month after a low- pathogenic form of the virus was reported on June 2, Denmark's Chief Veterinary Officer Preben Willeberg said in a report to the World Organization for Animal Health.

Winter

The U.K. and Denmark are among 37 countries reporting initial outbreaks this year, according to the Paris-based organization. More than 209 million poultry have died or been culled worldwide since January 2004 because of H5N1, the Food and Agriculture Organization of the United Nations said June 19.

A severe winter in Russia and the Caucasus area at the end of 2005 pushed migratory birds south and westward, the FAO said. That may happen again this year, Defra said.

``Tools are currently being developed, based on known information of bird migration routes and abundance, to estimate this likelihood more accurately, and to assess changes in likelihood to the U.K. in the event of new outbreaks elsewhere,'' Defra said in its working paper, written by Mirzet Sabirovic, Simon Hall, John Wilesmith, Nick Coulson and Fred Landeg.

Since January, at least 55 people have died from H5N1 strain in Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq and Turkey, the WHO said. That compares with 19 fatalities in Vietnam and Cambodia in the first six months of 2005.

Turkey's government agreed to publicly release genetic sequence information from H5N1 viruses isolated from four Turkish patients. The data has been submitted to the Influenza Sequence Database at Los Alamos, New Mexico.

``This represents a long-awaited resource to public health institutes and research institutes around the world,'' the WHO's European Regional Office said today on its Web site.

To contact the reporter on this story:
Jason Gale in Singapore at  j.gale@bloomberg.net

Last Updated: July 7, 2006 06:53 EDT

Inevitability of pandemic bird flu

Bird flu pandemic inevitable, says EU
07/07/2006 - 11:45:42

European Union experts today said a global influenza pandemic that could kill millions remains inevitable, although the immediate threat to human health from bird flu in Europe remained low.

“It’s when and not if,” Robert Madelin, director general of the EU’s Health and Consumer Protection department, said in Brussels.

Madelin cited scientists’ predictions suggesting a pandemic could kill 2-7 million people worldwide, 10 times the death rate from regular flu.

However, he warned forecasting was very difficult and current predictions could be “wildly wrong”.

The head of the EU’s centre for disease control said efforts to contain outbreaks of the deadly H5N1 strain among domestic poultry in Europe had been successful.

“H5N1 is a very low risk to public health in the European Union,” said Zsuzsanna Jakab.

Follow the money: how bird flu impacts the economy

Avian flu chops off 3.1% World GDP - World Bank
• Friday, Jul 7, 2006

The World Bank has estimated that a severe avian flu pandemic among humans could cost the global economy about 3.1 per cent of world gross domestic product (GDP) which is around $1.25 trillion on a world GDP of $40 trillion.

The revelation came as the avian flu virus, HSNI, has in the last six to nine months, gone global, spreading from East Asia to affect over 40 more countries. The number of human infections and deaths reported to World Health Organisation (WHO), the World Bank disclosed, has accelerated in the past six months.

There were 41 deaths in all of 2005, but 54 is only the first half of 2006, more than twice the pace of last year. The severe case scenario, prepared by the Banks Development Economic Prospect Group (DEPG) was presented by the Bank’s lead economist for East Asia, Mican Brahmbhaff, in a speed to the First International Conference on Avian influenza in Humans at the Institute Pasteur in Paris, France.

Brahmbhatt said that the severe case scenario was based on a one per cent mortality rate or about 70 million people.

He said mortality rates from a pandemic would be much higher in developing countries, with economic losses expected to be twice those of developed countries. Brahmbatt further said that in most countries the impact of avian flu at the macro economic level has been relatively limited, mainly because the poultry sector is a relatively small part of the world economy.

“But on the other hand, the impact on the poultry sector itself has been pretty severe”, he said. Partly, that is happening because birds are dying or they have to be killed off as a means of controlling the disease.

Secondly, what is happening is that in many places, there have been big declines in demand for poultry due to exaggerated public fears of infection. Even though there is no danger of this from properly cooked poultry and that has his farmers in the poultry sector pretty severely”.




