Egypt: #H5N1--75th and 76th confirmed cases [May 28 Cairo]--The Ministry of Health of Egypt has reported two new confirmed human cases of avian influenza on 26 May 2009. The two cases are from two separate districts of Sharkia Governorate.

The first case is a 4-year old male from Hehia City, Hehia District. His symptoms began with fever on 24 May 2009.

The second case is a 4-year old female from Abo Hammad District. Her symptoms began with fever on 23 May 2009.

Both cases were admitted to Zagazig Fever Hospital where they received oseltamivir and are in a stable condition.

Investigations into the source of infection indicated that the above two cases had close contact with dead and sick poultry. Both cases were confirmed by the Egyptian Central Public Health Laboratories on 26 May 2009.

Of the 76 cases confirmed to date in Egypt, 27 have been fatal.

Egypt: #H5N1--70th, 71st, 72nd, 73rd, and 74th confirmed human cases [May 22 Cairo]--Between 13 to 20 May, the Ministry of Health of Egypt reported five new confirmed human case of avian influenza.

The first case is a 4-year old boy from Kafr Sakr District, Sharkia Governorate. His symptoms began on 10 May 2009 and he was admitted to Zagazig Fever Hospital on 11 May. He is in a stable condition.

The second case is a 3-year old boy from Mahalla District, Gharbia Governorate. His symptoms began on 12 May and he was admitted to Mahalla Fever Hospital on 15 May 2009. He is in a stable condition.

The third case was a 4-year old girl from Meet Ghamr District, Dakahlia Governorate. Her symptoms began on 9 May 2009 and she was admitted to Mansoura Chest Hospital on 17 May 2009. She died on 18 May 2009.

The fourth case is a 4-year old boy from Sherbin District, Dakahlia Governorate. His symptoms began on 18 May 2009 and he was admitted to Mansoura Chest Hospital on the same day. He is in a stable condition.

The fifth case is a 3-year old boy from Sohag District, Sohag Governorate. His symptoms began on 17 May 2009 and he was admitted to Sohag Fever Hospital on 18 May 2009. He is in a stable condition.

Investigations into the source of infection indicated that all the above cases had close contact with dead and sick poultry. All five cases have been confirmed by the Egyptian Central Public Health Laboratory.

Of the 74 cases confirmed to date in Egypt, 27 have been fatal.

Egypt: 69th confirmed human cases of H5N1--deaths of previously confirmed cases [May 18 Sohag]--The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza. The case is a 5-year old female from Tama District, Sohag Governorate. Her symptoms began on 7 May and she was admitted in Sohag Fever Hospital on 9 May where she received oseltamivir. She is in a stable condition.

The case was confirmed by the Egyptian Central Public Health Laboratories on 10 May 2009.

Investigations into the source of infection indicate close contact with dead and sick poultry.

The Ministry of Health of Egypt has announced the deaths of previously confirmed cases of H5N1 as follows:

6-year-old male from Qaliobia Governorate;
33-year-old female from Kfr El Sheikh Governorate
25-year-old female from Cairo Governorate

Of the 69 cases confirmed to date in Egypt, 26 have been fatal.

Scotland: Ensuring resilience to pandemic outbreak with 'Cauld Craw' exercise [Apr 22 Edinburgh]--The Scottish Government will be running an emergency exercise next week to make sure it is prepared for any pandemic flu outbreak that may occur.

'Cauld Craw' will be the government's main civil contingencies exercise for 2009 and is part of a programme of events to ensure Scotland is well prepared to deal with the consequences of any emergency.

The four week exercise, involving a range of agencies across the country, will test resilience and improve knowledge and understanding of how to handle the issues Scotland would face in the event of a pandemic.

Speaking ahead of Cauld Craw, Justice Secretary Kenny MacAskill said: "Although there has been no change to the level of risk of a flu pandemic, an outbreak has been identified as one of the main risks Scotland could face.

"Scotland is not immune from the consequences of major incidents as highlighted by the Glasgow Airport attack and more recently the fuel disputes.

"It is vital that we continue to build on the expertise and knowledge we have already developed in dealing with these kinds of emergencies. Exercise Cauld Craw will test how ready we are and help us strengthen our plans for the future"

Exercise Cauld Craw will involve a number of responder agencies across Scotland including the emergency planning Strategic Co-ordinating Groups in Tayside, Dumfries and Galloway and Strathclyde. The NHS Boards of Ayrshire & Arran, Dumfries & Galloway, Greater Glasgow and Clyde, Lanarkshire, Tayside, and the State Hospital will also participate, as will the Scottish Ambulance Service, NHS24, National Procurement, The Golden Jubilee Hospital and Health Protection Scotland.

The exercise will run over four weeks from April 27 and all participants will be conducting business as usual during this period.

A pandemic flu outbreak has been identified as one of the main risks Scotland could face along with terrorism, extreme weather and widespread utilities failure. These four risks form the priority issues which Scottish Resilience - the part of the Scottish Government which works with frontline organisations on emergency planning - is currently focussing on. The Scottish Government is currently working with the UK Government to develop a national pandemic flu communications strategy.

Egypt: 65th and 66th human cases of H5N1 infection confirmed [Apr 22 Cairo]--The Ministry of Health of Egypt has reported two new confirmed human cases of avian influenza.

The first case is a 25-year old pregnant female from El Marg District, Cairo Governorate. Her symptoms began on 6 April and she was hospitalized at Ain Shams University hospital on 11 April where she was started on oseltamivir on 16 April. She is in a critical condition. Investigations into the source of her infection indicated close contact with sick poultry prior to becoming ill.

The second case is 18-month old female from Kellin District, Kafr Elsheikh Governorate. Her symptoms began on 15 April and she was hospitalized at Kafr Elsheikh Fever Hospital on 18 April where she was started on oseltamivir on the same day of hospitalization. Her condition is stable. Investigations into the source of infection indicated close contact with dead and sick poultry prior to becoming ill.

For both cases, infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory and subsequently confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3).

Of the 66 cases confirmed to date in Egypt, 23 have been fatal.

United States: FDA researchers contribute insights into avian flu virus [Apr 22 Rockville MD]--An in-depth analysis of blood from patients recovering from the H5N1 avian influenza virus has provided important insights into how to combat the potentially lethal virus.

The findings by U.S. Food and Drug Administration scientists and collaborators better explain what part of the “bird flu” virus is seen by the immune system once a person becomes infected. As one result of this research, a protein of the bird flu virus called PB1-F2 was identified as a potentially potent target for attack by immune systems to stop the spread of the virus.

“Analysis of blood from patients recovering from the H5N1 avian influenza virus can lead to new tools for testing the potential protective activity of vaccines under development,” said Karen Midthun, M.D., acting director of the FDA’s Center for Biologics Evaluation and Research (CBER). “The findings could also lead to new tests to detect infections, and improved therapies.”

Since 2003, more than 400 people worldwide have been infected with the bird flu virus. About 60 percent of them have died. No cases of avian flu have been reported in the United States. Most of the avian flu infections in humans involve people who have had direct contact with infected poultry. However, there is a potential risk for a global influenza pandemic should the virus acquire the ability to spread directly from person to person.

The study, titled “Antigenic Fingerprinting of an H5N1 Avian Influenza Using Convalescent Sera and Monoclonal Antibodies reveals Potential Vaccine and Diagnostic Targets,” appears in the April 20, 2009, edition of the online journal PLoS Medicine.

The researchers adapted an existing technique using genetically modified viruses (phages) to create a library of fragments representing all of the proteins found in the H5N1 virus. Scientists mixed these fragments with antibodies from five Vietnamese patients recovering from the H5N1 infection and observed which fragments attracted the patient’s antibodies.

Several targets that are likely to trigger strong antibody responses to the H5N1 virus were identified, including PB1-F2, a protein that researchers believe contributes significantly to the virus’s ability to cause disease.

“We believe this is the first evidence of the human immune system reacting this strongly against PB1-F2,” said Hana Golding, Ph.D., chief of CBER’s Laboratory of Retrovirus Research and senior author of the article. “This is an indication that it may be a good target for a drug or vaccine.”

The study’s other authors include first author Surender Khurana, Yonaira Rivera, Jody Manischewitz, and Lisa R. King (FDA); Kanta Subbarao, Amorsolo L. Suguitan Jr. (National Institute of Allergies and Infectious Diseases); Cameron P. Simmons (Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam); and Antonio Lanzavecchia (Institute for Research in Biomedicine, Bellinzona, Switzerland).

Tibet: China confirms bird flu outbreak in Lhasa [Apr 22 Beijing]--China's Ministry of Agriculture (MOA) confirmed Sunday a new outbreak of bird flu in Lhasa, southwestern Tibet Autonomous Region.

The national bird flu laboratory confirmed that the H5N1 bird flu virus was found in poultry sold at a poultry wholesale market in Chengguan District of Lhasa on April 12.

Emergency measures have been taken and the epidemic has been brought under control, the MOA said in a brief notice, and 1,679 fowl were culled after the outbreak.

According to the local health department, no abnormalities were found among people in contact with the poultry, the ministry said.

Egypt: 64th human case of H5N1 infection confirmed [Apr 20 Cairo]--The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza . The case is a 33 year old female from Kellin district, Kfr El Sheikh Governorate. Her symptoms began on 7 April and she was hospitalized at Kfr El Sheikh Fever Hospital on 15 April where she was started on oseltamivir the same day (15 April). She is in a critical condition.

Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 15 April.

Investigations into the source of her infection indicate a history of close contact with dead and sick poultry prior to becoming ill.

Of the 64 cases confirmed to date in Egypt, 23 have been fatal.

Egypt: 61st, 62nd and 63rd human cases of H5N1 infection confirmed [Apr 8 Cairo]--The Ministry of Health of Egypt has reported 3 new confirmed human cases of avian influenza.

The first case is a 2 year-old boy from Kom Hamada District, El Behira Governorate. He developed symptoms on 27 March and was admitted to Naaora Fever Hospital on the 30 March where he was started on oseltamivir the same day (30 March). He remains in a stable condition.

The second case is also a 2 year-old boy from the same district and was detected through the investigation around the above-mentioned case. He developed symptoms on 31 March and was admitted to Damanhor Fever Hospital on 1 April where he was started on oseltamivir the same day (1 April ). He remains in a stable condition.

Both boys had contact with sick/dead poultry prior to the illness onset. Close contacts of both boys have been identified and none has shown symptoms of the infection .

The third case is a 6 year-old boy from Shubra El Khema District, Qaliobia Governorate. He developed symptoms on 22 March and was admitted to Ain Shams University Hospital on the 28 March where he was started on oseltamivir on 3 April. He was exposed to sick/dead poultry prior to the illness onset. He is in a critical condition.

For all of the three cases reported above, infection with H5N1 avian influenza virus was tested positive by the Egyptian Central Public Health Laboratory and subsequently confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3).

Of the 63 cases confirmed to date in Egypt, 23 have been fatal.

Viet Nam: 110th human case of H5N1 infection confirmed [Apr 8 Chau Thanh District]--The Ministry of Health in Viet Nam has reported a new confirmed case of human infection with the H5N1 avian influenza virus. The case has been confirmed at the National Institute of Hygiene and Epidemiology (NIHE).

The case is a 3 year old boy from Chau Thanh District, Dong Thap Province. He developed symptoms on 12 March, was hospitalized on 13 March, and died on 19 March.

Investigations into the source of infection indicated a history of close contact with sick and dead poultry prior to the onset of symptoms.

Of the 110 cases confirmed to date in Viet Nam, 55 have been fatal.

Egypt: 60th human case of H5N1 infection confirmed [Mar 31 Qena District]--The Ministry of Health and Population of Egypt has reported a new confirmed human case of avian influenza. The case is a two and a half year old female from Qena District, Qena Governorate. Her symptoms began on 23 March. She was admitted to Qena Fever Hospital on 24 March where she was started on oseltamivir the same day (24 March) and remains in a stable condition. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 26 March.

Investigations into the source of infection indicate a history of close contact with dead and sick poultry prior to becoming ill.

Of the 60 cases confirmed to date in Egypt, 23 have been fatal.

Investigations into the source of her infection indicate a history of close contact with dead and sick poultry prior to becoming ill.

Of the 59 cases confirmed to date in Egypt, 23 have been fatal.

Egypt: 58th human case of H5N1 infection confirmed [Mar 11 Menofia]--The Ministry of Health and Population of Egypt has reported a new confirmed human case of avian influenza. The new case is a one and a half year old female from Menofia Governorate. Her symptoms began on 6 March and she was hospitalized on 9 March where she remains in a stable condition. Infection with H5N1 avian influenza was confirmed on 10 March by the Egyptian Central Public Health Laboratory.

Investigations into the source of her infection indicate a history of close contact with dead and sick poultry prior to becoming ill.

Of the 58 cases confirmed to date in Egypt, 23 have been fatal.

Egypt: 57th human case of H5N1 infection confirmed [Mar 11 Alexandria]--The Ministry of Health and Population of Egypt has reported a new confirmed human case of avian influenza. The new case is a two and a half year old male from Amaria District, Alexandria Governorate. His symptoms began on 3 March and he was hospitalized at Alexandria Fever Hospital where he remains in a stable condition. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 4 March.

Investigations into the source of infection indicate a history of close contact with dead and sick poultry prior to becoming ill.

Of the 57 cases confirmed to date in Egypt, 23 have been fatal.

Australia: Important discovery in research for vax against bird flu [Mar 7 Melbourne VIC]--A vaccine to protect humans from a bird flu pandemic may be within reach after a new discovery by researchers at the University of Melbourne, Australia

The discovery, published today in the prestigious Proceedings of the National Academy of Sciences, reveals how boosting T cell immunity could better protect humans from a bird flu pandemic.

The continued spread of the highly virulent "bird flu" virus has experts worried that we are facing a new potential influenza pandemic which could transfer between humans. Furthermore, given the bird flu is new, there is no pre-existing immunity in the population and current vaccine formulations would be useless.

"The 'Killer T cell' is the hit-man of the immune system. It is able to locate and destroy virus-infected cells in our body helping rid us of infection," said A/Prof Stephen Turner, from the Department of Microbiology and Immunology at the University of Melbourne who is a lead author on the paper.

"Unfortunately, current influenza vaccines are poor at inducing killer T cell immunity. Therefore, we wanted to see if we could improve the current vaccine formulation to induce killer T cells after vaccination," he said.

"We added a compound, known to increase immunity, to the flu vaccine in an animal model. The addition of this compound promoted significant generation of potent killer T cell immunity and provided protection from infection.

"The significance of these findings is that rather than having to design a new vaccine altogether, we can improve current flu vaccines by adding this potent immune modulator.

"With appropriate clinical testing, we could see improvements to current vaccines within the next five years."

Dr Turner said the key to vaccine effectiveness was ensuring a match between the vaccine and the current circulating flu strain. However, the spike proteins varied over the course of a flu season rendering the current vaccine ineffective. As such, the vaccine needs to be updated every year to match the likely strain for that winter.

"It is a different situation for influenza pandemics. Pandemics arise due to the introduction of a new influenza virus into human circulation. As such, there is little or no pre-existing immunity to the bird flu virus enabling it to spread rapidly."

"'Killer' T cells recognise components that are conserved between different influenza viruses. Therefore, a vaccine strategy that induced killer T cells pre-emptively would provide protection from a potential pandemic."

India: Status report on avian influenza outbreak for Mar 5 [Mar 6 West Bengal]--West Bengal

District Darjeeling

Department of Animal Husbandry, Dairying & Fisheries, GOI has notified Avian Influenza outbreak in Punding Forest Busty [block Kurseong], district Darjeeling on 24th February, 2009. A central Rapid Response Team of MoHFW has been deputed to assist the State health authorities. Containment operations are on. Culling of birds has been completed. A total of 644 birds have been culled. 54 cullers are under chemoprophylaxis.

Surveillance in 0-3 Km and 3-10 Kms is continuing. The total population of 3448 in 0-3 Km area is covered on daily basis. 11 cases of fever/URI have been identified but none had exposure history to dead/sick poultry. In 3-10 Km area population is covered in phases. On 4.3.2009 a population of 11,325 have been covered and no cases of URI/fever have been detected.

In the identified health facility, 14 cases of fever/URI have been identified but none had exposure history to dead/sick poultry

The district authorities have been provided adequate logistics like Oseltamivir capsules, PPE and N-95 masks.

District Dakshin Dinajpur

Central Rapid Response Team of MoHFW is assisting the state health authorities. Culling activity has been completed on 21.2.2009. A total of 8273 birds have been culled.

Surveillance activities is continuing in 0-3 Km and 3-10 Km. In 0-3 Km area the total population of 22251 is covered on daily basis. 5 cases of fever/URI have been identified on 4.3.2009 but none had exposure history to dead/sick poultry. In 3-10 Km area surveillance is conducted in phases. On 4.3.2009 a population of 50,044 have been covered and 392 cases of fever/URI have been identified but none had exposure history to dead/sick poultry

In the identified health facility, 88 cases of fever/URI have been identified but none had exposure history to dead/sick poultry

State Govt. has adequate stock of Oseltamivir, personal protective equipments etc.

