Saturday, December 30, 2006

Oh no...bird flu hits in Vietnam again...

Vietnam Reports First Suspected Cases of Human Bird Flu in a Year

30 December 2006


A trader transports chickens on the back of his motorbike on a road near Hanoi, Vietnam (file photo)
A trader transports chickens on the back of his motorbike on a road near Hanoi, Vietnam (file photo)
Authorities in Vietnam say four members of a family have been hospitalized with symptoms of bird flu, in the country's first suspected cases of the disease in more than a year.

Officials say the mother and her three children, aged between three and 13 years old, fell ill after eating a sick chicken earlier this month in Ca Mau province. Health officials say they are being tested for the deadly H5N1 strain of the virus.

Earlier this month, Vietnam reported its first bird flu outbreaks in poultry in a year in Ca Mau and two other provinces in the Mekong Delta. The outbreaks killed or forced the slaughter of thousands of poultry there.

Vietnam has the second highest number of human bird flu deaths after Indonesia. More than 150 people have died from the disease, mainly in Asia.

Most of the deaths happened as a result of contact with sick birds, but experts fear the virus could mutate into a form that easily transmits by human-to-human contact.

Some information for this report was provided by AP and Reuters.

Friday, December 29, 2006

New website for me and maybe you



http://www.irinnews.org
EGYPT: Bird flu claims tenth fatal victim

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


© Victoria Hazou/IRIN



CAIRO, 28 Dec 2006 (IRIN) - Health ministry officials reported the tenth death in Egypt to be caused by the avian influenza virus H5N1, this time a 26-year-old male factory worker. He died on 27 December.

According to ministry media official Sayyid al-Abbasi, the latest victim was a relative of two females, one aged 30 and the other 15, who died over the course of the week in Gharbiyya province, 90 km north of Cairo.

“They all lived in the same house,” he said, where infected domestically kept birds were being reared. “All three were in frequent contact with the infected ducks, cleaning and slaughtering them.”

Tests for the virus have been run on the rest of the household. “No other members of the family are infected,” al-Abbasi said.

Virus H5N1 was first detected among humans in Egypt in March 2006, and a month earlier among birds. The majority of infections and all of the deaths have been among people who reared birds domestically as opposed to on farms.

In response to the risk of infection by rearing birds at home, the government banned domestic poultry rearing in urban centres. However, the country’s health authorities did not impose similar restrictions in rural areas where domestic breeding is more widespread and economically vital.

“A ban would lead many to conceal their birds, heightening the danger rather than quelling it,” Abdel Rahman Shahine, a health ministry official, said.

“Instead, the government plans to intensify its awareness campaign,” al-Abbasi told IRIN, to prevent new infections among humans from occurring.

Egypt’s densely inhabited Nile Valley saw the worst concentration of bird flu infection this year outside Asia. The area has a large rural population that has traditionally reared poultry for food and income, and lies on major routes for migratory birds.

sa/ar

US and international preparedness evaluated


Feds detail progress on pandemic preparedness

Dec 29, 2006 (CIDRAP News) – In a recent update on pandemic influenza preparedness planning, the US government reported meeting more than 90% of a long list of objectives it set for itself about 6 months ago.

The report charts progress on a wide range of preparedness measures, from shoring up laboratory capabilities to planning for distribution of critical medical supplies and preparing checklists for various sectors of the economy.

In May, federal officials released the National Strategy for Pandemic Influenza: Implementation Plan, a 228-page document describing how the government will cope with an influenza pandemic. The statement was a follow-up to the HHS Pandemic Influenza Plan, released by the Department of Health and Human Services (HHS) in November 2005.

The status report, released Dec 18, covers 104 tasks that were to be completed within 6 months of release of the implementation plan. The tasks fall into 6 categories: international efforts, transportation and borders, protecting human health, protecting animal health, law enforcement and public safety, and institutions.

Of the 104 tasks addressed, 96 have been completed, and 8 are in progress, the report says. The introduction notes that even though most of the 6-month goals have been met, work on many of the tasks is continuing.

Jeff Levi, PhD, executive director of Trust for America's Health (TFAH), a Washington, DC-based nonprofit public health advocacy group, commended federal officials for meeting most of the 6-month benchmarks in the pandemic plan.