The Tide Online is published by Rivers State Newspaper Corporation,

Spain has first case of H5N1

Spain's first avian flu case confirmed

By: ThinkSpain

Vitoria mayor, Alfonso Alonso, has called for calm after the confirmation of the first case of a bird infected with the most agressive strain of avian flu, N5H1. "There is no cause for public health concerns, and people should carry on as normal," explained the mayor, who went on to explain that the disease can only be transmitted between animals.

The case was confirmed by the director of the Basque animal health laboratory in Derio, Ramón Juste, after an examination of a dead grebe found in marshland near Alava. Notwithstanding, the dead duck has been sent to a laboratory in Madrid for a second confirmatory analysis, the results of which should be known by the end of today. If confirmed, this would be the first case of avian flu detected in Spain since the scare began.

Friday, July 7, 2006

Thailand's bird flu issues

WHO puts Thais on alert against influenza and bird flu

WHO officials in Thailand have asked for cooperation from the Thai people in preventing the spread of influenza and bird flu. Doctor Somchai Phirapakorn (สมชาย พีระปกรณ์), an official attached to WHO office in Thailand, cited researches as showing that the H5N1 strain, or bird flu, has undergone a mutation but not completely enough to make it communicable between humans. However, the finding underlined higher chances for human contraction than in the past 10 years. The doctor called for public cooperation in controlling the spread of the strain by reporting any sight of unusual illnesses both in human and poultry. Members of the public are also requested to distance themselves from poultry as far as possible while frequently washing hands and having properly cooked and clean food. Bird flu has already been found among poultry in Asia, Europe and Africa covering 48 countries. As for contraction in humans, Indonesia has the highest number of patients while no report on such a case in Thailand and Vietnam.

Multi-language messages aimed at preventing bird flu

Jul 6, 2006 10:11 am US/Central

Non-English Speakers Targeted For Bird Flu Message

(AP) Minneapolis As part of preparations for a possible bird flu outbreak, Minnesota health officials are taping public health announcements in six languages that are aimed at people who raise chickens at their homes.

Most major poultry producers, from Jennie-O Turkey Store in Willmar to Gold'n Plump in St. Cloud, have biological security measures in place. But industry officials worry that migratory birds could infect back-yard flocks, particularly those raised by a growing number of immigrants.

Fears about bird flu have caused poultry consumption to plummet in other countries, but authorities say you won't get it from birds that are properly handled and cooked.

In the effort to reach new immigrants, local health departments and other agencies have collaborated on a program that will air from 7 p.m. to 9 p.m. Aug. 27 on Twin Cities Public Television, Ch. 17. The show, "Keeping Birds Free of Influenza," will be broadcast in Spanish, Hmong, Somali, Vietnamese, Lao and Khmer, with English captions.

"We feel that there's a lot of these ethnic groups that are raising their own birds, as well as going to live-bird markets," said Kevin Elfering, director of dairy and food inspections at the Minnesota Agriculture Department.

On the program, Elfering -- with the help of translators -- discusses how wild ducks and geese and their droppings can spread the disease. He describes the difference between mild and deadly forms of bird flu, and the symptoms. He tries to make consumers comfortable with the idea of calling veterinarians and other public health officials.

Strains of the bird disease have surfaced in U.S. flocks, but not the deadly subtype H5N1, which has spread from Asia to Africa.

The disease is most often detected after fowl die. A major part of the education effort is to provide people who raise back-yard chickens with contacts to call, from veterinarians to the University of Minnesota's veterinary laboratory to the U.S. Department of Agriculture.

(© 2006 The Associated Press.

Grant for bird flu planning

Wichita Falls Receives Grant For Bird Flu Preparedness

The state government just gave Wichita Falls a 29 thousand dollar grant to help prepare for the one kind of the flu: the bird flu.

"Locally we're suppose to have a plan in place so that if anything happened here we can handle it as best as we could locally," Amy Cone of the Wichita Falls Health Department said.

In November President Bush asked Congress for 7.1 billion dollars in emergency funding to combat a possible U.S. bird flu epidemic. Today's grant is a result of Congress and President Bush's actions.

"As part of a national strategy its important for us to remember locally that all emergencies are local," Cone said.

The big problem with the bird flu is its deadly strain.

"The concern is that H5N1 will either mutate so that there is human to human transmission or that migratory birds will bring it over to our area," Cone said.