Situation is being monitored on a daily basis.
 

China: Chicken carcass confirmed positive for H5N1 [Mar 6 Tung Ping Chau]--A spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (March 6) that a chicken carcass found in Tung Ping Chau was confirmed to be H5N1 positive after a series of laboratory tests.

The carcass was found floating in the sea off Kang Lau Shek, Tung Ping Chau, on March 2. It was highly decomposed when found and required a series of confirmatory tests for avian influenza. Test results available today confirmed that the dead bird was H5N1 positive.

The spokesman said there were no poultry farms within three kilometres of where the dead bird was found. No unauthorised keeping of poultry has been observed during inspections.

"The AFCD has contacted poultry farmers reminding them to strengthen precautionary and biosecurity measures against avian influenza. Pet bird shop owners, licence holders of pet poultry and racing pigeons have also been reminded to take proper precautions," the spokesman said.

The spokesman said the department would conduct frequent inspections of poultry farms, the wholesale market and the Yuen Po Street Bird Garden to ensure that proper precautions against avian influenza had been implemented. The department would continue its wild bird monitoring and surveillance.

The Food and Environmental Hygiene Department (FEHD) will continue to be vigilant over imported live poultry as well as live poultry stalls. It will also remind stall operators to maintain good hygiene.

The Department of Health will enhance health education and distribute health advice leaflets.

The AFCD, the FEHD, the Customs and Excise Department and the Police will strive to deter the illegal import of poultry and birds into Hong Kong to minimise the risk of avian influenza outbreaks brought by imported poultry and birds that have not gone through inspection and quarantine.

All relevant government departments will continue to remain highly vigilant and strictly enforce preventive measures against avian influenza.

"The public can call 1823 Call Centre for follow up if they come across suspicious sick or dead birds, including carcasses of wild birds and poultry," the spokesman said.

Members of the public are reminded to observe good personal hygiene. They should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. Poultry and eggs should be thoroughly cooked before consumption.

Advice on biosecurity measures for people working in poultry farms, wholesale and retail markets and health advice for the public are available at the "H5N1 Health Advice" of the AFCD's website at www.afcd.gov.hk  The website also includes the latest information on the H5N1 infected birds found in Hong Kong this year.

China: Investigation group releases report on avian influenza outbreak in Yuen Long chicken farm [Mar 6 Hong Kong]--The Investigation Group on Epidemiological Study appointed by the Secretary for Food and Health today (March 5) released its report on the investigation into the highly pathogenic avian influenza H5N1 outbreak in a chicken farm in Ha Tsuen, Yuen Long, in December 2008.

The investigation group examined the details of the outbreak, revisited the regulatory regime of poultry farms, analysed the virus recovered from the index farm and test samples taken from other local farms, and recommended improvement in biosecurity measures for the index farm and other local farms.

Outlining the report findings on the avian influenza outbreak at a press conference today, the convenor of the investigation group, Dr Thomas Sit, said, "The investigation group noted that the outbreak was confined to the index farm in Ha Tsuen. The outbreak was detected early to enable immediate action to be taken to prevent further spread of the disease. There was no indication of spread of infection to other farms."

Genetic analyses showed that the virus belongs to the family Clade 2.3.4, a clade which is commonly found in the south China region. The virus was most closely related to and shared a common ancestry with isolates detected in poultry retail markets in Hong Kong in June 2008 and a dead wild bird found in Tsing Yi in March 2008. No mutation associated with virulence in mammals was found.

"As with many epidemiological studies of this nature, it is difficult to determine the exact cause of the outbreak. The investigation group considered that the H5N1 virus was most likely to have been introduced to the farm by wild birds. Droppings of wild birds could have contaminated the dust and dirt near the entrance of one of the two affected sheds which was subsequently blown into the shed area during windy days. Once the virus had gained entry, farm workers could have contributed to its spread to the other shed via contaminated hands/gloves and/or clothing," Dr Sit explained.

Also speaking at the press conference, the Director of Agriculture, Fisheries and Conservation, Miss Cheung Siu-hing, noted that the investigation had revealed some biosecurity vulnerabilities and breaches on the index farm, including wild bird protection, and possible non-compliance by workers with biosecurity measures (including hand/glove hygiene) relating to entry into the chicken sheds.

The investigation group recommended the following measures for improving the biosecurity on the index farm:

* modify the structure of one of the affected sheds so that the shed area is fully covered by its roof and add a solid partition on the side facing north to protect against wind gusts;
* cover all open soak away pits and wells to avoid gathering of aquatic birds on the farm; and
* improve bird protection facilities.

The investigation group also put forward improvements to biosecurity measures for all poultry farms to strengthen the procedures for prevention of avian influenza infection, which include:

* further tightening of biosecurity through tailor-made biosecurity plans, record keeping in standard templates, provision of hand washing facilities and refresher courses;
* facilitating early detection by increasing the inspection frequency and sampling size of blood tests for vaccinated chickens; and
* preventing spread of avian influenza through scattered distribution of sentinels and segregating the operations relating to the rearing of breeder and broiler flocks.

"The Agriculture, Fisheries and Conservation Department (AFCD) has taken on board the recommendations and will facilitate the implementation of enhanced biosecurity on local farms. Discussions and planning with individual farmers are already underway.

"Biosecurity measures on the farms are one of the most important preventive measures against the threat of avian influenza virus. We call on the farmers to stay vigilant and comply with the biosecurity requirements at all times. The AFCD will continue to work with them and provide the necessary support," Miss Cheung said.

The investigation group's convenor was the Assistant Director of Agriculture, Fisheries and Conservation (Inspection & Quarantine), Dr Thomas Sit. Members of the group included the Head of the Department of Microbiology of the University of Hong Kong, Professor Yuen Kwok-yung; Head of the Laboratory Animal Unit of the University of Hong Kong, Dr Lo King-shun; and representatives of the AFCD, Department of Health and Food and Environmental Hygiene Department.

The full report has been uploaded onto the AFCD's website, www.afcd.gov.hk for public viewing.

Egypt: 56th case of human infection with H5N1 confirmed [Mar 2 Cairo]-- The Ministry of Health and Population of Egypt has reported a new confirmed human case of avian influenza on 1 March 2009. The new case is a two-year old male from Yousef el seddik district of Fayoum Governorate whose symptoms began on 25 February.

China: Preventive and control measures on seasonal influenza and avian influenza - Q&A in the Hong Kong Legislative Council [Feb 16 Hong Kong]--Following is a question by the Hon Audrey Eu and an oral reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (February 11):

Question:

A number of confirmed cases of human infection of avian influenza have occurred on the Mainland since January this year, resulting in five deaths. At the same time, the World Health Organisation (WHO) has indicated that there is an increasing likelihood of a major global outbreak of influenza on a scale similar to that in 1968. In this connection, will the Government inform this Council:

(a) of the latest information about the avian influenza epidemic on the Mainland that the Government has obtained through the exchange and notification mechanism on infectious diseases; and

(b) in the face of the recent spate of fatal avian influenza cases on the Mainland and WHO's warning, what measures the Government will take to prevent the outbreak of influenza and human infection of avian influenza in Hong Kong?

Reply:

President,

Hon Eu's question touches on seasonal influenza and avian influenza. First of all, I would like to explain the differences between the two.

Seasonal influenza is caused by different strains of influenza virus transmitted among people. There are three known categories of influenza: A, B and C. The most common types of influenza in Hong Kong are influenza A H1N1 and H3N2. Minor changes of the antigen of influenza viruses every year lead to seasonal influenza. As such, reformulation of the influenza vaccine is required every year to cope with the mutation of viral strains. Influenza is mainly transmitted through air or droplet in crowded and enclosed areas, or through direct contact with the secretions of a person suffering from the disease.

As for avian influenza, it is usually caused by influenza A H5N1 and H9N2. While avian influenza normally infects birds, poultry are especially vulnerable to infections resulting in epidemics. According to the World Health Organisation (WHO), there have been over 400 human cases of avian influenza H5N1 globally since 2003, with the fatality rate of about 60%. Cases of human infection of avian influenza are usually the result of close contact with live poultry and their droppings. Wild birds are not a major channel of spreading avian influenza to human. Up till now, there is no epidemiological evidence to show that avian influenza can be transmitted to humans through consumption of properly cooked poultry according to WHO. Neither is there any evidence of efficient human-to-human transmission of the virus. In the circumstances, our strategy to prevent avian influenza is primarily on prevention of poultry from avian influenza infection, and minimising contact between the members of the public and live poultry.

An influenza pandemic occurs when there is an extensive human-to-human transmission of a new influenza virus or an influenza virus which has not been around for a long time. An influenza pandemic takes large toll as the majority of the population lack immunity to the virus.

My replies to the two parts of the question are as follows :

(a) As at February 10, the Department of Health (DH) has received notifications from the Ministry of Health (MoH) concerning eight confirmed human cases of avian influenza A H5N1 so far this year. Of these cases, five were fatal. Investigations conducted by the Mainland health authorities reveal that seven cases had contact with diseased poultry or exposure history to live poultry market in the Mainland prior to the onset of symptoms. The Mainland Government has taken preventive and control measures accordingly, including placing the close contacts of patients under medical surveillance and carrying out epidemiological investigations. The MoH's investigation reveals that all eight cases are sporadic cases without epidemiological linkage and there are no obvious signs of human-to-human transmission of the virus at the moment. Details of the cases are at the Annex.

(b) To mitigate the effect of seasonal influenza, the Centre for Health Protection (CHP) has been closely monitoring the local influenza situation through different channels, including the sentinel surveillance in general out-patient clinics, private clinics, homes for the elderly, child care centres, etc.

We provide free influenza vaccination for some high-risk target groups under the "Government Influenza Vaccination Programme" every year. The "Influenza Vaccination Subsidy Scheme" was also launched in November last year to provide government subsidies to encourage young children to receive influenza vaccination at private clinics, so as to reduce their risk of hospitalisation due to influenza.

In addition, at end of last year, we have stepped up our preventive publicity and education efforts before the arrival of the winter influenza season. The CHP has set up a dedicated webpage in its website to publish the updated figures and information on the influenza daily situation for public reference. The CHP also disseminates relevant messages and guidelines to doctors, homes for the elderly, hostels for people with disabilities, schools, kindergartens and child care centres from time to time, so as to strengthen the surveillance, prevention and control of influenza. These measures have not only facilitated effective surveillance of influenza in Hong Kong, but also significantly heightened public alertness to influenza.

As for avian influenza, the Government has already put in place a series of measures to reduce the risk of virus transmission from poultry and birds to human. These measures include banning the keeping of backyard poultry, requiring the compliance with biosecurity measures in local farms, requiring vaccination for chickens in local farms and imported chickens, banning the keeping of live poultry overnight at retail level, as well as enhancing the testing of antibodies for chickens in local farms and imported chickens. Besides, we have also arranged influenza vaccination for poultry workers and cullers to reduce the chance of genetic reassortment between human and avian influenza viruses. We are also actively pursuing the development of a poultry slaughtering plant to achieve complete segregation of humans from live poultry.

In respect of surveillance, avian influenza H5, H7 and H9 are currently notifiable infectious diseases under the Prevention and Control of Disease Ordinance. In addition to statutory notifications, the CHP also maintains close monitoring of the avian influenza situation locally through various means including laboratories and hospitals.

On the other hand, DH has implemented temperature screening for in-bound travellers in all Immigration Control Points and will conduct further assessment on those with fever or illness. For any suspected avian influenza cases, rapid diagnosis using molecular methods will be conducted by DH. Once avian influenza cases are detected, the DH will conduct epidemiological investigations promptly and take necessary control measures including contact tracing, environmental investigation, finding the source of infection and prevention of the spread of diseases.

We have all along been maintaining close communication and co-operation with the Mainland and Macao health authorities to ensure expeditious and effective exchange of important information about infectious disease outbreaks and incidents of the three places. Contingency measures have been taken to reduce the chance of infectious disease outbreak. In addition, we have been maintaining close liaison with WHO and the health authorities of other regions to obtain the latest information on avian influenza cases. Regular exercises and drills are also conducted to test and enhance the emergency preparedness of government departments in case of public health emergencies. Besides, health authorities in Hong Kong, the Mainland and Macao organise joint exercises regularly to review the emergency response and notification mechanism of the three places in handling cross-boundary public health emergencies.

Despite the occasional cases of human infection of avian influenza in other countries and places, there is no evidence yet of efficient human-to-human transmission of the virus. We will continue to minimise the risk of avian influenza and influenza pandemics through the above measures.

China: Crested Myna tested positive for H5 virus [Feb 16 Hong Kong]--Under the present avian influenza surveillance programme on dead wild birds, preliminary testing of a dead Crested Myna found in Tung Ping Chau has indicated a suspected case of H5 avian influenza, a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (February 15), adding that further confirmatory tests were being conducted.

The bird carcass was collected at Shau Tau, Tung Ping Chau on February 12.

The spokesman said there were no poultry farms within three kilometres of where the dead bird was found.

"In view of the recent cases of H5N1 found in poultry and wild bird carcasses, the AFCD has phoned poultry farmers reminding them to strengthen precautionary and biosecurity measures against avian influenza. Pet bird shop owners, licence holders of pet poultry and racing pigeons have also been reminded to take proper precautions," the spokesman said.

The spokesman said the department would conduct frequent inspections of poultry farms, the wholesale market and the Yuen Po Street Bird Garden to ensure that proper precautions against avian influenza had been implemented. The department would continue its wild bird monitoring and surveillance.

The Food and Environmental Hygiene Department (FEHD) will continue to be vigilant over imported live poultry as well as live poultry stalls. It will also remind stall operators to maintain good hygiene.

The Department of Health will enhance health education and distribute health advice leaflets.

AFCD, FEHD, the Customs and Excise Department and the Police will strive to deter the illegal import of poultry and birds into Hong Kong to minimise the risk of avian influenza outbreaks brought by imported poultry and birds that had not gone through inspection and quarantine.

All relevant government departments will continue to remain highly vigilant and strictly enforce preventive measures against avian influenza.

"The public can call 1823 Call Centre for follow up if they come across suspicious sick or dead birds, including carcasses of wild birds and poultry," the spokesman said.

Members of the public are reminded to observe good personal hygiene. They should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. Poultry and eggs should be thoroughly cooked before consumption.
 

All birds on the second infected premises have been humanely destroyed and will be disposed of in accordance with provincial environmental regulations and internationally accepted disease control guidelines.
 

People are rarely affected by avian influenza, except in a limited number of cases when individuals have been in close contact with infected birds. Nevertheless, public health authorities are taking precautionary measures as warranted.
 

Tests to date indicate the strain of avian influenza virus on the second premises is of low pathogenicity and similar to the original virus identified on the first infected premises. Further testing is underway to confirm the precise pathogenicity, subtype and strain of the virus.
 

The CFIA has applied movement restrictions on commercial poultry operations within three kilometres of the second infected premises. This new 3-km radius overlaps the 3-km radius previously established around the first infected premises. The CFIA has placed quarantines on an additional 12 premises as a result. Ten of the new quarantines are within the new 3-km radius and two are for premises that have had some contact with the second infected premises. Surveillance activities will be undertaken of these newly quarantined premises for a minimum of twenty-one days.
 

The total number of quarantined premises as of February 13, 2009 is 45.
 

Prior to moving poultry or poultry products off the quarantined premises, birds must be sampled, tested negative and a license for their movement must be issued by the CFIA.
 

Poultry owners in the area are encouraged to take an active role in protecting their flocks by enhancing their biosecurity measures, monitoring their flocks regularly and immediately reporting any signs of illness that could be consistent with avian influenza by calling 604-227-1753.
 

Wisconsin: Op-ed as state receives high marks for pandemic flu preparedness [Feb 9 Milwaukee] by Karen Timberlake, Secretary, Wisconsin Dept of Health Services--Planning and preparing for emergencies is a continual process that requires the efforts of federal, state and local officials. In Wisconsin, we are fortunate to have dedicated partners that plan, test and exercise preparedness plans that cover a variety of emergencies, both man made and acts of nature. One of these emergencies that we plan for is a pandemic flu outbreak.

Recently, Wisconsin's hard work on disaster preparedness and pandemic flu planning has been recognized nationally. As a result, our counterparts in other states are modeling the success that Wisconsin has achieved.

Last December, the Trust for America's Health gave Wisconsin a perfect score on 10 key preparedness indicators. The report, Ready or Not, noted improvement in pandemic influenza planning, public risk communication, disease tracking and tactical communication. Wisconsin's State Laboratory of Hygiene was praised as "a first-class operation."