"This first phase of the federal pandemic preparedness plan moved at full speed ahead," he said in a Dec 18 TFAH press release. "It has been an historic government-wide effort, and the release of the results demonstrates a serious commitment to transparency and accountability, allowing Americans to see how well their tax dollars are being spent to improve preparedness for a major health emergency."

The status report shows that overall progress is being made, even though media reports on pandemic flu have waned, Chris Logan, a senior policy analyst with the National Governors' Association, told CIDRAP News. The status report is useful for state officials because it raises questions they need to be thinking about. "It's not just the obvious stuff, it's the implications of decisions that people need to be aware of and thinking through," he said. "To the extent these documents help people think through the potential second- and third-order effects, they're helpful."

Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP), publisher of the CIDRAP Web site, said he applauds the Bush administration for issuing a progress report on pandemic preparedness. "But we really have to ask ourselves the hard question 'What does it mean to be prepared?', and right now, I don't think we have a clue," he said.

It's difficult to determine if the country is better prepared now than it was 6 months ago, Osterholm told CIDRAP News. He said officials need to start the difficult task of prioritizing preparation measures. "We've got to do a better job of understanding the key factors that will get us through a pandemic," he said. "If there are 10 major factors and 100 little ones, you can get 90 done, but if you don't get the 10 major ones done, you're not prepared."

Osterholm said one problem with the status report is that it reflects a US-centered view of pandemic planning. "What happens to the world will happen to the United States because of the global just-in-time economy," he said.

A number of the activities discussed in the report are summarized below.

International efforts
The federal government has informed 2 million US citizens living abroad about the latest developments in avian and pandemic flu, mainly through the US government's main pandemic flu site, and has provided additional information through US consulates and warden networks.

Also, federal officials have developed a policy for contributing to international medication stockpiles and deploying antiviral medications. The government reviewed whether or not US stockpile contributions should require liability limits, but officials found that there's not an urgent need to propose such arrangements.

The US Agency for International Development (AID) and the US Department of Agriculture (USDA) developed a model compensation program for farmers affected by animal influenza outbreaks, which will be launched in early 2007 with partners at the World Bank, United Nations Food and Agriculture Organization (FAO), and the Indonesian government.

Work is continuing on an international strategy to contain pandemic influenza outbreaks, and the US has provided $400,000 to the World Health Organization to host workshops on proper transport of influenza samples to reference laboratories.

The US State Department, along with the Department of Commerce and the Centers for Disease Control and Prevention (CDC), drafted a pandemic preparedness checklist for US companies that have overseas operations. Three major business organizations are reviewing the checklist, and once completed, the document will be posted on the government's pandemic flu Web site.

Transportation and borders
HHS and the departments of Homeland security (DHS), Transportation, and Labor (DOL) developed a pandemic planning checklist for the travel industry and workforce protection guidelines for airline crew members and other people who may come in contact with people and cargo from pandemic-affected areas.

To ensure that all border and transportation stakeholders receive accurate and current information about quarantinable diseases, HHS, USDA, and other departments reviewed the current protocol and added several groups to the notification chain.

Policy recommendations for air, land, and maritime entries and exits, including response plans and screening, were developed by HHS with assistance from 5 other federal departments.

Federal security forces have been briefed by the Department of Justice and DHS about protecting shipments of critical supplies and facilities and are developing contingency plans to carry out the security responsibilities.

Protecting human health
HHS, with the Department of Defense (DOD), the Veterans Administration, and medical specialty societies, developed a guide to help community planners address mass-casualty care with scarce resources. The document was released in November and is posted on the Web site of the Agency for Healthcare Research and Quality.

To coordinate and communicate effective messages to the public about pandemic flu, HHS and several other federal agencies and local officials enlisted and trained a wide range of influential community spokespeople who will be available to speak on the pandemic crisis. Risk communication strategies are also planned for local public health, community, and tribal leaders. Several government agencies have also help develop risk communication strategies ("message maps") on avian flu, pandemic flu, antiviral medications, and vaccines.