The H5N1 strain is the type of bird flu that has everyone from senators to scientists worried and its almost exclusively bird disease. The grant for the health department will buy training materials, a new television and d-v-d player and fund outreach activities and personal protective equipment.

"It was needed. It was really needed," Cone said.

The question still remains: will the pandemic jump from Europe to North Central Texas?

"You never know. Everything is a plane ride away, literally. You don't know who is coming into your community and you don't know if that virus is going to mutate," Cone said.

KAUZ

Story Created: Jul 5, 2006 at 5:58 PM CST

Cidrap news on avian flu

HHS has enough H5N1 vaccine for 4 million people

Jul 5, 2006 (CIDRAP News) – In an update on pandemic influenza preparedness efforts, the federal government said last week it had stockpiled enough vaccine against H5N1 avian influenza virus to inoculate about 4 million people and enough antiviral medication to treat about 6.3 million.

Health and Human Services (HHS) Secretary Mike Leavitt said his department has stockpiled about 8 million doses of H5N1 vaccine. "Given a two-dose vaccination schedule, this would allow vaccination of 4 million people," Leavitt wrote in a 12-page report.

The report outlines the status of federal efforts to boost US flu vaccine production capacity, increase the stockpile of antiviral drugs, monitor the spread of avian flu in the United States, and assist states with pandemic planning. The report is a follow up to a March report that announced the government's initial plan for boosting the nation's supply of avian influenza vaccines and treatments.

The H5N1 vaccine being stockpiled now is based on a virus isolated from a Vietnamese patient in 2004 (a clade 1 virus), Leavitt noted. He said a second H5N1 vaccine under development is based on an H5N1 strain that was collected in Indonesia in 2005 (clade 2 virus) and has circulated in Europe, Africa, and parts of Asia.

"While the efficacy of these pre-pandemic vaccines cannot be predicted, there is reason to believe they may provide some level of protection for priority personnel and those at greatest risk," Leavitt wrote.

Boosting antiviral stockpiles
Leavitt reported that as of Jun 1, the Strategic National Stockpile (SNS) of antiviral drugs contained about:

• 6.2 million treatment courses of oseltamivir (Tamiflu) capsules, with an additional 15.4 million courses expected by the end of December
• 8,600 courses of Tamiflu oral suspension
• 84,000 courses of zanamivir (Relenza), with an additional 3.9 million courses expected by the end of December

In sum, the stockpile is expected to reach 26 million antiviral drug courses by the end of 2006. At least 20 million courses are earmarked for states for distribution in proportion to population, the report says. Up to 6 million courses are reserved for mass prophylaxis in isolated community outbreaks.

HHS received a $170 million appropriation to provide a subsidy to states and other jurisdictions that will allow them to buy up to 31 million treatment courses of antiviral medications at 25% off the federal contract price.

HHS also will spend $162 million to stockpile other medical supplies, including 6,000 ventilators, 100 million N95 respirators, and 50 million surgical masks, plus face shields, gowns, and gloves, Leavitt reported. So far the department has amassed 20.2 million respirators and 12.3 million surgical masks.

Investing in vaccines
In May, federal officials awarded more than $1 billion worth of contracts for cell-based vaccine technology. Leavitt wrote that reliance on traditional egg-based vaccine production is problematic because an avian flu outbreak, and the poultry culling that would follow, would jeopardize the supply of eggs needed to produce the vaccine. He said vaccine-production cell lines can be frozen indefinitely and that, in comparison with eggs, can more rapidly be used to produce vaccines in the event of a pandemic.

Contracts for cell-based vaccine production went to five companies: Solvay Pharmaceuticals ($299 million), GlaxoSmithKline ($275 million), Novartis Vaccines & Diagnostics ($221 million), MedImmune ($170 million), and DynPort Vaccine ($41 million).

Another HHS goal is to expand the nation's capacity for producing the traditional egg-based vaccine. Leavitt wrote that this summer the HHS will issue requests for proposals (RFPs) for building new facilities or retrofitting existing ones.

HHS also has issued RFPs for antigen-sparing vaccine technologies that would stimulate protection using a smaller amount of the vaccine, the report says.