Also, an assessment done in 2008 led by the U.S. Department of Health and Human Services and submitted to U.S. Homeland Security ranked Wisconsin among the top states in the nation for pandemic flu preparedness

Both achievements reflect the hard work of state agencies, local government and the private sector. For example, receiving and distributing medications in a public health emergency requires an orchestrated ballet involving Federal strike teams, state health officials, Wisconsin's National Guard and State Patrol, local health departments, healthcare providers, distribution sites, and a volunteer medical support corps.

Public health, public safety and law enforcement professionals are planning with businesses, utilities, health care providers, education and community-service organizations to respond "as one" to emergencies.

This professionalism and can-do attitude not only helps us prepare for emergencies that have not yet occurred, but is also demonstrated by the response to real events that happen in our state now. Wisconsin's prompt response to last spring's large scale flooding emphasizes our progress. Thirty counties suffered closed highways, destroyed homes, contaminated wells, and disruption of business and tourism.

Throughout the crisis, local, state and federal officials worked together with each community to save lives, control damage, prevent disease and injury, supplement human services, and support economic relief. Intensive prior planning, training and drills helped shape this response. The lessons learned this time will further improve our response to the state's next emergency.

We will continue to work with our partners across the state to continue to prepare and test so that we can help serve the citizens of our state effectively. We also encourage you to think about what you can do in your home and community to prepare yourself.

President Eisenhower once said, "Plans are useless but planning is indispensable." Relationships and skills developed through plans and drills pay off in unexpected ways during any incident. We look forward to continuing to work with our partners on the federal, local and statewide level to help continue our preparation to help the citizens of our state when they are in need.

Egypt: 55th human case of H5N1 infection confirmed [Feb 9 Cairo]--The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A(H5N1) virus infection. The case is a one and a half year old male from the Maghagha District of Menia Governorate. His symptoms began on 6 February and he was hospitalized at the Maghagha Fever Hospital on 7 February where he remains in a stable condition. Infection with the H5N1 avian influenza virus was confirmed by the Egyptian Central Public Health Laboratory.

Investigations into the source of his infection indicate a history of close contact with dead poultry prior to becoming ill.

Of the 55 cases confirmed to date in Egypt, 23 have been fatal.

Egypt: 54th human case of H5N1 infection confirmed [Feb 6 Cairo]--The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A(H5N1) virus infection. The case is a 2-year-old male from Suez Governorate, Ganain District. His symptoms began on 2 February and he was hospitalized at the Suez Fever Hospital on 3 February. He remains in a stable condition. Infection with the H5N1 avian influenza virus was confirmed by the Egyptian Central Public Health Laboratory.

Investigations into the source of his infection indicate a recent history of contact with dead poultry.

Of the 54 cases confirmed to date in Egypt, 23 have been fatal.

China: Latest avian influenza tests positive for three more dead birds [Feb 5 Hong Kong]--Under the present surveillance programme on dead wild birds, preliminary testing of three bird carcasses collected in the past few days has indicated suspected cases of H5 avian influenza, a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (February 5), adding that further confirmatory tests were being conducted.

___

Following is the transcript of remarks made by the Secretary for Food and Health, Dr York Chow, at a stand-up media session after attending Hospital Authority Spring Gathering 2009 today (February 5):

Reporter: (inaudible)

Secretary for Food and Health: It is very difficult to postulate where the three carcasses came from. But from the various investigations we have done, it is most likely drifting down from the Pearl River in the last week or two. Some of the new carcasses we have found are still under investigation. So far we have not found any extra H5 affected carcasses.  But as you know that we are doing wild bird and dead bird surveillance all the time. We test about 40 to 80 dead birds all over the territory every day. These include both those we have discovered in North Lantau and other areas. If we found any positive test results, we will announce right away. Every year we found some 10 to 20 such cases. As long as they are limited to wild birds, the risk to Hong Kong people is not that high because it has not been reported that wild birds can transmit the disease directly to human beings. It is usually through infection of poultry, and then the sick poultry would affect human beings.

Reporter: (about the risk of avian influenza)

Secretary for Food and Health: I don’t think so because the whole region is still under the threat of avian flu, particularly during the whole winter. It is usually after May that the whole region starts to warm up, we will then see a decline of these incidents.

Reporter: (about the H5N1 virus)

Secretary for Food and Health: Let me talk about the virus samples we have collected so far. In the three carcasses which we have isolated the virus, the preliminary discovery is that it is related to a similar type of virus that happened in the southern part of China in the last two years, which is clade 2.3.2. But it is slightly different from what we have discovered last year in our market and the outbreak in our local farm in December, which is clade 2.3.4. But these are quite common clades of avian flu in the southern part of China and Hong Kong. It is certain that there is no significant mutation of the virus. That is actually what we have discovered so far. On the eight human infections of avian flu in the Mainland, we do not have the full report yet. But according to the preliminary information that is given to us, it is similar to the various virus that was isolated in northern China in the last one or two years. So there is no significant epigenic mutation. As far as the nature of the virus is concerned, we are confident that at this moment there is no evidence of human to human transmission and no significant epigenic change.

Reporter: (inaudible)

Secretary for Food and Health: What I have told you is that the virus has not changed that much. Whether the poultry and reaction to the virus, and whether the type of vaccine that is given to the various poultry in different parts of China might have slightly different response, these are something that we cannot conclude at this moment.

Reporter: The threat of avian influenza is still there, right?

Secretary for Food and Health: The threat is always there. We should always be vigilant against infectious diseases, particularly new diseases.  For avian flu, the most important aspect is to prevent any people from approaching sick poultry or poultry from unknown source. This is the most important point I want to stress. If we can stay away from live poultry, particularly sick poultry or poultry from unknown source, I think we are pretty safe. I hope this will be the message you can tell all the citizens, particularly those who might have a habit of shopping in places where the poultry might come from unknown source, whether it is in Hong Kong or across the border. This is a very important message for them.

China: SW province reports sixth human bird flu case in 2009 [Feb 4 Guiyang]--A 29-year-old man had been confirmed as infected with bird flu in southwest China's Guizhou Province, the sixth case of human bird flu found in China this year, local authorities said Sunday.

The man, surnamed Zhou, fell ill on Jan. 15 in Guiyang City, the provincial capital. He was then sent to Guizhou Provincial People's Hospital, said a provincial health department official.

The man is still in a critical condition, the official said.

Zhou tested positive for the H5N1 strain of avian influenza, according to the test result on Sunday from the Chinese Center for Disease Control and Prevention.

Guizhou has launched an emergency response against the virus. Those who had close contact with the patient are under medical observation. No one has been found ill so far.

China's Ministry of Health has reported the case to the World Health Organization and informed the health authorities of the Hong Kong and Macao special administrative regions.

China: Carcasses of a goose and two ducks tested positive for H5 virus [Jan 31 Sha Lo Wan]--Preliminary testing of a dead goose and two dead ducks found in Sha Lo Wan, Lantau has indicated a suspected case of H5 avian influenza, a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (January 31), adding that further confirmatory tests were being conducted.

The carcasses of a goose and a duck were found and collected on January 29 at a beach near Sha Lo Wan football pitch. They were highly decomposed when being found. Today AFCD staff collected another dead duck at the same location.

The spokesman said there were no poultry farms within three kilometres of where the carcasses were found. This morning AFCD staff conducted inspection of the beach and the nearby villages of Sha Lo Wan Tsuen and Sha Lo Wan San Tsuen. There was no evidence of any backyard poultry being kept there.

AFCD is very concerned about the incident and will continue to monitor the situation. Inspections of the beach and its vicinity will be stepped up. The department is looking into different possibilities of why the goose and duck carcasses were found at the beach, including whether they had been washed ashore or dumped.

The spokesman said a ban on backyard poultry has been in force since 2006. Unauthorised keeping of five kinds of poultry -chickens, ducks, geese, pigeons or quails – is an offence with a maximum fine of $50,000. Repeat offenders are subject to a maximum fine of $100,000.

"The public can call 1823 Call Centre for follow up if they come across suspicious sick or dead birds, including carcasses of wild birds and poultry," the spokesman said.

The Centre for Health Protection of the Department of Health (DH) is contacting relevant parties and has put them under medical surveillance. People are advised to consult their doctors for medical advice promptly if they develop symptoms of influenza.

Members of the public are reminded to observe good personal hygiene. They should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. Poultry and eggs should be thoroughly cooked before consumption.

"In view of the case, the AFCD has phoned poultry farmers reminding them to strengthen precautionary and biosecurity measures against avian influenza. Pet bird shop owners, licence holders of pet poultry and racing pigeons have also been reminded to take proper precautions," the spokesman said.

The spokesman said that the department would conduct frequent inspections of poultry farms, the wholesale market and the Yuen Po Street Bird Garden to ensure that proper precautions against avian influenza had been implemented. The department would continue its wild bird monitoring and surveillance.

The Food and Environmental Hygiene Department (FEHD) will continue to be vigilant over imported live poultry as well as live poultry stalls. It will also remind stall operators to maintain good hygiene.

DH will enhance health education and distribute health advice leaflets.

AFCD, FEHD, the Customs and Excise Department and the Police will strive to deter the illegal import of poultry and birds into Hong Kong to minimise the risk of avian influenza outbreaks brought by imported poultry and birds that had not gone through inspection and quarantine.

The spokesman said the threat of avian influenza remained. The relevant departments will remain vigilant and continue to strictly implement preventive and control measures against avian influenza.

China: Notification of a human case of H5N1 in Hunan Province [Jan 31 Hong Kong]--The Centre for Health Protection (CHP) of the Department of Health received notification from Ministry of Health (MoH) tonight (January 31) concerning a confirmed human case of avian influenza H5N1.

A CHP spokesman said the patient was a 21-year-old farmer living in Xupu, Hunan. She developed symptoms on January 23. She is now receiving medical treatment. She is in stable condition. She had a history of exposure to dead sick poultry before onset of symptoms.

Laboratory tests on the patient's specimen by Chinese Centre for Diseases Control and Prevention yielded positive to H5N1.

Further investigations on her contact history with poultry before the onset of symptoms are on-going.

The CHP is maintaining close liaison with the MoH to obtain more information on the case.

The spokesman reminded members of the public to remain vigilant against avian influenza infection and to observe the following measures:

* Avoid direct contact with poultry and birds or their droppings; if contacts have been made, they should wash hands thoroughly with soap and water;
* Poultry and eggs should be thoroughly cooked before eating;
* Wash hands frequently;
* Cover nose and mouth while sneezing or coughing, hold the spit with tissue and put it into covered dustbins;
* Avoid crowded places and contact with sick people with fever;
* Wear a mask when you have respiratory symptoms or need to take care of patients with fever;
* When you have fever and influenza-like illnesses during a trip or when coming back to Hong Kong, you should consult doctors promptly and reveal your travel history.
 

Nepal: On alert against bird flu [Jan 29 Kathmandu]--The authorities in southeastern Nepal are stepping up anti-bird flu measures after the first case of a bird found to have the deadly H5NI virus was discovered earlier this month. There have been no reports of humans affected.

To date 26 out of 75 districts in the densely populated Terai region in the south of the country bordering India have been placed on high alert.

The move follows the virus’s detection in the town of Kakarvitta, Jhapa District, bordering on the Indian state of West Bengal, nearly 450km southeast of Kathmandu, on 16 January.

“We are taking all measures to prevent further infections among birds,” said Manas Kumar Banerjee, coordinator of the Health Ministry’s Avian Influenza Control Project (AICP).

An emergency cabinet meeting on 19 January ordered the culling of all birds within 3km of Kakarvitta. As of 26 January, more than 23,000 had been culled. All poultry meat, eggs and production facilities in the area were to be destroyed.

Ban on Indian products

Nepal has been concerned about a possible outbreak since India reported its first case in 2006: Large amounts of poultry were imported from the Indian states of West Bengal and Bihar, but Nepal has now banned the import of all poultry products from its neighbour.

The Word Health Organization (WHO) described a January 2008 outbreak of bird flu in West Bengal as the worst ever in India.

The decision to ban poultry products would remain in tact unless international institutions certified that an epidemic no longer existed in India, according to Dalaram Pradhan, director-general at the government’s Department of Livestock Services (DLS).

The authorities have also warned Nepalese traders against illegally importing birds, promising firm action against violators.

Police and health officials have started checking vehicles suspected of carrying birds or poultry meat from India, and more than 50 families with coughs or respiratory problems have been investigated.

Kathmandu has sought New Delhi's help in controlling the spread of bird flu, as well as stopping the illegal export of birds.

Preparedness

Since 2006 when bird flu was detected in India, the AICP has been supported by the UN and World Bank, and the latter has provided a grant of more than US$18 million for the AICP over four years.

Although there have been bans by the authorities on the import of Indian poultry and eggs, they were very poorly implemented, said a local public health expert.

In the past the UN has warned that Nepal was vulnerable, given the large number of migrating birds.

According to the WHO, since 2003 there have been 399 confirmed human cases of avian influenza worldwide, of whom 251 died.

WHO remains concerned that the H5N1 virus might mutate or combine with a highly contagious seasonal influenza virus to spark a pandemic that could kill millions of people.

Europe: Avian influenza in China - assessment of recent human cases of H5N1 [Jan 28 Stockholm Sweden]--PUBLIC HEALTH ISSUE: Assessment of the epidemiological situation in China in relation with 4 confirmed human cases of influenza A(H5N1) reported in 3 weeks.

DISEASE BACKGROUND INFORMATION

Travellers to China and other affected countries should be reminded of the importance of following ECDC’s guidance of not handling poultry and not visiting live poultry markets without practising good hygiene http://ecdc.europa.eu/en/Health_Topics/avian_influenza/travelling.pdf.

CONCLUSIONS

The second case, a 2-year-old female from East Jakarta, developed symptoms on 18 November, was hospitalized on 26 November and died on 29 November. Laboratory tests have confirmed infection with the H5N1 avian influenza virus. Initial investigations into the source of her infection suggest exposure at a live bird market.

Of the 139 cases confirmed to date in Indonesia, 113 have been fatal.

Genetics provide evidence for the movement of avian influenza viruses from Asia to North America via migratory birds [Oct 31 Reston VA]--Wild migratory birds may be more important carriers of avian influenza viruses from continent to continent than previously thought, according to new scientific research that has important implications for highly pathogenic avian influenza virus surveillance in North America.

As part of a multi-pronged research effort to understand the role of migratory birds in the transfer of avian influenza viruses between Asia and North America, scientists with the U.S. Geological Survey (USGS), in collaboration with the U.S. Fish and Wildlife Service in Alaska and the University of Tokyo, have found genetic evidence for the movement of Asian forms of avian influenza to Alaska by northern pintail ducks.

In an article published this week in Molecular Ecology, USGS scientists observed that nearly half of the low pathogenic avian influenza viruses found in wild northern pintail ducks in Alaska contained at least one (of eight) gene segments that were more closely related to Asian than to North American strains of avian influenza.

It was a highly pathogenic form of the H5N1 avian influenza virus that spread across Asia to Europe and Africa over the past decade, causing the deaths of 245 people and raising concerns of a possible human pandemic. The role of migratory birds in moving the highly pathogenic virus to other geographic areas has been a subject of debate among scientists. Disagreement has focused on how likely it is for H5N1 to disperse among continents via wild birds.

"Although some previous research has led to speculation that intercontinental transfer of avian influenza viruses from Asia to North America via wild birds is rare, this study challenges that," said Chris Franson, a research wildlife biologist with the USGS National Wildlife Health Center and co-author of the study. Franson added that most of the previous studies examined bird species that are not transcontinental migrants or were from mid-latitude locales in North America, regions far removed from sources of Asian strains of avian influenza.

Scientists with the USGS, in collaboration with the U.S. Fish and Wildlife Service, state agencies, and Alaska native communities, obtained samples from more than 1,400 northern pintails from locations throughout Alaska. Samples containing viruses were then analyzed and compared to virus samples taken from other birds in North America and Eastern Asia where northern pintails are known to winter. Researchers chose northern pintails as the focus of the study because they are fairly common in North America and Asia, they are frequently infected by low pathogenic avian influenza, and they are known to migrate between North America and Asia. None of the samples were found to contain completely Asian-origin viruses and none were highly pathogenic.

"This kind of genetic analysis - using the low pathogenic strains of avian influenza virus commonly found in wild birds - can answer questions not only about the migratory movements of wild birds, but the degree of virus exchange that takes place between continents, provided the right species and geographic locations are sampled," said John Pearce, a research wildlife biologist with the USGS Alaska Science Center and co-author of the study. "Furthermore, this research validates our current surveillance sampling process for highly pathogenic avian influenza in Alaska and demonstrates that genetic analysis can be used as an effective tool to further refine surveillance plans across North America, Pearce added.