One topic of interest to state officials is the possibility of broadening the Food and Drug Administration's Shelf Life Extension Program to state stockpiles of antiviral medications. The program allows the federal government to keep medications beyond the expiration date under certain conditions. However, federal officials determined that including state stockpiles in the program is not currently feasible.

Logan said that decision is a concern for states. The federal government is providing a 25% subsidy to help states build their own antiviral stockpiles, but the drugs have a listed shelf-life of 5 years and can be used only for pandemic flu, not for seasonal flu, he said. "If a pandemic doesn't happen before the end of the shelf-life, you have to throw the antivirals out. . . . And then states will have to go out and buy replacement antivirals for their stockpiles. That's obviously an issue of concern for the states."

To boost vaccine production in the event of an influenza pandemic, HHS explored current production capacities of US vaccine producers and in June issued a request for proposals to retrofit their facilities to produce pandemic vaccines in an emergency.

Smooth, efficient allocation of medical equipment such as ventilators and gloves is a key part of a pandemic response, and HHS and other government agencies have developed and tested a plan to distribute critical materials. The plan was tested in October, and will undergo further trials through March 2007.

To speed the genetic sequencing of viral isolates during a pandemic, HHS set a goal of releasing the findings to GenBank within 1 week of diagnosis confirmation at the Institute for Genomic Research. Complete viral genome sequences can now be obtained from a clinical sample in 3 days, and HHS, with the Association of Public Health Laboratories, can publish sequence data on a human H5N1 isolate within 1 week.

There were other accomplishments on the laboratory front. HHS improved access to standardized influenza reagents for use in tests and research; it can now distribute the reagents within 3 business days of a request. HHS, along with other government agencies and partners, has supplied all members of the US Laboratory Response Network with reagents and protocols to conduct tests using real-time reverse-transcriptase polymerase chain reaction (RT-PCR). These labs are prepared to use RT-PCR to identify and confirm pandemic flu strains within 24 hours.

HHS, using DOD threat-reduction modeling tools and software from other agencies, has developed a real-time epidemic analysis and modeling system for public health use and emergency preparedness.

The National Disaster Medical System has developed a strategy for deploying medical assets, such as materials and mobile medical units, held by DHS and HHS. Several federal agencies also developed a "Pandemic Influenza Playbook" that describes what public health and medical capabilities the federal government has available to support state responses to pandemic influenza.

Protecting animal health
Federal agencies, with the assistance of states, launched a wild-bird testing program for H5N1 avian flu in August along with an electronic reporting system, and is working on a response strategy if such an outbreak occurs.

In assessing the abilities and needs of federal animal research facilities, the USDA and DHS identified problems at a key animal influenza research facility. The departments completed a study of the facility's deficiencies, along with plans to address its needs.

Because of the risk of an avian flu outbreak in birds, several government agencies have prepared three messages based on three scenarios that can be used to deliver clear, coordinated information to the public. Federal departments, with the assistance of industry groups, have also developed food safety messages that can be customized and distributed if an avian influenza outbreak occurs.

Law enforcement and public safety
The Department of Justice, along with HHS, DHS, DOL, sponsored a forum in May for criminal justice officials on best practices to meet the challenges they may face in a pandemic outbreak. Information from the forum is available on the Web site of the Bureau of Justice Assistance. In addition, a consortium of criminal experts was convened in conjunction with the forum to guide ongoing criminal justice planning efforts.

To address emergency response issues, DHS and several other government agencies will host a forum in February for selected federal, state, local, and tribal officials. The group will review interim guidance and adopt a national pandemic flu planning model.

Checklists for law enforcement personnel and emergency responders on issues such as prepandemic vaccination have been developed by HHS and DOL. The documents, which were reviewed by police unions and other professional organizations, also include planning checklists for correctional facilities.

Institutions
Government officials have developed preparedness exercises with private-sector partners, and templates of the exercises are available for use by other interested groups. Business continuity guidance was developed and published on the government's pandemic flu Web site.

Interim guidance on environmental management and cleaning practices, including the handling of potentially contaminated waste materials, has been developed. The guidelines are intended for healthcare facilities, homes, schools, and businesses.