Coordinating state preparedness
Congress allocated $350 million this year to assist with state and local pandemic preparedness. Of this amount, Leavitt said $100 million has already been earmarked to help states identify gaps in preparedness. They are now submitting applications for how they will spend $250 million, which is intended to cover the cost of ranking gaps and making plans for addressing them, developing plans for distributing antiviral drugs, and designing pandemic response exercises.

Leavitt said HHS has convened state summits in 48 states, and the remaining two have summits scheduled. He added that many states have progressed to the next step of holding interstate and regional planning meetings.

This fall HHS will begin holding risk-communication training sessions for state and local public health professionals and community leaders in 10 HHS regions. "State by state, we are moving from awareness to preparedness," Leavitt wrote.

Other developments
Leavitt's report describes several other elements of federal pandemic planning activities, including:

• International cooperation: The nation has pledged $334 million to assist nations most severely affected by avian influenza. In May, HHS shipped Tamiflu to a secure location in Asia to help contain a pandemic. (If containment is not possible, the drug would be sent back to the US.)
• Domestic monitoring: The government has expanded its early detection network to monitor wild birds. Sampling in Alaska is focused on species that are thought to have the highest chance of bringing the virus to North America: those that migrate to and from wintering areas in the Russian Far East and Southeast Asia.
• Diagnostic tests: In collaboration with the Centers for Disease Control and Prevention (CDC), the Food and Drug administration recently approved a new laboratory test that can detect H5 flu viruses within a few hours. In April, the FDA provided the biotechnology industry with guidance for evaluating performance and writing product labeling for in-vitro diagnostic tests.
• Flu-tracking software: The CDC developed two pandemic modeling software programs—FluSurge and FluAid--for communities and hospitals.
• Public communication: Leavitt reported that content on the cross-government Web site, pandemicflu.gov, has increased 25% in the last 3 months and that over the last several months HHS has held roundtable talks on avian and pandemic flu with major broadcast and cable networks.

"While we have accomplished much in a short period of time, the race we are in is not a sprint, but a marathon," Leavitt wrote.

See also:

Leavitt's report "Pandemic Planning Update II"
http://www.pandemicflu.gov/plan/pdf/PanfluReport2.pdf

Mar 15, 2006 CIDRAP News article "Leavitt vows action on flu vaccine technology"

Pet and live bird restrictions in the EU

EU Beefs Up Bird Flu Measures

On EU Doorstep: 4 July 2006, Tuesday.

The European Commission has beefed up measures to combat bird flu, extending an import ban on live birds.

It also tightened movement restrictions on pet birds entering the European Union.

EU veterinary experts green-lighted the current ban, which runs out at the end of the month, to be prolonged until December 31.

An embargo on poultry meat exports from Turkey will also be extended until the end of the year, the EC said in a statement.

The EU's executive also allowed the Netherlands to continue a vaccination program aimed at protecting its poultry industry from the lethal disease, and add more species, like geese, to it.

A ban on the import of poultry products from China, Malaysia and Thailand will also remain in place until December 31, 2007 due to the persistence of the disease.

Health experts fear the H5N1 strain of bird flu could mutate into a form that is transmitted more easily between humans, marking the first stage of a global flu pandemic that could kill millions.

Lagos has dying birds, not diagnosed yet

Daily Champion (Lagos)

July 4, 2006
Posted to the web July 5, 2006

Lagos

President Olusegun Obasanjo yesterday described as false media report (not Daily Champion) alleging an outbreak of Avian influenza in Taraba State.

The President made the denial while addressing a delegation of the Poultry Association of Nigeria in State House.

He said "it has not been diagnosed or classified as avian flu. I spoke to the Governor, who told me that in a backyard farm in Ibi, some birds were dying, and based on precedent, he ordered them slaughtered and the farm cordoned off. This is the normal thing to do."

"Nobody has the right to call this avian flu; no diagnosis has been carried out to ascertain the problem. It could be any of half a dozen chicken diseases", he said.

President Obasanjo told the Association that he was satisfied with the action taken by the Taraba State Governor and advised that "Nigerians shouldn't rush to call themselves bad names, giving the nation a bad image without foundation".