Implications of the Research:

* Migratory bird species, including many waterfowl and shorebirds, that frequently carry low pathogenic avian influenza and migrate between continents may carry Asian strains of the virus along their migratory pathways to North America.
* USGS researchers found that nearly half of influenza viruses isolated from northern pintail ducks in Alaska contained at least one of eight virus genes that were more closely related to Asian than North American strains. None of the samples contained completely Asian-origin viruses and none were highly pathogenic forms that have caused deaths of domestic poultry and humans.
* The central location of Alaska in relation to Asian and North American migratory flyways may explain the higher frequency of Asian lineages observed in this study in comparison to more southerly locations in North America. Thus, continued surveillance for highly pathogenic viruses via sampling of wild birds in Alaska is warranted.

Future surveillance for avian influenza in wild birds should include the type of genetic analyses used in this study to better understand patterns of migratory connectivity between Asia and North America and virus ecology.

Website for USGS northern pintail avian influenza research.

Avian flu threat: New approach needed [Oct 24 London England]--As the first globally co-ordinated plan for the planet's gravest health threats is hatched by government ministers from around the world this weekend, a new report sets out a 10-point plan for this new, globalised approach to infectious diseases such as avian flu.

The full report and its bite-sized companion briefing may be accessed online.

THE STEPS CENTRE (Social, Technological and Environmental Pathways to Sustainability) is a new interdisciplinary global research and policy engagement hub uniting development studies with science and technology studies. We aim to develop a new approach to understanding, action and communication on sustainability and development. The STEPS Centre is collaboration between the Institute of Development Studies and SPRU Science and Technology Policy Research at the University of Sussex with a network of partners in Asia, Africa and Latin America and is funded by the Economic and Social Research Council. Find out more online.

In a new study published August 13 in the journal PLoS ONE, Daniel Perez (of the University of Maryland) and colleagues used ferrets to characterize the mechanism of replication and transmission of recent avian H9N2 viruses. The researchers show that some currently circulating avian H9N2 viruses can transmit to naïve ferrets placed in direct contact with infected ferrets. However, aerosol transmission was not observed, a key factor in potentially pandemic strains.

More importantly, Perez and colleagues show that a single amino acid residue (Leu226) at the receptor-binding site (RBS) of the hemagglutinin (HA) surface protein plays a major role in the ability of these viruses to transmit. They also found that an avian-human H9N2 reassortant virus increases virulence, pathology and replication in ferrets. These results suggest that the establishment and prevalence of H9N2 viruses in poultry could pose a significant threat for humans.

Citation: Wan H, Sorrell EM, Song H, Hossain MJ, Ramirez-Nieto G, et al. (2008) Replication and Transmission of H9N2 Influenza Viruses in Ferrets: Evaluation of Pandemic Potential. PLoS ONE 3(8): e2923. doi:10.1371/journal.pone.0002923

The comic book follows the fictional account of a young World War I veteran and his family as their world is transformed overnight by the arrival of the deadly flu virus. No Ordinary Flu also describes the current threat of a flu pandemic and includes information on how to prepare.

Artist David Lasky brings a personal connection to his work on the comic, as his great-grandmother died during the 1918 pandemic that killed over 675,000 Americans. Her grieving husband left three of his children to be raised in an orphanage, including Lasky’s grandmother.

“The 1918 pandemic left such a mark on my family, but until this project, I never really knew much about the pandemic itself,” commented Lasky. “I was completely surprised to learn how deadly it was, and how quickly it had spread.”

“A severe pandemic would affect the lives of everyone in our community, and this comic book helps people to visualize pandemic flu’s speed and impact, which can be difficult to grasp,” explained Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “Everyone needs to prepare for the health and economic impacts of a pandemic, so we’re delivering the message in a way that reaches diverse communities.”

The idea for No Ordinary Flu came from requests from local immigrant groups for emergency preparedness materials that use pictures to communicate. Public Health educators chose the comic book format because comics are widely read by people of all ages in parts of Latin America and Asia. The comic book has been translated into 11 languages to make it accessible to many of King County’s immigrant populations. All language versions are available from the Public Health – Seattle & King County website.

“My great-grandmother who died in the 1918 pandemic was an immigrant from Russia,” noted Lasky. “So knowing that this comic is available in multiple languages and could be helping to save lives in today's immigrant communities makes me very proud to have participated.”

A pandemic flu is a new influenza virus that could be a much more serious flu virus than seen in a typical flu season. Different from the typical, seasonal strains of flu, humans would have no or little natural resistance to a new strain of influenza.

Once a pandemic virus develops, it can spread rapidly with the ease of global travel, causing outbreaks around the world. The Centers for Disease Control and Prevention (CDC) predicts that as much as 25% to 30% of the United States population could be affected. In King County alone, a severe pandemic flu could make 540,000 people ill, over 59,000 would need hospitalization, and 11,500 could die in the first six weeks of an outbreak.

Funding for the comic book was provided by the National Association of County and City Health Officers (NACCHO) Advanced Practice Center (APC) Program, a diverse network of local health departments actively working to help the public health community prepare for, respond to, and recover from public health emergencies and other disasters.

"This guidance is the result of a deliberative democratic process," HHS Secretary Mike Leavitt said. "All interested parties took part in the dialogue; we are confident that this document represents the best of shared responsibility and decision-making."

"A severe pandemic has the potential to disrupt our everyday way of life," said DHS Assistant Secretary for Health Affairs and Chief Medical Officer Dr. Jeffrey Runge. "This guidance was developed to ensure that our nation's critical infrastructure remains up and running and we address the needs of all of our citizens, enabling the country to recover from a pandemic more quickly."

As part of developing the guidance, HHS held day-long public engagement and stakeholder meetings throughout the country and received more than 200 written public comments on the goals and objectives of pandemic vaccination. In all the meetings, stakeholders and the public identified the same four vaccination program objectives as the most important:

• Protect persons critical to the pandemic response and who provide care for persons with pandemic illness;
• Protect persons who provide essential community services;
• Protect persons who are at high risk of infection because of their occupation; and
• Protect children.

The guidance is also firmly rooted in the most up-to-date scientific information available and directly considers the values of our society and the ethical issues involved in planning a phased approach to pandemic vaccination.

The ultimate goal of the pandemic vaccination program is to vaccinate every person in the United States who wants to be vaccinated. Because pandemic vaccine cannot be made fast enough for everyone to be vaccinated at once, federal, state, local and tribal governments, communities, and the private sector can use the guidance to decide who should be vaccinated during this early stage to best protect people and communities.

The guidance's vaccination structure defines four broad target groups: people who 1) maintain homeland and national security, 2) provide health care and community support services, 3) maintain critical infrastructure and 4) are in the general population.

Everyone in the United States is included in at least one vaccination target group. People who are not included in any occupational group would be vaccinated as part of the general population based on their age and health status.

While vaccines are an important resource in a pandemic, vaccination will only be one of several tools to fight the spread of influenza if and when a pandemic emerges. Other tools include community public health measures, antiviral medications, facemasks and respirators, washing hands, and covering coughs and sneezes.

Among those most vulnerable to a pandemic flu outbreak are the 2.5 million residents of the nation's 18,000 residential care (nursing home) facilities. Because there are few anti-virals and no vaccines available to combat such a flu epidemic, these facilities most likely will try to prevent introduction of the flu through non-pharmaceutical interventions (NPI), like the use of masks, social distancing, isolating symptomatic persons, etc.

But among NPI interventions, which methods or combinations of methods will work and be effective in keeping the flu outside the walls of a facility or keep the flu spread to a minimum among a population that literally will be sitting ducks in the path of the disease?

Now, a team of researchers, including one from Arizona State University, has taken a major step in determining what will work by developing mathematical models and testing scenarios that show which NPIs are appropriate for which levels of pandemic flu. Their work is published in an early on-line edition (July 21) of the journal Proceedings of National Academy of Sciences.

"Our work is the first to provide a flexible road map for prevention and protection of vulnerable populations living in residential care facilities, said Gerardo Chowell-Puente, an assistant professor in ASU's School of Human Evolution and Social Change.

"We found that something previously considered implausible – the protection of a health care institution against pandemic influenza by using only non-pharmaceutical measures – may be possible and may be practical," Chowell-Puente said. "We want this work to get those concerned with mitigating the impact of pandemic influenza in such facilities to evaluate and consider implementation of the recommendations implicit in our study."

In "Protecting residential care facilities from pandemic influenza," authors Miriam Nuño of UCLA and the Harvard's School of Public Health; Tom Reichert of the Entropy Research Institute; Abba Gumel of the University of Manitoba along with Chowell-Puente, say their roadmap provides an important planned first line of defense for the pandemic flu.

"Currently, most facilities do not have a ready to implement plan in place should a pandemic take place," the researchers said. "Our work details a set of simple interventions that seem workable and may be easily implemented by current staff members."

Five types of NPIs were evaluated. They included: screening visitors and staff who leave and then return to the facility; isolating symptomatic residents; placing restrictions on visitors, like reducing visit times or having them use electronic communications devices or communicating from behind transparent impermeable barriers; modifying work schedules, which could include four full days on site followed by four full days off site with a period of isolation from the community for a portion of the time off site; and precautions taken by staff and visitors to reduce their risk of infection, like washing hands and using protective masks.

"Overall, we found that conventional NPIs sufficed to curtail only mild outbreaks, and that higher level of NPIs requiring greater social restrictions and higher levels of cooperation were needed to manage more severe outbreaks," said Chowell-Puente, who evaluated the NPIs effectiveness through the use of mathematical models for the study.

"The biggest surprise in our study was identifying the critical role that staff plays in controlling the spread and preventing the introduction of disease in the facilities," said lead author Miriam Nuño.

"Many residential facilities (like nursing homes) are chronically understaffed," Nuño added. "Our research shows the current working demands of staff need to be improved if we hope to improve our preparedness plans."

Some of the improvements, the researchers note, include more regular work hours and schedules for care givers, as well as other basic benefits, like paid sick days.

"Our research shows that work schedules that include multiple days on-site at the facility are the key to surviving pandemics. With that practice, employees must go into isolation for several days at home before coming back to work. But, the benefits from longer work- and off-periods incorporating isolation periods can only be had if employees can be fully engaged in the protection of their institution," the researchers stated.

"Facilities must eliminate disincentives. For example, employees sick themselves with the flu or forced to care for afflicted family members must be paid for time away. A single act of non-cooperation can bring down an entire facility. In return, those employees who recover become immune, become fully available for further service and no longer represent a threat for introducing the virus," they added.

Home health care agencies already provide routine care for acute and chronically ill, permanently disabled and terminally ill patients. In fact, on any given day, there are three times as many patients in home health care settings as there are in hospitals.

"To date, there has been little information about how home health providers could meet a sudden demand for services during a public health emergency, although it is extremely likely that these agencies would be called on to provide additional services at a time of need," said AHRQ Director Carolyn M. Clancy, M.D. "This report offers practical advice and potential strategies to ensure that home health care can meet emergency demands and continue to provide safe, high-quality care."

The report emphasizes the home health care sector's potential to help handle a surge in patients during a biologic event and stresses the need for involvement of home health care agencies in advance planning and coordination at the local level. It offers resources and suggestions on addressing key elements of home health care preparedness and includes lists of existing tools and models throughout.

Examples of issues and strategies addressed in the report include:

• Exploring the use of technology to monitor patients at a distance.
• Collaboration with community partners.
• Legal and ethical considerations of providing care under emergency conditions.
• Home health care workforce issues, including training.
• Recommendations for additional action and research at the Federal, State and local levels.

"Community planners, state and local public health departments and health care systems must look critically at leveraging the existing resources of home health care agencies to meet the possible surge demands of an influenza pandemic," said HHS Assistant Secretary for Preparedness and Response RADM W. Craig Vanderwagen, M.D., whose office initiated and funded the report in collaboration with the Centers for Disease Control and Prevention.

"Home health care agencies, community-based service providers and area agencies on aging are an essential fabric of our communities," added Josefina G. Carbonell, HHS Assistant Secretary for Aging. "The services they provide are already necessary for home and community living for more than 10.4 million older adults and their caregivers. A pandemic will increase the need for these services and provide challenges to their delivery."

The report, Home Health Care During an Influenza Pandemic: Issues and Resources, is based on the findings of an expert panel meeting, including representatives of home health care, emergency and disaster planning, professional organizations and federal and state government agencies. The report can be accessed online.

"The mutations needed for the emergence of a potential pandemic virus are likely to originate and be selected within infected human tissues," said Professor Dr Prasert Auewarakul from Mahidol University, Thailand. "We analyzed specific molecules called haemagglutinin on viruses derived from fatal human cases. Our results suggest new candidate mutations that may allow bird flu to adapt to humans."

Viruses with a high mutation rate such as influenza virus usually exist as a swarm of variants, each slightly different from the others. These are called H5N1 bird flu quasispecies. Professor Dr Auewarakul and his colleagues found that some mutations in the quasispecies were more frequent than others, which indicates they may be adaptive changes that make the virus more efficient at infecting humans. Most of these mutations were found in the area required for the virus to bind to the host cell.

"This study shows that the H5N1 virus is adapting each time it infects a human," said Professor Dr Auewarakul. "Such adaptations may lead to the emergence of a virus that can cause a pandemic. Our research highlights the need to control infection and transmission to humans to prevent further adaptations."

The research has provided genetic markers to help scientists monitor bird flu viruses with pandemic potential. This means they will be able to detect potentially dangerous strains and prevent a pandemic. The research also gives new insights into the mechanism of the genesis of a pandemic strain.

"Our approach could be used to screen for mutations with significant functional impact," said Professor Dr Auewarakul. "It is a new method of searching for changes in H5N1 viruses that are required for the emergence of a pandemic virus. We hope it will help us to prevent a pandemic in the future."

Researchers from the University’s National Centre for Epidemiology and Population Health and ANU Medical School examined 89 Australian and international pandemic response plans and found general practice involvement was limited, and sometimes not considered.

Research lead Associate Professor Mahomed Patel says international evidence from the SARS outbreaks and influenza epidemics illustrates GPs and allied health professionals have an important role to identify and treat cases, take on hospital workload and continue to support the chronically ill in the event of an outbreak.

“Studies in other countries show that during public health emergencies, most people prefer to see their GPs whom they trust and have a good relationship with. Yet most plans focused on the responses by health departments with little reference to collaborations with GPs,” he said.

Despite health experts around the world saying a pandemic was a ‘when not if’ scenario, pandemic planning is still not seen as an activity to be jointly prepared by health departments, general practitioners and hospitals, Dr Patel added.

“With over 97 million visits annually, general practice is Australia’s single largest health sector. If we do not prepare it well, our responses will fail in critical points during an influenza pandemic,” he said.

The researchers have devised a framework to guide planning to include general practice covering clinical care for influenza and other conditions, public health responsibilities, the internal environment of general practice and interactions within the broader health system.

General practice coordination was identified as an area of need during Exercise Cumpston 2006, which tested systems for an influenza outbreak, and national guidelines for primary care providers are being developed, the researchers said. The researchers also emphasise the need to move beyond a paper exercise in planning, to drills, simulations and continuing collaboration among people who will need to pull together in a crisis situation.

On March 29, 2006, the Deputy Secretary of Energy signed a memorandum, "Development of the Department of Energy Pandemic Influenza Plans," which required all DOE entities, including the National Nuclear Security Administration [NNSA], to develop specific pandemic influenza plans with full implementation by May 31, 2006. On November 8, 2006, the White House Homeland Security Council issued a pandemic influenza plan checklist that contained additional criteria for agencies to follow. The objective of the DOE inspection was to determine if DOE was taking appropriate and timely actions regarding its pandemic influenza planning.

Results of inspection: The inspection team concluded that while DOE Headquarters and many department sites were making progress in their pandemic influenza planning, much remained to be implemented... Read the entire report online at:

Professor Nigel Lightfoot, of the Health Protection Agency said “The framework sets out the Government's strategic approach to preparing for an influenza pandemic and gives guidance to all public and private organisations to further develop their plans for a flu pandemic. The plan will support flu preparedness and help reduce the impact of pandemic flu on the UK population.

“The Agency helps people prepare for a flu pandemic. UK planning and preparedness is well advanced and a significant number of exercises to test these plans have been carried out locally, regionally and at a national level”.

The HPA plays a key role in informing public health policy development on pandemic influenza, through its expert advice, modelling and reference virological services. It has produced a suite of guidance documents for control of infection in health and non-health settings. The HPA has produced protocols and algorithms for the investigation and management of early cases and contacts, and it keeps a watch on the global avian influenza situation by carrying out periodic risk assessments. During a pandemic the HPA will provide surveillance information and real time modelling of the expected impacts to inform Government decisions.

Published: 22 November 2007

This document describes the Government's strategic approach for responding to an influenza pandemic published jointly by the Department of Health and the Cabinet Office. It provides background information and guidance to public and private organisations developing response plans. It updates and expands upon health advice and information contained in previous plans issued by UK health departments and is intended to replace those documents. Supporting guidance includes an ethical framework and operating guidance for adult social care, ambulance services, community and acute healthcare.