Unfinished tasks
Eight of the tasks were not completed by the 6-month deadline, and the report notes that work on each is continuing. They include measures to:

  • Draft a report analyzing the pros and cons of invoking the Defense Production Act to procure medical countermeasures during a pandemic
  • Improve the speed of mortality surveillance through the 122 Cities Mortality Reporting System
  • Establish a protocol for state governments on how to request federal military assistance under the Insurrection Act
  • Adopt and test a planning and preparation model for emergency response systems
  • Publish interim guidance on environmental management of pandemic flu viruses
  • Publish final pandemic planning guidelines for critical infrastructure owners and operators
  • Help critical infrastructure entities conduct collaborative exercises to test essential functions and identify critical planning, response, and mitigation needs.

Thursday, December 28, 2006

A universal flu vaccine?

The vaccine to cure every strain of flu

by FIONA MacRAE Last updated at 22:20pm on 28th December 2006

Comments

Just a couple of injections could give long-lasting immunity



British scientists are on the verge of producing a revolutionary flu vaccine that works against all major types of the disease.

Described as the 'holy grail' of flu vaccines, it would protect against all strains of influenza A - the virus behind both bird flu and the nastiest outbreaks of winter flu.

Just a couple of injections could give long-lasting immunity - unlike the current vaccine which has to be given every year.

The brainchild of scientists at Cambridge biotech firm Acambis, working with Belgian researchers, the vaccine will be tested on humans for the first time in the next few months.

A similar universal flu vaccine, being developed by Swiss vaccine firm Cytos Biotechnology, could also be tested on people in 2007 - and the vaccines on the market in around five years.

Importantly, the vaccines would also be quicker and easier to make than the traditional jabs, meaning vast quantities could be stockpiled against a global outbreak of bird flu.

Martin Bachmann, of Cytos, said: "You could really stockpile it. In the case of a pandemic, that would be a huge advantage.

"If you were to start making a traditional vaccine at the start of a pandemic, there is no way there would be enough."

The Government believes a bird flu pandemic is inevitable, killing 50,000 people in Britain alone.

However, it acknowledges that the bug could be much more lethal - infecting one in two people and claiming more than 700,000 lives.

Normal winter flu can also kill, claiming up to 12,000 lives a year in the UK.

Although a vaccine exists, constant changes in the virus's appearance have until now made it impossible to create just one flu vaccine. Instead a new vaccine is put together each year to protect against the particular strains circulating at that time.

In addition, the virus used in the jab is grown in hen's eggs - a time-consuming process that yields just one shot of vaccine per egg.

The new jabs would be grown in huge vats of bacterial 'soup', with just two pints of liquid providing 10,000 doses of vaccine.

Current flu vaccines focus on two proteins on the surface of the virus. However, these constantly mutate in a bid to fool the immune system, making it impossible for vaccine manufacturers to keep up with the creation of each new strain.

The universal vaccines focus on a different protein called M2, which has barely changed during the last 100 years.

The protein is found in all types of Influenza A, including the current bird flu and the virus that caused the 1918 Spanish flu pandemic which killed up to 50 million across the globe.

Normally, such vaccines would have to go through at least five years of human tests before going on the market. However, if a bird flu pandemic occurs before that, they could be made more quickly available.

Zurich-based Cytos, which is also developing anti-smoking and obesity vaccines, has showed that its version of the jab stops mice dying from a dose of flu strong enough to kill them four-times over.

The vaccinated animals were also spared the fever that normally goes along with flu.

Although it is too early to say what the effect would be in humans, an initial course of two or three shots could provide long-lasting immunity, topped up with booster shots given every five to ten years.

Dr Ashley Birkett, of Acambis, said: "It wouldn't be that one shot protects for life but you would need fewer doses over your lifetime."

In addition, the jabs could be produced in vast quantities and stockpiled ahead of a flu pandemic - or even given to people in advance.

In contrast, a traditionally-produced vaccine, matched to the specific strain of flu, would not be available until around six months after the start of the pandemic.

The new vaccines only protect against influenza A - the version of the bug responsible for pandemic flu and the most severe cases of winter flu.