He said the country now had "enough equipment to contain any outbreaks of the avian flu, even to cover the West African sub-region", and commended members of the Poultry Association for the support they gave to the Government during the unfortunate outbreak of the flu in February.

While welcoming the determination of the poultry farmers to begin exporting day-old chicks and hatchable eggs by November 2006, despite the six-month setback arising from losses from the flu, the President said Government would encourage the achievement of that goal and challenged them to set a target of $20 million export earnings by the end of the year.

He also spoke of the need to get support for the small farmers, since "the banks will not touch their business because it is small".

President Obasanjo also said the Federal Government would encourage State governments to include eggs in the school meal programmes.

The President commended the Ministers of Agriculture, Health and Information and National Orientation and their staff for the exemplary cooperation during the avian flu outbreak in the country. "Their cooperation stood out in Africa as an example on how to treat the avian flu", he said.

Earlier, Otunba Badmus, president of the Poultry Association of Nigeria, had told President Obasanjo that the Association suffered losses amounting to N24 billion to the flu, and needed access to soft bank loans to be able to recover and begin export in November, 2006. He also stated the preparedness of the Association to provide sufficient eggs for the school feeding programme.

Nigeria and the bird flu

Bird flu virus infected Nigeria multiple times

05 Jul 2006 17:00:02 GMT

Source: Reuters

By Patricia Reaney LONDON, July 5 (Reuters) - Nigeria has been infected multiple times with H5N1 bird flu probably carried by migratory birds from southern Russia and northern Europe or introduced by imported chickens, scientists said on Wednesday. After analysing samples from infected birds on two farms in south-western Nigeria they found the viruses were genetically distinct from each other and from H5N1 found in the north of the country. So rather than one strain spreading through the country, different strains had been introduced on separate occasions, which could make controlling the spread of the virus more difficult. "It strongly suggests that the virus in the north and the virus in these two southern farms have been independently introduced into Nigeria," Claude Muller, of the National Public Health Laboratory in Luxembourg, said in an interview. The analysed samples were similar to strains found in southern Russia and northern Europe but not from southeast Asia, which has been hardest hit by avian flu. Muller added that the H5N1 virus has infected nearly half of the 31 federal states in Nigeria so measures such as mass culling and vaccination, as well as international assistance, will be needed to contain or eradicate the virus. "For the countries in western Africa I think it will be very difficult for them, just on their own, to efficiently combat these viruses," he said. Nigeria was the first country in Africa to be hit by bird flu when ducks tested positive for H5N1 in February. Since then Niger, Egypt, Burkina Faso and Cameroon have also had outbreaks. There have been no human cases of the infection in Nigeria but Muller said it is not easy in Africa to monitor humans in an efficient way to exclude the virus. Each strain of the virus poses an added risk to people. Muller said the poultry industry is second only to oil production in Nigeria and is particularly vulnerable to avian virus because chickens are imported from all over the world. The country also has several bird sanctuaries along the flight paths that link Nigeria with southern Russia and Europe and western Asia. "These migratory birds could be a source of introduction but this we cannot prove it," said Muller, adding that the other possibility is trade. Scientists fear H5N1, which has infected 229 people since late 2003 and killed at least 131, could mutate into an easily transmissible form in humans that could cause a pandemic. Muller and his team, who reported their findings in the journal Nature, work with scientists at the University of Ibadan in Nigeria and the World Health Organisation to monitor poultry viruses. Within four days of the first case being reported in the African nation they had set up a laboratory to analyse samples.

AlertNet news is provided by

Why does Iran protest so much: no bird flu here...

There is no Sign of Bird Flu in Iran Service: Health 1385/04/14 07-05-2006 14:59:57 News Code :8504-07350

ISNA - Tehran Service: Health TEHRAN, July 05 (ISNA)-Iran's Veterinary Organization chief announced bird flu has been completely controlled in Iran and that there is no sign of this disease in the country. "We have carried out strict human and bird controls and implemented a wide control area in the Caspian Borders," said Hussein Hassani. Iran launched its bird flu control plan from May. This plan is to be carried out till the end of July and has all borders up to the depth of 10kilometers under control. End Item

Zeenew.com Roundup on H5N1

'Bird flu may evolve into more transmissible agent in humans'