• Pandemic flu: A national framework for responding to an influenza pandemic, and supporting guidance

Invitation to comment

Published: 22 November 2007

The UK’s plans for responding to an influenza pandemic are set out in the recently published Pandemic Flu: A national framework for responding to an influenza pandemic. To assist responders in developing their local plans further draft guidance has been produced with the participation and advice of subject experts and representatives from key stakeholder groups. We are seeking wider comments on these drafts and would particularly welcome views and contributions from those individuals and organisations involved in pandemic influenza planning and preparedness. These will be collated and analysed in depth and used to inform final guidance on this issue, which will be available on the DH website in the summer. We would be grateful for your comments by 22 February 2008.

• Consultation on pandemic influenza

Pandemic influenza: guidance for infection control in hospitals and primary care settings

Published: 22 November 2007

This guidance document replaces the infection control guidance published in October 2005. The changes and amendments in this edition are detailed on page 4 and include updated advice on aerosol- generating procedures. This advice takes into consideration and addresses the categorisation of such procedures in the recently published interim guidance from the World Health Organization on 'Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care' (June 2007).

• Pandemic influenza: guidance for infection control in hospitals and primary care settings

Scientific evidence paper

Published: 22 November 2007

Cabinet Office paper summarising the wide-ranging evidence behind strategies to respond to pandemic influenza.

• Scientific evidence paper

Medicines consultation

Published: 22 November 2007

The consultation on possible changes to medicines and associated legislation for use during a pandemic suggests ways to maintain people's access to regular essential medicines in this period and looks at the amendments which are required to support the operational framework. It asks when these changes might be brought into force and when they should be lifted, how far existing safeguards should be relaxed to ensure access and whether there are other barriers to access that should be considered. The consultation ends on 26 February 2008 and views are welcomed.

• Possible amendments to medicines and associated legislation during an influenza pandemic

Last spring, the World Health Organization (WHO) and vaccine manufacturers said that about 100 million courses of pandemic influenza vaccine based on the H5N1 avian influenza strain could be produced immediately with standard technology. Experts now anticipate that global production capacity will rise to 4.5 billion pandemic immunization courses per year in 2010.

"With influenza vaccine production capacity on the rise, we are beginning to be in a much better position vis-à-vis the threat of an influenza pandemic," Dr Marie-Paule Kieny, Director of the Initiative for Vaccine Research at WHO, said today. "However, although this is significant progress, it is still far from the 6.7 billion immunization courses that would be needed in a six month period to protect the whole world."

"Accelerated preparedness activities must continue, backed by political impetus and financial support, to further bridge the still substantial gap between supply and demand," she said.

This year, manufacturers have been able to step up production capacity of trivalent (three viral strains) seasonal influenza vaccines to an estimated 565 million doses, from 350 million doses produced in 2006, according to the International Federation of Pharmaceutical Manufacturers & Associations. According to experts working in this field, the yearly production capacity for seasonal influenza vaccine is expected to rise to 1 billion doses in 2010, provided corresponding demand exists.

This would help manufacturers to be able to deliver around 4.5 billion pandemic influenza vaccine courses because a pandemic vaccine would need about eight times less antigen, the substance that stimulates an immune response. Vaccine production capacity is linked to the amount of antigen that has to be used to make each dose of the vaccine. Scientists have recently discovered they can reduce the amount of antigen used to produce pandemic influenza vaccines by using water-in-oil substances that enhance the immune response.

The progress was reported Friday at the first meeting of a WHO Advisory Group on pandemic influenza vaccine production and supply.

The Global Action Plan Advisory Group, an independent, international committee of 10 members, met at WHO headquarters one year after eight new strategies to increase pandemic influenza vaccine were identified and published in the WHO Global pandemic influenza action plan to increase vaccine supply.

At the Advisory Group meeting, other progress on the Global Action Plan was discussed. WHO reported it is setting up a training hub that would serve as a source of technology transfer to developing countries.

The Advisory Group also discussed a new business plan which assessed options for further increasing vaccine production capacity and reviewed priority next steps. The three most valuable options include continuing to promote seasonal influenza vaccine programmes, supporting the industry to sustain production capacity beyond seasonal demand and enabling some vaccine production facilities to change, at the onset of a pandemic, from producing inactivated vaccines to live attenuated vaccines. Due to the higher yields obtained with live attenuated influenza vaccine technology, facility conversion could, by 2012, bridge the expected supply-demand gap and produce enough vaccine to protect the global population within six months of the declaration of a pandemic.

The report concludes that the response to the outbreak was effective and  highlights the benefits of the contingency planning work over the last six years. Disease was contained to one premises and controlled both quickly and successfully. This view was reflected by stakeholders and operational partners demonstrating their increased confidence in the Government’s contingency planning and ability to respond to a disease outbreak.

The report also makes 34 detailed operational recommendations on the management of an outbreak of avian influenza, or other exotic animal disease. These recommendations have all been accepted and have already been adopted in our response to the current Foot and Mouth Disease and Bluetongue outbreaks.

Commenting on the report, the Deputy Chief Veterinary Officer, Fred Landeg, said:

“I welcome the publication of this report and congratulate all those involved for their hard work in containing the outbreak so quickly and effectively.  Even when things have gone well, it is very important to learn the lessons and improve the way we prepare for the future. This is especially relevant as we are in the midst of dealing with two outbreaks of animal disease at the moment. This is a shared responsibility, and I urge the farming industry to work to develop their own contingency plans to prepare for possible future outbreaks too.

“Cases of avian influenza, H5N1, over the last few months in the Czech Republic, Germany and France demonstrate the threat to UK is continuing and real.  We will be at increased risk during the autumn migration period.  Therefore, it is as important as ever that we are properly prepared, and I would urge all bird keepers to retain high levels of vigilance and biosecurity.”

Key themes & recommendations include:

• Working ever more closely with delivery partners and the livestock industry to plan and deliver disease control activities.
• Animal Health working with industry to ensure that plans are in place at every large commercial poultry premises.
• Animal by-product arrangements to be reviewed and strengthened for premises similar to the Holton site.
• Communications need to be fast and effective, focused on key audiences (e.g. through timely use of the GB Poultry Register).

As part of the lessons learned process, Defra and the Food Standards Agency also jointly commissioned an independent review of the role and responsibilities of the Meat Hygiene Service in animal disease outbreaks.  This is also being published. This review concluded that the arrangements had worked well, but that there were lessons to be learned around clarifying roles and responsibilities for designation of slaughterhouses and enforcement activities.

USA: Testimony of Dr. Kimothy Smith, Acting Director of the National Biosurveillance Integration Center before the Senate Homeland Security and Governmental Affairs Committee, Subcommittee on Oversight of Governmental Management, the Federal Workforce, and the District of Columbia

As you may know, the Office of Health Affairs, within DHS, is leading the National Biosurveillance Integration Center, or NBIC, partnership. Establishing NBIC has been, and continues to be, a top priority for Secretary Chertoff. NBIC brings together biological information from various Federal partners and open sources to develop an integrated picture of biological risks. The President has called for a “timely response to mitigate the consequences of a biological weapons attack.” Our mission was initially established through Homeland Security Presidential Directives (HSPDs) 9 and 10. It was also recently codified in title XI of P.L. 110-53, Implementing Recommendations of the 9/11 Commission Act of 2007.

NBIC seeks to provide information to allow early recognition of biological events of national concern, both natural and man-made, to make a timely response possible. No other place in government serves to integrate this information from across the spectrum of public and private, domestic and international, open or protected sources. The three vital component parts of NBIC are:

• A robust information management system capable of handling large quantities of structured and unstructured information;
• A corps of highly-trained subject matter experts and analysts; and
• A clear establishment of a culture of cooperation, trust and mutual support across the Federal government and other partners.

NBIC has agreements with a number of Federal partners and other relevant entities. Many of these agreements have been formalized through MOUs, while others are still being developed. Specifically, we have MOUs with Departments of the Interior, State, Agriculture, Defense, Health and Human Services and Transportation, as well as working closely with our DHS components. We also have formal outreach with the Department of Veterans’ Affairs, FBI, U.S. Postal Service, Environmental Protection Agency and the National Oceanic and Atmospheric Administration. Additionally, we are developing relationships with State Intelligence Fusion Centers and with outside entities such as Georgetown University’s ARGUS Project – who are represented here today. As we have learned throughout this process, each agency and organization is quite unique and there are many forms and types of information out there to identify, capture, analyze and integrate into a common picture. To succeed, we must leverage all possible information sources within their limits. The key to the success of NBIC is the trusted relationships among Federal partners and others who provide access to the valuable information necessary to meet the needs of decision-makers. 

A system of this complex nature, however, is not fully functional without the subject matter expertise and analysis. Thus, subject matter experts from the various agencies and organizations must also be leveraged to examine information, provide informed interpretation, and accomplish consultations, when necessary, to meet the needs of the appropriate decision makers.

To provide additional value to our partners, DHS has the advantage of its access to threat information, which, when integrated with surveillance of health data and disease outbreak trends may provide early warning of a biological attack. To accomplish this, fused information products and other patterns and trends developed from biosurveillance sources are provided to our agency partner, the DHS Office of Intelligence and Analysis, for incorporation with intelligence analysis products. When appropriate, the product can be forwarded to the wider Intelligence Community and pertinent threat analysis information added for return to the Center for further interagency dissemination. This final process of actionable information preparation fuses biosurveillance patterns and trends with threat information. The completed products can then be provided to the National Operations Center (NOC) for inclusion in the Common Operating Picture (COP). This distribution closes the loop by providing biosurveillance situational awareness back to NBIC partner agencies and other organizations.

By integrating and fusing this large amount of available information we can then begin to develop a base-line against which we can recognize anomalies and changes of significance. NBIC seeks to identify patterns and trends, which in combination with threat analysis provide the situational awareness our partners need to execute their mission.

The NBIC is operating today, providing analysis and developing biosurveillance assessments, while responding with our Federal partners to real-world events. However, it should be noted that it is not at Full Operational Capability (FOC). The projected date for full NBIC operations is September 2008. The Center currently operates a 24 hour/7 days a week National Biosurveillance Watch Desk, within the National Operations Center (NOC), which first stood up in December 2005. Over the last few months, we have transitioned to having U.S. Public Health Service officers posted at our Watch Desk, a change that provides a needed, initial “eyes-on” assessment of incoming information to determine potential importance to health security and the need for further analysis. Facilities have been acquired and personnel requirements have been finalized with two-thirds of those requirements filled to date. Interagency Agreements and Memorandums of Agreement (MOAs) have also been developed for the integration of subject matter experts (SMEs) from the Centers for Disease Control and Prevention (CDC) and the Armed Forces Military Intelligence Center (AFMIC).

We have also recently introduced our National Biosurveillance Integration System Operational Display System (NODS), an IT system that provides our Center the visibility into over 300-plus unclassified sources of biosurveillance information from across multiple sources. This information is aggregated with various reports that we receive from the departments of Defense, State, Health and Human Services, Agriculture, and Transportation and other sources. Our relationship and integration of such valuable sources, such as ARGUS is firmly established within NODS. 

Currently, the acquisition process of our biosurveillance program is based on monitoring sources of biological information used to develop information products for dissemination to decision makers and key stakeholders. Some of these sources include: ARGUS, the Office International des Epizooties (OIE -The World Organization for Animal Health), and the World Health Organization (WHO), among others. Our system collects and stores information, permitting easy querying via web-based interface. Our early experience has shown that much of this information is not neatly packaged, but comes mostly unstructured, sometimes as simple “e-mail” message traffic or reports in multiple formats. As we become aware of new, useful information streams, we will assess their value and will incorporate them as appropriate.

We are expanding NODS capabilities to automate the development and dissemination of reports. Our NBIC reports, to be distributed through the NOC-COP fall into three categories: real-time notifications, daily and weekly reports and situational reports. Notifications are short, factual summaries developed immediately following significant or newsworthy “bio-events.” Daily and weekly reports, highlight events of potential significance. Situation reports provide daily updates of ongoing domestic or international “bio-events.” Additionally, we have instituted a Pilot Biosurveillance Common Operating Picture (BCOP) that incorporates weekly Avian Influenza updates. 

One important function of NBIC will be the integration of wildlife biosurveillance information as a potential key early indicator of a possible disease outbreak. The U.S. Fish and Wildlife Service, USDA and the U.S. Geological Survey, along with information networks such as the Global Avian Influenza Network for Surveillance (GAINS), that receives support from my colleagues at USAID and CDC and the International Species Information System/Zoological Information Management System (ISIS/ZIMS) community all provide data that may prove useful as a “very early” indicator of a significant bio-event.. To this end, we have clear interest in supporting the ISIS/ZIMS efforts as well as deepening our relationship with our GAINS colleagues for enhanced information sharing beneficial to the broader biosurveillance community. NBIC’s ability to fuse data gathered from across Federal agencies and others will assist in public health risk determinations in the event sick animals are detected in wildlife. As an example, sampling of birds for the H5N1 virus is useful to support the Nation’s effort against pandemic influenza.

Mr. Chairman, and members of the subcommittee, there are numerous challenges before us to develop an effective biosurveillance capability, which require a tremendous amount of continued partnership, dialogue and development of system capacity. However, the consequences of not developing this capability could be devastating. While continuing to move forward to meet our initial goals, we are cognizant of maintaining a realistic assessment of the biosurveillance mission to assure success. There are no perfect data sets available at the present time that gives a picture of all bio-events.

Even as we work toward the acquisition and automation of the myriad information streams, the heart and soul of our program continues to be people representing our various partners and NBIC staff. Retention of existing staff and completing interagency agreements for additional subject-matter experts and analysts are essential to accomplishing the mission.

The scope and quality of our reporting continues to be our emphasis and our daily challenge in an effort to serve our customers. Facilitating distribution of the information products will be in place when NBIS 2.0 is launched providing web-based, security level specific access. Data from multiple domains, bringing it together and providing substantive analysis is complex and difficult. Additionally, there are the challenges of privacy and propriety of information, information-sharing protocols, and system security.

At DHS, we continue to work on obtaining the needed systems, information and subject matter expertise to meet this critical mission of biosurveillance; one that remains a top-priority of Secretary Chertoff. Our job is to ensure that the nation has the capability for comprehensive, integrated biosurveillance situational awareness, early-warning of a possible attack and a decision support system for outbreak and event response in the event of a biological incident, whether intentional or naturally occurring. With your continued support, as well as our interagency and organizational partners, we can achieve this critical mission. Thank you for your time and continued leadership on these critical issues. I look forward to answering your questions.

USA: Testimony of Dr. Til Jolly, DHS Associate Chief Medical Officer for Medical Readiness before the U.S. House of Representatives Committee on Homeland Security Subcommittee on Emerging Threats, Cybersecurity, and Science and Technology

Thank you for the opportunity to testify before the Subcommittee to discuss the progress of the National Strategy for Pandemic Influenza and its Implementation Plan.  I am Dr. Til Jolly, Associate Chief Medical Officer for Medical Readiness, within the Office of Health Affairs at the Department of Homeland Security (DHS).  Before I begin, I would like to take this opportunity to thank you and Members of the full Committee on behalf of Secretary Chertoff for your continued willingness to work alongside the Department to provide leadership in protecting and ensuring the security of our homeland.  I would also like to thank our partners at the Department of Health and Human Services (HHS) and others with whom we work every day.

To begin, I would like to take a few moments to review some basic facts about pandemics and their potential impacts on our nation.  Pandemic influenza occurs when a novel strain of influenza virus emerges that has the ability to infect humans and to cause severe disease, and when efficient and sustained transmission between humans occurs.  This scenario creates unique challenges.  Unlike other incidents, a pandemic is not a singular event, but is likely to come in waves, each lasting weeks or months, passing through communities of all sizes across the nation and the world simultaneously.  The complete pandemic cycle may last as long as 18 months.  Based on projections modeled by the Department of Health and Human Services from prior pandemics, an influenza pandemic could result in 200,000 to 2 million deaths in the United States, depending on its severity.  Further, an influenza pandemic could have major impacts on society and the economy, including our nation's critical infrastructure and key resources, as many of our nation's workforce could be absent for extended periods of time, either sick themselves or caring for loved ones at home.

The Implementation Plan for the National Strategy for Pandemic Influenza was released over a year ago by the President's Homeland Security Council to guide our nation's preparedness and response to an influenza pandemic.  DHS has been actively engaged with its federal, state, local, territorial, tribal, and private sector partners to prepare our nation and the international community for an influenza pandemic.  As outlined in the Implementation Plan DHS is responsible for the coordination of the overall domestic Federal response during an influenza pandemic, including implementation of policies that facilitate compliance with recommended social distancing measures, development of a common operating picture for all Federal departments and agencies, and ensuring the integrity of the Nation's infrastructure, domestic security and entry and exit screening for influenza at the borders.