However, it may also be possible to create a similar jab against influenza B, which causes a milder form of winter flu.

Professor John Oxford, Britain's leading flu expert, said the development of a universal vaccine was the "holy grail" of flu research.

He added: "If you get a M2 vaccine which protects against the whole caboodle in the same vaccine, the possibilities are huge."

But, others cautioned that there is no guarantee that the jabs would be as effective in humans as it has been in animals.

Virologist Professor Ian Jones, of the University of Reading, said: "It is an encouraging technique which may have a role to play but it is too soon to assume that it will translate into a universal vaccine in the human population."

Dr Jim Robertson, a vaccine expert from the government-funded National Institute for Biological Standards and Control, said the main advantage of a universal jab would be lasting immunity.

"If it works, it will be lovely," he said. "The best result would be that it would last for a long, long time."

Dr Ron Cutler, an infectious diseases expert from the University of East London, said: "Continual protection would be a tremendous advantage against flu."

He cautioned however, that there is no guarantee that the M2 protein will not mutate in the future - meaning the jab will have to be regularly reformulated.

Wednesday, December 27, 2006

Lancet article on flu treatment (H5N1)


The Lancet is a free website, but you must register (very quick).http://www.thelancet.com

The Lancet Infectious Diseases 2007; 7:21-31

DOI:10.1016/S1473-3099(06)70684-3

Review

WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus

Summary

Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.

What's a footbath got to do with it?













NAIA intensifies bird-flu watch


By Jonathan M. Hicap, Reporter

The Manila International Airport Authority (MIAA) has intensified its watch against bird flu following reports of continued outbreaks in several countries.

In a memorandum issued on December 27, Alfonso Cusi, MIAA general manager, ordered all airport personnel to continue the use of thermal scanning for incoming passengers and flight crew and the use of footbath to prevent the entry of the virus from affected countries.

Cusi said the Ministry of Health in Indonesia confirmed the country’s 57th death from the bird-flu virus. A 35-year-old female died of the virus on November 28. Indonesia confirmed 57 deaths of the 74 cases of bird flu.

He also ordered the full staffing of medical personnel detailed at the MIAA-Bureau of Quarantine and the continuous coordination with offices to ensure that guidelines are followed.

The World Health Organization said there are 258 confirmed bird-flu cases in the world with 154 confirmed human deaths.

“We cannot allow any risk or threat that will imperil our nation’s present condition,” Cusi said in the memo.


Sunday, December 24, 2006

Off to spend Christmas without computer!

May your days be Merry and Bright
And may all your Christmases be White..
Joy, peace, prosperity and good health to all.

Egyptian family cluster?

Bird Flu Infects Three Family Members In Egypt

Article Date: 24 Dec 2006 - 4:00 PST

A family cluster infection of bird flu has been identified in Garbiya, about 55 miles north of Cairo, Egypt, say officials from the World Health Organization (WHO). Two infected people had been slaughtering ducks prior to becoming infected, say WHO officials.

Official confirmation conflicts with the WHO version. A spokesman for the Egyptian Health Ministry said only two patients had been infected with H5N1, the virulent bird fly virus strain.

Authorities say birds in the immediate vicinity of the infections are being culled as a precautionary measure. They added that all humans in the area who have been handling poultry are being checked.

Egypt has had 18 cases of human H5N1 infection, including these three. The first case was reported in March 2006.

Backyard poultry is widespread in Egypt. WHO says the risk of bird flu spreading fast is greater in countries where backyard poultry is more common.

Written by: Christian Nordqvist
Editor: Medical News Today

Egyptian bird flu hits hard



Eighth Egyptian dies of bird flu - WHO
24 Dec 2006 14:33:19 GMT

CAIRO, Dec 24 (Reuter) - An Egyptian woman died of bird flu on Sunday, only hours after tests confirmed she had been suffering from the highly pathogenic H5N1 virus, a World Health Organization official said.

Hassan el-Bushra, regional adviser for communicable diseases surveillance at the WHO, said the 30-year-old woman had been in hospital since mid-December, but doctors had not immediately suspected bird flu as she denied having had contact with poultry.

Her death brings the number of total human deaths from H5N1 in Egypt to eight.