New York, July 04: The risk of bird flu evolving into a more transmissible agent in humans remains high due to the widespread distribution of the H5N1 virus in poultry and the continued exposure to humans, according to a study by the UN health agency. The overall case-fatality rate was 56 percent with the highest rate in persons aged 10 to 39 years, according to the study by the World Health Organisation (WHO), which analysed epidemiological data of all cases reported so far. Cases have occurred all year round, but human cases peaked during the period roughly corresponding to winter and spring in the Northern Hemisphere. If this pattern continues, an upsurge in cases could be anticipated starting in late 2006 or early 2007, the WHO says. In case of seasonal influenza, the mortality is highest in the elderly. Half of the cases occurred in people under the age of 20 and 90 percent of cases in people under 40 years. This was the first analysis released by the agency encompassing all cases reported between December 2003 and April 2006. The analysis calls for better collection of essential data to understand and refine case management of H5N1, which experts fear could, in a worst case scenario, mutate into a deadly human pandemic. "The sharing of data may be seen as part of an early warning system that will collectively defend all countries against a common threat," the WHO said. Bureau Report

Africa prepares for bird flu

ali: New Centre to Tackle Bird Flu Across Africa

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UN Integrated Regional Information Networks

July 4, 2006
Posted to the web July 4, 2006

Bamako

The World Organisation for Animal Health, or OIE, has set up its first regional control centre in Africa with the aim of coordinating measures against bird flu, which is threatening livelihoods and health across the continent.

Centre head Samba Sidibe told IRIN after the special opening in June that Africa is particularly vulnerable to the threat of the deadly H5N1 virus.

"Avian flu represents a serious threat to agriculture and in particular the fight against poverty," said Sidibe.

And often, said Sidibe, shortages of funds prevent the establishment of projects to tackle animal diseases such as bird flu.

Relevant Links West Africa Mali Wildlife Health and Medicine Food, Agriculture and Rural Issues

The new centre to date is the OIE's only regional office in Africa. The OIE aims to collate and disseminate veterinary information and safeguard world trade by producing health guidelines for international trade in animals, among other things.

Africa's first recorded case of H5N1 was in Nigeria in February and since then the disease has killed hundreds of thousands of poultry through eight countries, from Cote d'Ivoire in West Africa to Egypt in the north east, according to figures from the World Health Organisation.

[ This report does not necessarily reflect the views of the United Nations ]

Chinese problems with bird flu

Villagers eat dead poultry, neglecting bird flu caution, in Thailand

Hundreds of domestic poultry died in a village in northern Thailand Phet last week, and villagers cooked and ate them without regard to possible bird flu,local medical officials reported on Tuesday. Public health officials in the lower northern province of Phichit have renewed precautionary measures against avian flu after hundreds of chickens died from unknown causes. After visiting Mabkrapao village in Sam Ngam district, Dr. Prachak Wattanakun, a provincial health official, said that hundreds of local poultry had died suspiciously, and that villagers had eaten them while disregarding the potential of avian flu. Local health officials warned villagers not to eat sick chickens and advised them to use rubber gloves when handling the poultry, dead or alive, to prevent the spread of possible bird flu virus and contracting the disease. Samples of the dead poultry were sent for laboratory testing, but the results are not yet available, he said. Anyway, the incident raises questions regarding the effectiveness of the government's anti-bird flu education among rural farm families, observers was quoted by the Thai News Agency as saying. Last year, bird flu was detected at the village,which straddles the shared border of Phichit and Kamphaeng Phet provinces. Source: Xinhua

It is not too late to start prepping for bird flu

Issues Center > Index of Issues > Homeland Security & Defense

Pandemic Planning

Most experts agree that there is a growing and significant threat of a global pandemic, but that there is no way to predict either exactly when it might occur or the severity of the impact. As with any of the risks that we face as a country -- including natural disasters and the ongoing possibility of another terrorist attack -- it is imperative that all segments of society be prepared for such a threat. The U.S. Chamber of Commerce is therefor encouraging preparedness for an influenza pandemic within the business community.

In addition to the threat that a pandemic could pose to human health world-wide, few industries will be insulated from the economic effects resulting from absenteeism in the workplace or from the downstream effects stemming from supply-chain and travel disruption.