To date DHS has accomplished over 80% of the requirements outlined in the Implementation Plan.  DHS recognizes the key role of HHS in its responsibilities to lead clinical disease surveillance and rapid detection during a pandemic, and, under Emergency Support Function (ESF)-8, to plan, prepare, mitigate and support the coordination of the public health and medical emergency response activities during a pandemic under ESF-8, including the deployment and distribution of vaccines and of antivirals and other life-saving medical countermeasures from the Strategic National Stockpile.  DHS also recognizes the Department of State's role to lead the coordination of international efforts including U.S. engagement in a broad range of bilateral and multilateral initiatives that build cooperation and capacity to fight the spread of avian influenza, to prepare for a possible pandemic, and to coordinate with our neighbors Canada and Mexico.  The Department of Agriculture (USDA) conducts surveillance for influenza in domestic animals and animal products, monitoring wildlife in partnership with the Department of the Interior, and working to ensure an effective veterinary response to a domestic animal outbreak of highly pathogenic avian influenza.

In working with our partners DHS has developed and implemented a number of initiatives and outreach to support continuity of operations planning for all levels of government and private sector entities.  I will highlight a few noteworthy accomplishments and responsibilities under the Implementation Plan particular to DHS.

DHS produced and released the Pandemic Influenza Preparedness, Response, and Recovery Guide for Critical Infrastructure and Key Resources (Guide). Tailored to national goals and capabilities, and to the specific needs identified by the private sector, this business continuity guidance represents an important first step in working with the owners and operators of critical infrastructure to prepare for a potentially severe pandemic outbreak. The Guide has served to support business and other private sector pandemic planning by complementing and enhancing, not replacing, their existing continuity planning efforts. With that in mind, the Federal government developed the Guide to assist businesses whose existing continuity plans generally do not include strategies to protect human health during emergencies such as those caused by pandemic influenza or other diverse natural and manmade disasters.

DHS is currently leading the development of specific guides for each of the 17 critical infrastructure and key resource sectors. These include agriculture, food, and water, public health, emergency services, telecommunications, banking, defense systems, transportation, energy resources, and others.  These guides are being developed utilizing the security partnership model and in collaboration with our Federal partners.

In coordination with other Federal departments and agencies, DHS is developing a coordinated government-wide planning forum.  An initial analysis of the response requirements for Federal support has been completed. From this analysis, a national plan defining the federal concept for coordinating response and recovery operations during a pandemic has been developed and will be undergoing interagency review. Utilizing this planning process, a coordinated federal border management plan has been developed and is currently in review. This process included state, local, tribal, territorial, and private sector stakeholder input, along with our Federal interagency partners.

DHS has conducted or participated in federal and state interagency pandemic influenza exercises which have focused on varied issues related to preparedness. These exercises have included:

• FEMA's Determined Accord series for continuity of operations with federal, state, local, tribal, territorial entities.
• Several Customs and Border Protection exercises – addressing transportation and border challenges.
• A U.S. Fire Administration tabletop exercise for development of best practices models and protocols for EMS, 911 Call Centers, Fire Services, Emergency Managers, Law Enforcement and Public Works.  This will allow for further integration of a unified Federal, state, local and private sector emergency response capabilities.
• HHS sponsored regional National Governors Association Pandemic Influenza exercises, CDC funded and provided guidance for state and local exercises, and DOD pandemic influenza exercises.
• Multiple workshops and forums with the owners and operators of critical infrastructure and key resources.

Consistent with his role under Homeland Security Presidential Directive (HSPD) 5, Secretary Chertoff pre-designated Vice Admiral Crea, the Vice Commandant of the US Coast Guard, as the National Principal Federal Official (PFO) for pandemic influenza and has pre-designated five regional PFOs and 10 deputy PFOs. Likewise, our partners have pre-designated Infrastructure Liaisons, Federal Coordinating Officers, Senior Officials for health as well as Defense Coordinating Officers. VADM Crea and the Regional PFOs have participated in several training sessions regarding preparedness duties, and have held two orientation sessions to date.  These sessions included updates from the Department of State, the Department of Agriculture, the Department of Health and Human Services, the Department of Defense, as well as updates from various DHS components and staff regarding their work to date.  Additionally, the PFO teams have begun outreach both nationally and in their regions in advance of a more formalized exercise program which is being developed by DHS.

On an ongoing basis, DHS participates in interagency working groups to develop guidance including community mitigation strategies, medical countermeasures, vaccine prioritization, and risk communication strategies.  These groups bring together a wide range of federal partners to discuss preparedness issues.

In closing, significant progress that has been made in national preparedness for pandemic influenza.  In fact, September is National Preparedness Month, which encourages all Americans to prepare for emergencies and take the necessary actions for all-hazards.  Many of these accomplishments can be incorporated into an all-hazards framework to promote the national culture of preparedness.  DHS looks forward to continuing its partnership with the federal interagency, state, local, tribal, territorial, and private sector stakeholders to complete the work of pandemic preparedness and to further the nation's ability to prepare for, respond to, and recover from all-hazards.

Thank you again for the opportunity to testify on behalf of the Department of Homeland Security on these issues of critical importance to our nation's security and well-being.  I would be happy to answer any questions you might have.

Public comment welcome on community measures to prevent deaths during a pandemic [Sep 13 Salt Lake City UT USA]--The Utah Department of Health (UDOH) has posted information on its Web site outlining recommendations that may be implemented during an influenza pandemic. The issue has been studied and debated by many over the past year and the UDOH believes these steps will be important to reduce the number of deaths in Utah.

A study published in the August 8th issue of the Journal of the American Medical Association looked at public records from the 1918-1919 influenza pandemic. That study demonstrated that school closures and other community strategies were the most effective in reducing the possibility of spreading disease between people during an epidemic.

“Communities that were most successful in warding off deaths during the 1918 pandemic quickly enacted a number of measures,” according to Dr. Robert Rolfs, Utah State Epidemiologist.

“These strategies are particularly important because the intervention most likely to provide the best protection against pandemic influenza, a vaccine, will most likely not be available at the beginning of the outbreak,” adds Dr. Rolfs.

Dr. Rolfs says, “In order for the restrictions to be most effective, we’ll have to rely on the public’s willingness to make some pretty substantial changes in day-to-day life. We hope that people will look at the restrictions, learn about what they’ll need to do during the next pandemic, and tell us if we need to make any changes for this plan to work.”

To read and make comments on the recommendations, please visit
http://pandemicflu.utah.gov/.

Combatting avian flu in North America - The North American Plan for Avian and Pandemic Influenza [Aug 21 Montebello QC Canada]--“Canada, Mexico and the United States face a growing threat posed by the spread of avian influenza and the potential emergence of a human influenza pandemic…While the virus has not yet reached North America, the three countries must be prepared for the day when it—or some other highly contagious virus—does.” – North American Plan for Avian and Pandemic Influenza.

The North American Plan for Avian and Pandemic Influenza was announced by the Presidents of the United States and Mexico and the Prime Minister of Canada on August 21, 2007 in Montebello, Canada, at the North American Leaders Summit. The Plan was developed as part of the Security and Prosperity Partnership of North America (SPP). The SPP is a trilateral effort launched in March 2005 to increase security and enhance prosperity in Canada, Mexico and the United States through greater cooperation and information sharing. The three nations are working together through the SPP to prepare for a threat that could disrupt our economies and cause widespread illness and death if it reaches our shores: highly pathogenic avian influenza—or bird flu—and the potential emergence of a human influenza pandemic.

Background
 

The highly pathogenic H5N1 avian influenza virus, which re-emerged in Asia in late 2003, has infected birds in more than 55 countries in Europe, the Middle East and Africa, and has resulted
in the deaths, through illness and culling, of over 250 million birds across Asia. The virus is now endemic in parts of Southeast Asia, is present in long-range migratory birds, and is unlikely to be
eradicated in the short term. Although it has not yet become easily transmissible among humans, the disease has sickened over 300 people and resulted in more than 190 deaths.

Although the timing cannot be predicted, history and science suggest the world will face at least one influenza pandemic this century. A worldwide outbreak of a new influenza virus could result in a high death toll, millions of hospitalizations, and hundreds of billions of dollars in direct and indirect costs to North American economies.

The North American Plan for Avian and Pandemic Influenza

The North American Plan for Avian and Pandemic Influenza outlines a collaborative North American approach that recognizes that mitigating the effects of a pandemic requires coordinated action by all three countries. It outlines how Canada, Mexico and the United States will work together to prepare for and manage outbreaks of highly pathogenic avian influenza and pandemic influenza.

At the March 2006 SPP summit in Cancun, Mexico, the leaders of the three countries committed to developing a comprehensive, coordinated, science-based approach to prepare for and manage avian and pandemic influenza. This common approach would be based on the four pillars of emergency management: prevention and mitigation, preparedness, response, and recovery.

Canada, Mexico and the United States also established a senior-level Coordinating Body on Avian
and Pandemic Influenza to facilitate effective planning and preparedness within North America for a possible outbreak.

Key Objectives of the North American Plan
 

The North American Plan provides a framework to accomplish the following:

Detect, contain and control an avian influenza outbreak and prevent transmission to humans;
Prevent or slow the entry of a new strain of human influenza into North America;
Minimize illness and deaths; and

Sustain infrastructure and mitigate the impact to the economy and the functioning of society.
 

The Plan establishes a framework for action on priority areas including: trilateral emergency coordination and communication; joint exercises and training; response to outbreaks in animals;
surveillance among animals and in humans; laboratory practices; research; personnel exchange; screening for air, sea and land travel; and maintaining continuity for critical infrastructure and key services.

Central to the Plan is a North American approach that undertakes measures to maintain the flow of people, services, and cargo across the borders during a severe pandemic while striving to
protect our citizens.

The Plan also complements existing national emergency management plans, and builds upon the core principles of the International Partnership on Avian and Pandemic Influenza, the standards and guidelines of the World Organization for Animal Health, the World Health Organization (including the revised International Health Regulations), and the rules and provisions of both the World Trade Organization and the North American Free Trade Agreement. It represents a significant contribution to the concerted efforts of national and multilateral partners worldwide to combat a growing challenge to animal and human health.

The North American Plan for Avian and Pandemic Influenza may be found at www.state.gov/g/avianflu

NIH scientists target future pandemic strains of H5N1 avian influenza [Aug 9 Bethesda MD USA]--Preparing vaccines and therapeutics that target a future mutant strain of H5N1 influenza virus sounds like science fiction, but it may be possible, according to a team of scientists at the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health (NIH), and a collaborator at Emory University School of Medicine. Success hinges on anticipating and predicting the crucial mutations that would help the virus spread easily from person to person.

Led by Gary Nabel, M.D., Ph.D., director of the NIAID’s Dale and Betty Bumpers Vaccine Research Center (VRC), the team is reporting in the August 10, 2007 issue of the journal Science that they have developed a strategy to generate vaccines and therapeutic antibodies that could target predicted H5N1 mutants before these viruses evolve naturally. This advance was made possible by creating mutations in the region of the H5N1 hemagglutinin (HA) protein that directs the virus to bird or human cells and eliciting antibodies to it.

“What Dr. Nabel and his colleagues have discovered will help to prepare for a future threat,” says NIH Director Elias A. Zerhouni, M.D. “While nobody knows if and when H5N1 will jump from birds to humans, they have come up with a way to anticipate how that jump might occur and ways to respond to it.”

“Now we can begin, preemptively, to consider the design of potential new vaccines and therapeutic antibodies to treat people who may someday be infected with future emerging avian influenza virus mutants,” says NIAID Director Anthony S. Fauci, M.D. “This research could possibly help to contain a pandemic early on.”

Making a vaccine against an existing strain of H5N1 or any other type of influenza virus is relatively routine. Typically, samples of existing influenza virus strains are isolated and then grown inside eggs or in cell cultures. The virus is then collected, inactivated, purified and added to the other components of the vaccine.

A flu shot prompts a person’s immune system to detect pieces of the inactivated virus present in the vaccine and make neutralizing antibodies against them. Later, if that same person is naturally exposed to a flu virus, these same antibodies should help fight the infection.

Influenza viruses constantly mutate, however, and vaccines are most effective against the highly specific strains that they are made from. This makes it difficult to predict how effective a vaccine made today will be against a virus that emerges tomorrow.

Dr. Nabel and his colleagues started their project by focusing narrowly on mutations that render H5N1 viruses better able to recognize and enter human cells. Bird-adapted H5N1 binds bird cell surface receptors. But these receptors differ slightly from the receptors on human cells, which in part explains why bird-adapted H5N1 can infect but not spread easily between humans.

About a year ago, the research team began asking what mutations help the virus shift its adaptability. They compared the structural proteins on the surface of bird-adapted H5N1 influenza virus with those on the surface of the human-adapted strain that caused the 1918 pandemic. They focused specifically on genetic changes to one portion of the H5 protein — a portion called the receptor binding domain. They showed that as few as two mutations to this receptor binding domain could enhance the ability of H5N1 to recognize human cells.

Additional mutations would likely need to accumulate for H5N1 to spread more easily from person to person, says Dr. Nabel. The few mutations he and his colleagues identified are likely just a subset of those, he emphasizes.

Moreover, they found that these mutations change how the immune system recognizes the virus. Mouse antibodies that target H5N1 were up to tenfold less potent against the mutants. Dr. Nabel and his colleagues used their knowledge of receptor specificity to create vaccines and isolate new antibodies that might be used therapeutically against human-adapted mutants.

They vaccinated mice with the material from viruses they altered to contain the mutant receptors, and they discovered one broadly reactive antibody that could neutralize both the bird- and human-adapted forms of an H5N1 virus.

According to Dr. Nabel, their findings should contribute to better surveillance of naturally occurring avian flu outbreaks by making it easier to recognize dangerous mutants and identify vaccine candidates that might provide greater efficacy against such a virus before it emerges.

“Our findings build on elegant studies of the influenza HA protein by structural biologists,” notes Dr. Nabel. “Insight into the structure of the avian flu virus has enabled us to target a critical region of HA that directs its specificity. Such a structure-based vaccine design may allow us to respond to this future threat in advance of an actual outbreak.”

Reference: Z Yang et al. Immunization by avian H5 influenza hemagglutinin mutants with altered receptor binding specificity. Science DOI: 10.1126/science.1135165 (2007).

Australia:  Victoria well placed to fight a flu pandemic [Jul 18 Melbourne VIC]--Victoria's health system is in the best position yet to combat a possible influenza pandemic with the announcement of an updated statewide plan, Health Minister Bronwyn Pike said today.

Ms Pike said the Victorian Health Management Plan for Pandemic Influenza would be an essential guide for health professionals and the community to respond to a new pandemic strain of the virus and to ensure hospitals were well prepared for the demand for services.

"In the event of a major new flu outbreak Victoria's primary health care services, such as hospitals, GPs, community pharmacies and community health centres will play an important role in treating patients and informing the public during all stages of a pandemic," Ms Pike said.

"Past instances of avian flu and SARS overseas confirm the threat of a pandemic is very real and can strike without warning, so it's important health authorities and the community are prepared.

"Influenza viruses evolve rapidly and there is a risk that the virus could undergo genetic changes making it able to spread even more easily from person to person – if these changes occur, the virus could cause a pandemic," Ms Pike said.

A number of strategies would be used to respond to a pandemic threat including a concerted effort to contain the virus as long as possible, until a vaccine is developed to reduce infection. The plan incorporates a surveillance system to detect any emerging threats, aims to rapidly identify new virus sub-types and define roles and responsibilities of health agencies involved.

"The Bracks Government has worked closely with a range of Commonwealth and local government agencies as well as health, community and industry professionals to ensure we are well prepared and the plan will work effectively if there is a major flu outbreak," Ms Pike said.

Victoria's Chief Health Officer, Dr John Carnie, said the state is witnessing lower than average rates of influenza infection with just 73 cases compared to 126 at the same time last year, but insisted the community played a major role in the containment of the flu.

"Good personal hygiene, including covering your mouth when coughing and washing your hands regularly, can help reduce the risk of contracting the flu virus," Dr Carnie said. "Those at special risk – including persons aged over 65 – are strongly urged to have a yearly flu vaccination and if cold and flu symptoms persist after a few days, contact your local GP."

Dr Carnie said Victoria was among leading world research and support for investigation of influenza at the Victorian Infectious Diseases Reference Laboratory, while a world-class treatment facility was available at the Victorian Infectious Diseases Service.

Dr Carnie said the Victorian Health Management Plan for Pandemic Influenza is available at: http://www.health.vic.gov.au/pandemicinfluenza/prof_res.htm#general

Australia: Hospital network frontline weapon in updated pandemic plan [Jul 15 Melbourne VIC]--Victoria’s major metropolitan and regional hospitals will be used as specialist influenza hospitals in the event of an influenza pandemic, Health Minister Bronwyn Pike said today.

Launching the updated Victorian Health Management Plan for Pandemic Influenza today, Ms Pike said a network of 16 major metropolitan and regional base hospitals would be in the frontline if there was a pandemic.