It is important for business owners and leaders to be knowledgeable about the risks associated with the threat of an influenza pandemic and, in turn, to be adequately prepared for the possibility of a pandemic that would have significant social and economic costs.

"It's Not Flu as Usual" Brochure

Each winter, the flu kills approximately 36,000-40,000 Americans, hospitalizes more than 200,000, and costs the U.S. economy over $10 billion in lost productivity and direct medical expenses. As staggering as these figures are, health experts are now warning about a far more lethal kind of flu - a pandemic flu that could kill over a half of a million people in the U.S., hospitalize 2 million more, and cost our economy an estimated $70-$160 billion.

The Chamber and the Trust For America's Health (TFAH) have developed a brochure that will help guide businesses through the pandemic planning process.

Recent Action

U.S Chamber & TFAH Business Brochure

Bird flu death toll rises in hard hit Indonesia (Reuters)

Bird flu kills 40th human in Indonesia

Mon Jul 3, 2006 1:11 PM BST

By Telly Nathalia

JAKARTA (Reuters) - A World Health Organisation laboratory test has confirmed a 5-year-old Indonesian boy who died last month was infected with bird flu, a health ministry official said on Monday.

His death takes the total number of confirmed bird flu fatalities in the country to 40.

The victim died on June 16 in Tulungagung in East Java province after being admitted to hospital on June 8, I Nyoman Kandun, director general for communicable disease control at the health ministry, told Reuters.

The infection was confirmed to be from the H5N1 avian virus by a WHO laboratory in Hong Kong, he said.

An official at the health ministry's bird flu centre who declined to be identified said: "There was a dead chicken near his house."

The chicken cage was 15 metres (49 ft) from the boy's home, the official added.

Indonesia has seen a steady rise in human bird flu infections and deaths since its first known outbreak of H5N1 in poultry in late 2003, and has registered more deaths this year than any other country.

Indonesia has 220 million people and an estimated 1.2 billion chickens, some 30 percent of them in the yards of homes in both rural and urban areas.

The bird flu virus is endemic in poultry in nearly all of the 33 provinces in Indonesia, a country of 17,000 islands sprawling across some 5,000 km (3,100 miles).

Despite the climbing death toll, the government has resisted mass culling of birds, saying it is too costly and impractical.

Vaccination has been preferred to culling, which has been done only sporadically at selective farms and their immediate surroundings.

Bird flu remains essentially an animal disease but many countries around the world are on alert over fears it may mutate into a disease that could pass easily among people and trigger a pandemic, killing millions.

Indonesia drew international attention in May when the virus killed members of a single family in North Sumatra. Experts said there could have been limited human-to-human transmission in this cluster case.

But they stressed genetic analyses of the virus have not shown all of the traits that are known so far to allow it to spread easily among people.

Common sense tips to avoid the flu and other germs

From PandemicFlu.gov: a good preparedness website for generalities

Stay Healthy

Will the seasonal flu shot protect me against pandemic influenza?
No, it won't protect you against pandemic influenza. But flu shots can help you to stay healthy.
Get a flu shot to help protect yourself from seasonal flu.
Get a pneumonia shot to prevent secondary infection if you are over the age of 65 or have a chronic illness such as diabetes or asthma. For specific guidelines, talk to your health care provider or call the Centers for Disease Control and Prevention (CDC) Hotline at 1-800-232-4636.
Make sure that your family's immunizations are up-to-date.

Take common-sense steps to limit the spread of germs. Make good hygiene a habit.

• Wash hands frequently with soap and water.
• Cover your mouth and nose with a tissue when you cough or sneeze.
• Put used tissues in a waste basket.
• Cough or sneeze into your upper sleeve if you don't have a tissue.
• Clean your hands after coughing or sneezing. Use soap and water or an alcohol-based hand cleaner.
• Stay at home if you are sick.

It is always a good idea to practice good health habits.

• Eat a balanced diet. Be sure to eat a variety of foods, including plenty of vegetables, fruits, and whole grain products. Also include low-fat dairy products, lean meats, poultry, fish, and beans. Drink lots of water and go easy on salt, sugar, alcohol, and saturated fat.
• Exercise on a regular basis and get plenty of rest.