“Our hospitals have world-class infectious disease departments, the clinical expertise and experience in treating all forms of infectious diseases,” Ms Pike said.

“These hospitals are being provided with the latest equipment, building modifications and access to medications as part of the Bracks’ Government’s $4.5 million pandemic flu package announced last year. They now have enhanced ability to treat and isolate patients and will be our primary weapon in containing pandemic influenza cases.”

Ms Pike said developments in research and treatment have informed the update of the plan which is now consistent with the updated national arrangements.

“This plan aims to minimise the impact of a possible influenza pandemic on the Victorian community, healthcare system and economy,” Ms Pike said. “Putting together plans such as this and making sure our hospital system is prepared is the best way to counter the potentially very serious consequences of an influenza pandemic.

“I want to remind Victorians of the dangers of a possible influenza pandemic, that the risk is always present and we are better prepared than ever before.”

Ms Pike said the plan updates include:

· The inclusion of detailed operational guidelines for carrying out mass vaccination sessions during a pandemic including advice on recording and reporting arrangements;
· More detail on hospital and health service issues including the list of hospitals under the Designated Hospitals Model;
· The inclusion of a new section on Primary Health Care clarifying the roles of primary care practitioners in the different phases of a pandemic;
· A new section on the ethical considerations that will be required to guide decision making during a pandemic; and
· Clarification of the roles and responsibilities of key response agencies during a pandemic including community care agencies, DHS, other government departments, local government, businesses and the community.

Ms Pike said the plan was an essential guide for health professionals and the community to respond to an influenza pandemic and to ensure hospitals were well prepared for the demand for services.

“Victoria’s primary health care services, such as hospitals, GPs, community pharmacies and community health centres will play an important role in treating patients and informing the public during all stages of a pandemic,” Ms Pike said.

“Past instances of avian flu and SARS overseas confirm the threat of a pandemic is very real and can strike without warning, so it is important health authorities and the community are prepared.

“Influenza viruses evolve rapidly and there is a risk that the virus could undergo genetic changes making it able to spread even more easily from person to person – if these changes occur, the virus could cause a pandemic.”

If a pandemic affected 30 per cent of the Victorian population and there was no pandemic vaccine or treatment available over a six to eight-week period, it estimated there could be more than 10,000 deaths, 25,000 hospitalisations and more than 710,000 outpatient visits.

A number of strategies would be used to respond to a pandemic threat including a concerted effort to contain the virus as long as possible, until a vaccine is developed to reduce transmission. The plan incorporates a surveillance system to detect any emerging threats, aims to rapidly identify new virus sub-types and define roles and responsibilities of health agencies involved.

“The Government has worked closely with a range of Commonwealth and local government agencies as well as health, community and industry professionals to ensure we are well prepared and the plan will work effectively if there is a major flu outbreak,” Ms Pike said.

Victoria’s Chief Health Officer, Dr John Carnie, said Victorians can help play a part in reducing the transmission of influenza by simply washing their hands.

“This is good practice for everyone when it comes to communicable disease control,” Dr Carnie said. “While Victoria is witnessing lower than average rates of influenza infection with just 73 cases compared to 126 at the same time last year, good personal hygiene, including covering your mouth when coughing and washing your hands regularly, can help reduce the risk of contracting the flu virus.

“Those at special risk – including persons aged over 65 – are strongly urged to have a yearly flu vaccination and if cold and flu symptoms persist after a few days, contact your local GP.”

The Victorian Health Management Plan for Pandemic Influenza is available at: http://www.health.vic.gov.au/pandemicinfluenza/prof_res.htm#general

New Zealand: Getting through together - Ethical values for a pandemic [Jul 4 Wellington]--The National Ethics Advisory Committee – Kāhui Matatika o te Motu (NEAC) has completed its work on ethical values for a pandemic.

One of NEAC’s main statutory functions is to advise the Minister of Health on ethical issues of national significance regarding health and disability. The Committee believes that minimising harm from any pandemic, minimising inequalities in the impact of any pandemic, and getting through any pandemic together are issues of this sort.

Getting Through Together considers ethical issues in a pandemic:

* Section one introduces the statement of ethical values and its purpose and then describes how this statement could be used.
* Section two outlines two cases, one in an urban community and one in a hospital, to explore the challenges we may face when planning for, and responding to, a pandemic.
* Section three describes in a range of settings why we think the shared values identified in the statement are important.

NEAC hopes that a wide range of people, including health professionals, planners, policy makers and members of the public and business community, can use Getting Through Together as they plan for, and think about, their potential response to a pandemic. Emphasis is given to using shared values to assist people to care for themselves, their whānau and their neighbours, and using shared values to make decisions in situations of overwhelming demand.

Internationally, this work is unique in having had wide public input. It is the result of a consultation on a discussion document in 2006. NEAC warmly thanks all those who made valuable contributions to the creation of this document.

This publication and inserts are available in PDF format below:

Getting Through Together: Ethical values for a pandemic (PDF, 1.9 MB)

Ethical Values for a Pandemic (quick-reference guide) (PDF, 234 KB)

Guidance on Pandemic Ethics (quick reference guide) (PDF, 220 KB)

Background: The discussion statement [published July 2006]:

In an influenza pandemic, the better prepared we are, the better we would cope. One important way to be prepared is to think through our values – the basic things that matter to us. Many hard choices would need to be made in a pandemic. But if these choices are based on shared values, and made with goodwill and reasonable judgement, support may be expected for the decisions made.

The National Ethics Advisory Committee (NEAC) has prepared a statement of ethical values for planning for and responding to a pandemic. It identifies widely shared ethical values for our pandemic planning and response. Some are values to govern how we make decisions. Others are values to govern what decisions are made. Values that are recognised in Māori tikanga and kawa are identified alongside other values. The statement is designed to be thought provoking, accessible to a wide range of people, useful at all stages of pandemic planning, and useful in a wide range of situations.

NEAC is seeking feedback to make the statement as reflective of shared values, and as useful, as possible. NEAC also hopes that this discussion document will help to raise issues, and to facilitate public discussion. Feedback is being sought from people and organisations in the health sector, other sectors involved in pandemic planning, community groups and others who may be potentially affected by a pandemic. An initial version of this statement is included in the current Ministry of Health Influenza Pandemic Action Plan, and NEAC aims to include a finalised version of the statement in a subsequent version of this Plan.

Document availability

The discussion document is available in PDF and Word formats.

Ethical Values for Planning for and Responding to a Pandemic in New Zealand: A Statement for Discussion (PDF, 422 KB)

Ethical Values for Planning for and Responding to a Pandemic in New Zealand: A Statement for Discussion (Word, 560 KB)

Canada: Publication du plan de lutte contre la grippe pandémique [Jun 28 Halifax NS]--Le plan provincial de lutte contre la grippe pandémique visera à réduire le nombre de personnes malades et le nombre de décès pendant une pandémie possible de grippe.

La première version du Plan de lutte des services de santé de la Nouvelle-Écosse contre la grippe pandémique, publié aujourd'hui 26 juin, a été élaborée en consultation avec les régies régionales de la santé et inclut les suggestions et commentaires de divers organismes partenaires du domaine de la santé.

« Puisque nous savons qu'une pandémie de grippe causerait un stress important sur nos services de santé, ce plan met l'accent sur le maintien d'un certain niveau de soins, pour les Néo-Écossais, pendant une période qui sera sans aucun doute très éprouvante, » a souligné le ministre de la Santé, Chris d'Entremont. « Toutefois, un tel événement aurait une incidence non seulement sur les services de santé, mais aussi sur l'économie et sur la société en général. Nous devons nous préparer en conséquence. »

Le plan provincial continuera d'être mis à jour à mesure que de nouveaux renseignements sont disponibles aux niveaux local, national et international. Le plan décrit les mesures à prendre, organisées selon les phases d'une pandémie, dans les domaines suivants :
-- communications
-- surveillance
-- mesures de santé publique
-- vaccins
-- médicaments antiviraux
-- services de santé

« Le fait d'être prêt à faire face à une pandémie ne signifie pas que les gens ne seront pas malades, » a dit le ministre de la Promotion et de la Protection de la santé, Barry Barnet. « C'est pourquoi il est si important que les mesures de santé publique appropriées soient en place. De plus, nous allons suivre les lignes directrices nationales pour la mise en œuvre de notre stratégie d'administration de médicaments antiviraux et de vaccins, afin de s'assurer que les Néo-Écossais sont protégés le mieux possible dans une situation de pandémie. »

La planification est également en cours dans les domaines de l'éthique, du stockage et de la gestion des bénévoles au cours d'une pandémie. Des mises à jour auront lieu de façon continue à mesure que la planification avancera dans chaque domaine.

Il est prévu que de 15 à 35 pour cent de la population de la Nouvelle-Écosse sera malade pendant une pandémie de grippe. On estime que de 1 000 à 3 000 personnes devront être hospitalisées et que de 300 à 1 000 personnes pourraient mourir.

Chaque année, de 500 à 1 500 Canadiens, principalement des personnes âgées, meurent d'une pneumonie ou d'autres complications liées à la grippe ordinaire.

Les ministres ont fait référence à des situations d'urgence antérieures, par exemple l'ouragan Juan et la tragédie de la Swiss Air, qui ont aidé la province à comprendre la nécessité de mettre en place une planification d'urgence flexible, coordonnée et continue.

Une pandémie de grippe est une propagation à l'échelle mondiale d'un nouveau virus de la grippe qui se transmet facilement.

Pour consulter le plan de lutte contre la grippe pandémique ou pour obtenir plus d'information sur la grippe pandémique, consultez le site Web www.gov.ns.ca/govt/pandemic .

Canada: Province's pandemic plan released [Jun 28 Halifax NS]--The province's pandemic plan for the health system will aim to reduce the amount of sickness and death during a potential influenza pandemic.

The first version of the Nova Scotia Health System Pandemic Influenza Plan, made public today, June 26, was developed in consultation with the district health authorities and incorporates feedback from various health partner organizations.

"We know that an influenza pandemic would cause great stress on our health system, so this plan focuses on trying to ensure a level of care for Nova Scotians during what will be a very stressful time," said Health Minister Chris d'Entremont. "An event such as this, however, would not only stress the health system, but the economy and society in general. And we need to prepare for that."

The provincial plan will continue to evolve as new information emerges on the local, national, and international fronts. The plan describes action, organized by pandemic phase, in areas of:
-- communications
-- surveillance
-- public health measures
-- vaccines
-- antivirals
-- health services

"Being prepared for a pandemic doesn't mean that people won't get sick," said Health Promotion and Protection Minister Barry Barnet. "That's why having the right public-health measures in place is so important. As well, we will follow national guidelines in rolling out our vaccine and antiviral strategy so that Nova Scotians are protected as much as possible during a pandemic."

Planning is also underway in the areas of ethics, stockpiling, and volunteer management during a pandemic. It will continue to be updated on an ongoing basis as planning progresses in each area.

It is expected that 15 to 35 per cent of Nova Scotia's population will become ill during a pandemic. About 1,000 to 3,000 Nova Scotians will require hospitalization, and 300 to 1,000 people could die.

Every year between 500 and 1,500 Canadians, mostly seniors, will die from pneumonia and other complications of ordinary seasonal influenza.

The ministers referenced past emergencies like Hurricane Juan and Swiss Air, which have helped the province understand the need for flexible, co-ordinated, and ongoing emergency planning.

The global spread of a new influenza virus that can be easily transmitted is known as an influenza pandemic.

To access the pandemic plan or for more information on pandemic influenza, see the website at www.gov.ns.ca/govt/pandemic

Global: Model for tracking flu progression could reduce flu pandemic's peril [Jun 18 Cambridge MA USA]--Nearly 40 years ago, MIT Professor Richard Larson spent a week sick in bed with the worst illness he'd ever had--the particularly virulent strain of flu that swept the globe in 1968. "That was the sickest I'd ever been," Larson recalled. "I really thought that was the end." It took him two or three months to recover fully from the illness.

Known as the Hong Kong flu, the virus killed 750,000 people worldwide, the second worst influenza pandemic the world has seen since the infamous 1918-1919 epidemic of so-called Spanish flu.

Now, many experts fear the world is on the brink of another deadly flu pandemic. And Larson wants to be sure that people are ready to deal with it.

To that end, he and his colleagues have developed a mathematical model to track the progression of a flu outbreak, and their results show that the death toll of an epidemic could be greatly reduced by taking steps such as minimizing social contacts and practicing good hygiene, such as frequent handwashing.

The report, "Simple Models of Influenza Progression within a Heterogeneous Population," will be published in the May-June issue of Operations Research, which comes out June 4.

"We can't reduce to zero the chance that any of us will get the next bad flu. But there is compelling evidence that we can reduce the chances of our loved ones and ourselves getting the flu by a significant factor," said Larson, the Mitsui Professor of Engineering Systems and of civil and environmental engineering.

The H5N1 strain of flu, also known as avian flu, has infected birds throughout Asia and Europe, with a few known cases among humans. So far, the disease has not mutated to a form where it can jump easily between humans, but if that happens, the disease could spread around the world in days or weeks.

Larson's research team decided to model the progress of such an epidemic, taking a unique approach. Unlike most existing models, theirs takes into account people's different levels of social activity and susceptibility to the flu.

One of the report's key findings is that "social distancing"--reducing the frequency and intensity of person-to-person contact--could be an effective way to limit the spread of the disease.

Influenza is normally spread by person-to-person contact, so people who have more contact with others have a higher risk of catching the disease and then spreading it. However, most existing influenza models assume that all individuals within a population have the same degree of social contact. They also assume that social behavior does not change over the course of the epidemic.

Such models "didn't do justice to the complexity of the problem," Larson says.

He and his team developed a dynamic mathematical model that assumes a heterogeneous population with different levels of flu susceptibility and social contact. They then used the model to compare different scenarios: one where people maintained their social interactions as the flu spread, and others where they did not.

Their results showed that reducing the social contacts of people who normally have the most interactions could dramatically slow early growth of the disease. Most of the disease spread is due to a minority of the population--the people with the most daily human contacts. Focusing on these individuals and reducing their daily contacts can change an exponentially exploding disease into one that dies out over time.

A key feature of the model deals with "R0," a popular parameter of most other models, which is defined as the average number of new infections caused by a recently infected person in a population of susceptible individuals. An R0 greater than 1.0 leads to exponential increase in the number of cases.

However, because R0 is an average over the entire population, it does not reflect the fact that only a fraction of the population is responsible for the majority of new infections. Averages can be misleading--for example, when a billionaire enters any establishment, on average everyone there instantly becomes at least a millionaire.

The researchers believe that splitting R0 into components, one for each level of activity or propensity to become infected, provides better policy guidance. In Larson's model, every population component is assigned different values for R0 , depending on factors such as that component's frequency of human contact and susceptibility to infection if exposed to the flu. Each of these factors can be at least partially controlled, suggesting that our individual and collective behaviors in response to the flu can greatly influence the numbers who become infected.

The researchers also found a striking difference in death toll depending on how early in the epidemic social distancing measures went into effect. For example, in a hypothetical population of 100,000 susceptible individuals, 12,000 fewer people were infected if social distancing steps were taken on day 30 of an outbreak instead of day 33. But intervention on Day 0 is best.

This finding is consistent with historical research reported in April by two research teams, one led by the National Institute of Allergy and Infectious Diseases and one from the United Kingdom, that demonstrated that those communities in 1918 that took aggressive social distancing actions early usually suffered less from the "Spanish Flu" than those who waited and debated.

The findings strongly suggest that influenza emergency plans should include measures to reduce social contact, such as encouraging people to work from home and avoid large gatherings, Larson said. This is especially important because it generally takes at least six months from the time of an outbreak to develop an effective vaccine. Those who must continue to work, such as doctors and other health care workers, should be the first to receive any available avian flu vaccine that might be developed, he said.

Larson says that large institutions like MIT, as well as state and local governments, should have emergency plans ready to put into action as soon as the first case of human-to-human H5N1 influenza is reported.

"We need to be aggressive. We need to be assertive. Don't dilly-dally, don't have a lot of political debate and foot-dragging," he said. "If people do take it seriously, the number of deaths could be greatly reduced. A key is to start taking aggressive steps well before the flu is at your doorstep."

Larson became interested in modeling influenza after reading a book about the 1918 outbreak, which killed between 50 and 100 million people around the world. He had never heard much about the epidemic, which in the United States claimed more victims than World War I.

"Reading the history of it, I became fascinated," he said. "The wonderful thing about being in OR (operations research) is you can go into any problem you think is important and relevant and really contribute to it."

Larson said he hopes that other operations researchers will take up influenza research and develop more detailed models.

"Any mathematical model of the disease is bound to be incorrect," Larson wrote in the Operations Research paper. "But we are not seeking multidecimal accuracy, but rather insights on how to limit the spread of the disease. We firmly believe that fresh eyes from the OR community can play a significant role in this quest."

Other members of the MIT research team include undergraduate Kelley Bailey; Stan Finkelstein, senior research scientist in the Engineering Systems Division; Karima Robert Nigmatulina, graduate student in the Operations Research Center; Robert Rubin, faculty member at the Harvard-MIT Division of Health Sciences and Technology; and Katsunobu Sasanuma, a graduate student in the Engineering Systems Division and the Operations Research Center.

The research was funded in part by an IBM Faculty Research Award.

USA: During influenza pandemic, State Health Commissioner to decide if schools should close [Jun 18 Indianapolis IN]--State health officials report the state health commissioner will make the decision of when to close schools during an influenza pandemic. This plan of action comes after two years of meeting and working with Indiana schools.

“Studies of various U.S. cities during the 1918 influenza pandemic show that cities that closed schools early in the pandemic had fewer sick people than cities that closed schools later,” said State Health Commissioner Judy Monroe, M.D.

Dr. Monroe announced her intention to make the decision on closing all schools and licensed daycares in the state in a letter sent to pandemic flu planning partners throughout the state.

In February, the State Department of Health hosted a statewide tabletop drill with the Indiana Department of Education, focusing on the role of school closure in slowing the spread of the disease. As a result, school administrators recognized the need to have state leadership in making the decision to close schools.

“Schools are already known to be a hotbed of disease transmission. Diseases are easily spread among children and brought home to other household members. One study shows that 65% of those infected with influenza catch it from a child or teenager,” said Dr. Monroe.

The decision to reopen schools is more difficult. The timing is important, and will be determined by epidemiologists at the State Department of Health and at the Centers for Disease Control and Prevention, taking into account what is happening in surrounding communities.

“During the 1918 pandemic, many communities reopened schools or lifted restrictions too early and experienced a rapid upsurge in disease incidence. A few communities waited too long and lifted restrictions just before the onset of the next wave of the pandemic,” said Dr. Monroe.

The State Department of Health will continue to refine preparedness plans and work with state partners to provide the most effective response during a pandemic. Indiana schools now have plans, policies and procedures in place to quickly react to pandemics.

Hoosiers can take steps now to prepare themselves and their families. Health officials advise having a family emergency plan, including alternative child care plans if schools and licensed daycares are closed. Good respiratory hygiene habits should be practiced at all times: washing hands frequently and thoroughly, covering your mouth and nose when you sneeze or cough, and staying home from work or school when feeling ill can all prevent the spread of respiratory diseases.

People should also keep an emergency supplies kit to use for at least two weeks during a flu pandemic:

* Bottled water – 1 gallon per person per day
* Canned and packaged food
* Clothes
* Essential prescription medications
* Flashlight with extra batteries
* Hand-operated can opener
* Battery-powered or hand-crank radio
* Hygiene items, such as toothbrush, soap, and toilet paper
* First aid kit
 

USA: Rutgers study shows avian influenza on people's minds [Jun 16 New Brunswick NJ]--Researchers at the Food Policy Institute at the Rutgers New Jersey Agricultural Experiment Station have conducted a nationwide survey of public knowledge, attitudes, intentions and behaviors related to the threat of highly pathogenic avian influenza. The researchers conducted a total of 1200 telephone interviews on the topic between May 3 and June 5, 2006.

The results suggest that avian influenza is on the national agenda. Most Americans have heard about it and have talked about it, but don’t know much about it. Most are aware of the presence of highly pathogenic H5N1 avian influenza in people, birds, and poultry globally, but many are unaware that there have been no cases in humans or animals in the United States.

Despite this, Americans see their current risk of infection with avian influenza as low and are not particularly worried about it. They see the current supply of chicken products as relatively safe, and they continue to eat it. However, most see the risks of infection from avian influenza as much greater for other people than for themselves.

“This tendency to believe that others are at greater risk may be a problem in getting messages across, in influencing perceived susceptibility, and in persuading people to adopt appropriate behaviors,” says Sarah C. Condry, the lead author of the study.

The study focused on what American consumers would likely do if highly pathogenic H5N1 avian influenza were found in poultry in the United States. According to the United States Department of Agriculture (USDA), in such a scenario, “The chance of infected poultry or eggs entering the food chain would be extremely low because of the rapid onset of symptoms in poultry as well as the safeguards in place, which include testing of flocks and Federal inspection programs.”

Moreover, the USDA states, “Cooking poultry, eggs, and other poultry products to the proper temperature and preventing cross-contamination between raw and cooked food is the key to safety.”

However, according to William K. Hallman, director of the Food Policy Institute, “The results of the study suggest that much of the American public does not yet have the information they need to make informed choices about purchasing, preparing, and consuming poultry products, should avian influenza emerge in the United States.”

Hallman points out that U.S. farming methods for raising poultry drastically reduce the risk of an outbreak of avian influenza within our food supply. “Our poultry is typically farmed in tightly controlled environments,” he said. “The poultry industry is well aware of the dangers of avian influenza and is working closely with the USDA to take appropriate precautions to prevent an outbreak.”

Yet, according to the study, only about two-thirds of Americans seem aware that the majority of chicken sold in the United States is produced domestically and that poultry products from countries with reported outbreaks of avian influenza are banned from import. In addition, while a variety of clinical symptoms makes it relatively easy to identify domestic poultry infected with avian influenza, few Americans believe that live chickens infected with avian influenza are easily distinguishable from healthy birds.

According to the U.S. Centers for Disease Control and Prevention, however, a more significant fact is that “there is no evidence that people have been infected with bird flu by eating safely handled and properly cooked poultry or eggs.” Yet, less than half of Americans believe that cooking chicken to the recommended temperature kills the avian influenza virus and only four-in-ten believe that the avian influenza virus is not transmissible to humans from eating fully cooked chicken or eggs.

“The methods for destroying avian influenza during the cooking process are the same as for destroying salmonella,” said Hallman. “If poultry contaminated with avian influenza is cooked properly, a person cannot get sick from eating the finished product.” According to the USDA, poultry and egg products should be cooked to the minimum safe internal temperature of 165 °F.

However, even if consumers can be convinced that proper cooking kills the avian influenza virus, getting them to act on this information to reduce the risk of infection may be difficult. Surveys by the Food and Drug Administration suggest that fewer than 60 percent of Americans own a meat thermometer and only 12 percent always use it when they cook chicken or chicken parts.

Instead, suggests Condry, “Consumers are likely to try to eliminate the risk entirely by avoiding consumption of poultry altogether.” In fact, the study found that if highly pathogenic avian influenza were found in chickens in the United States, nearly 40 percent of Americans say they would stop eating chicken products altogether. The study also suggests that even after receiving reassurances that it is safe to eat chicken, it would take an average of nearly five months for most Americans to begin eating it again.

The USDA reports that Americans purchase an average of 86 pounds of chicken a year; nearly 26 billion pounds a year in total. A substantial drop in domestic consumer demand would result in significant economic losses.

According to Hallman, the social and nutritional costs would also likely be significant. “Chicken serves as a popular, low-cost source of protein for many American families.” Indeed, the USDA estimates that the per capita consumption of chicken in the United States has more than doubled since 1970. Loss of confidence in the safety of poultry would likely result in increases in the prices of alternative sources of animal protein resulting from higher consumer demands for substitutes for chicken products. “As a result, the costs of feeding the average American family would likely rise.”

The authors of the survey were Sarah C. Condry, William K. Hallman, Miranda Vata, and Cara L. Cuite. The survey project was funded through a National Integrated Food Safety Initiative grant awarded by the USDA Cooperative State Research, Education, and Extension Service and the New Jersey Agricultural Experiment Station at Rutgers, The State University of New Jersey.
 

United Kingdom: Avian influenza - Algorithm Alert Phase 3 updated [May 17 07 London England]--Health Protection Agency WHO Pandemic Alert Phase 3 Algorithms

Updates and changes (21 kB): a summary of updates and changes made to the HPA WHO Phase 3 algorithms

A3: WHO Pandemic Alert Phase 3: Algorithm for the management of returning travellers and visitors from countries affected by avian influenza (H5N1) presenting with febrile respiratory illness Last reviewed 16 May 2007. The following changes were made: Azerbaijan, Côte d'Ivoire, Croatia, Djibouti, England, Hungary and Romania were removed according to OIE reports. 

F3: WHO Pandemic Alert Phase 3: Algorithm for the management of persons resident in the UK or arriving from areas not known to have avian influenza H5N1 presenting with febrile respiratory illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. (208 kB) Last reviewed 06 September 2006. The following change was made: Added “close contact with a confirmed H5N1 infected animal other than poultry or wild birds (e.g. cat or pig)” in section “(3) Exposures” according to WHO case definitions (see reference 2). 

Interim HPA guidelines for investigation and reporting of suspected human cases of avian influenza Last reviewed 10 January 2006 

AI SOP: Health Protection Agency actions for dealing with human health implications of avian influenza in poultry and wildfowl (211 kB) Last reviewed 06 April 2006  

E3: WHO Pandemic Alert Phase 3: Draft Algorithm for the management of personnel involved in the response to an occurrence of highly pathogenic avian influenza (H5N1 only) in wild birds in the UK, presenting with febrile respiratory illness (165kB) Last reviewed 02 May 2006. The following change was made: title changed to more accurately reflect situation in which algorithm should be used.  

J3: WHO Pandemic Alert Phase 3: Draft Algorithm for the management of personnel involved in the response to an occurrence of confirmed highly pathogenic avian influenza (H5N1 only) in poultry in the UK, presenting with febrile respiratory illness (78kB) Last reviewed 08 February 2007. 

B3: WHO Pandemic Alert Phase 3 Draft Algorithm: Post-exposure prophylaxis (PEP) for contacts of confirmed human cases of avian influenza (H5N1) in the UK (155 kB) Last reviewed 19 June 2006. The following changes were made: action for contact type 4 (travel contact) clarified to include passive follow up. Actions for contact types 4 and 5 (holiday contact) expanded to include provision of information. Footnote 4: requirement for duration of travel lasting more than four hours removed due to practical difficulties in determining this.

C3: WHO Pandemic Alert Phase 3 Draft Algorithm: Post-exposure prophylaxis (PEP) for farm workers/residents, SVS staff, and cullers involved in confirmed or suspected outbreaks of highly pathogenic avian influenza suspected or known to be due to H5N1 in poultry in the UK (122 kB) Last reviewed 03 February 2007. The changes written follow up actions in line with the revised policy agreed by ACDP (Advisory Committee on Dangerous Pathogens).

D3: WHO Pandemic Alert Phase 3 Draft Algorithm: Management of human contacts in the event of confirmed highly pathogenic avian influenza [HPAI] (H5N1) in one or more wild birds in the UK (185 kB) Last reviewed 03 May 2006. The following change was made: clarification provided regarding PPE and PEP for veterinary workers handling wild birds confirmed to be infected with HPAI (H5N1) within a 10k Defra wild bird surveillance zone.  

This is the report form for health care professionals investigating respiratory illness in individuals meeting the avian influenza infection case definition.

HPA case report form for suspected human cases of avian influenza (93kB) Last reviewed 11 October 2006

The form is also available as a word document (241kB) that can be completed and emailed to Dr Hongxin Zhao.  

Laboratory Guidance

Microbiological guidance for taking and handling specimens for avian influenza testing Last reviewed 10 January 2006

Advisory Committee on Dangerous Pathogens (ACDP) laboratory advice (ACDP website)

Travel Advice

Travel Advice Page Last reviewed 07 April 2006

Frequently asked questions on travelling to zones affected by avian influenza (H5N1) Last reviewed 04 October 2006

United Kingdom: Avian influenza - Algorithm A3 updated [May 4 07 London England]--Algorithm for the management of returning travellers and visitors from countries affected by avian influenza [H5N1] presenting with febrile respiratory illness: recognition, investigation and initial management. http://www.hpa.org.uk/infections/topics_az/influenza/avian/algorithm.htm

Canada: Travel health advisory - Avian influenza A [H5N1] [May 4 07 Ottawa ON Canada]--The Public Health Agency of Canada (PHAC) continues to closely monitor avian influenza A (H5N1) activity in birds and humans. A particularly severe strain of the H5N1 virus has been circulating and causing disease among birds in parts of Asia, Europe, the Middle East and Africa since 2003. Although rare, infection with this strain has occurred in humans.

For more information on avian influenza, including countries where H5N1 has been confirmed in humans and/or birds, visit the Public Health Agency of Canada's Avian Influenza web site at: http://www.phac-aspc.gc.ca/influenza/avian_e.html

Recommendations

In addition to protecting your own health, travelers are encouraged to refer to the Canadian Food Inspection Agency's (CFIA) guidelines for information on how to prevent the introduction of H5N1 into Canada's animal population, as follows: CFIA Fact Sheet on Avian Influenza.

Information on Avian Influenza from the Public Health Agency of Canada

• Avian Influenza Page
• Human Health Issues related to Avian Influenza in Canada
• FAQ on Avian Influenza
• Current table of affected areas

External Sources of Information

• Government of Canada: Pandemic Influenza Avian Influenza information page
• Health Canada: Poultry cooking guidelines
• Canadian Food Inspection Agency recommendations to prevent the introduction of disease into Canada's animal population
• World Health Organization: Avian Influenza Disease Page
• World Organization for Animal Health: Reports of infected animals by country

USA: Interim guidance issued for the use of facemasks and respirators in public settings during an influenza pandemic [May 3 07 Atlanta GA USA]--The Centers for Disease Control and Prevention (CDC), part of the Department of Health and Human Services (HHS), today released interim advice to the public about the use of facemasks and respirators in certain public (non-occupational) settings during an influenza pandemic. There is very little research about the value of masks to protect people in public settings. These interim recommendations are based on the best judgment of public health experts who relied in part on information about the protective value of masks in healthcare facilities.

The guidance stresses that during an influenza pandemic a combination of actions will be needed, including hand washing, minimizing the likelihood of exposure by distancing people who are infected or likely to be infected with influenza away from others and treating them with antiviral medications, having people who are caring for ill family members voluntarily stay home, and encouraging people to avoid crowded places and large gatherings. When used in conjunction with such preventive steps, masks and respirators may help prevent some spread of influenza.

“Pandemic influenza remains a very real threat. We continue to look for ways to protect people and reduce the spread of disease,” Secretary Mike Leavitt said. “The guidance issued today is a good step forward in the broader, multifaceted federal effort to prepare the nation for an influenza pandemic.”

“During an influenza pandemic, we know that no single action will provide complete protection,” said Dr. Julie Gerberding, CDC director. “We also know that many people may choose to use masks for an extra margin of protection even if there is no proof of their effectiveness. If people are not able to avoid crowded places, large gatherings or are caring for people who are ill, using a facemask or a respirator correctly and consistently could help protect people and reduce the spread of pandemic influenza.”

Gerberding noted that while studies are underway in an effort to learn more about whether masks and respirators can provide protection from influenza and how people would use such things, the guidance was designed to be a “best estimate” based on what is currently known. It is designed to help guide people’s decisions regarding the use of masks.

Ireland: National pandemic influenza plan 2007 [Jan 16 07 Belfast Ireland]--The Department of Health and Children and the Health Service Executive (HSE) today (15th January 2007) published the National Pandemic Influenza Plan and Pandemic Influenza Preparedness for Ireland - Advice of the Pandemic Influenza Expert Group.

The chair of the Pandemic Influenza Expert Group, Professor William Hall said:

“I encourage all interested parties to provide feedback to the expert group. It is our intention that the final document will contain the best and most informed advice possible.”

The publication can be downloaded in english and irish HERE

CDC influenza pandemic operation plan [OPLAN] [Dec 20 06 Atlanta GA USA]--This CDC Influenza Pandemic OPLAN is an INTERNAL document that provides guidance for CDC operations as directed by the Director, Centers for Disease Control and Prevention.

Download the Entire OPLAN:

PDF version of entire CDC Influenza Pandamic Operation Plan (OPLAN)
 (14.81 MB/350 pages)

All downloads in Adobe PDF format: 

• Cover Page and Disclaimer (pages 1-2) (106 KB/2 pages)
• Record of Revisions (pages 3-4) (117 KB/2 pages)
• Table of Contents (pages 5-8) (271 KB/4 pages)
• References (pages 9-10) (111 KB/2 pages)
• Executive Summary (pages 11-78) (2.7 MB/68 pages)
• Annexes:
  • List of Annexes (pages 79-80) (115 KB/2 pages)
  • ANNEX A - (DEOC TASK ORGANIZATION) TO CDC INFLUENZA PANDEMIC OPLAN (pages 81-106) (1.06 MB/26 pages)
  • ANNEX B - (DISEASE INTELLIGENCE) TO CDC INFLUENZA PANDEMIC OPLAN (pages 107-164) (2.51 MB/58 pages)
  • ANNEX C - (OPERATIONS) TO CDC INFLUENZA PANDEMIC OPLAN (pages 165-200) (1.86 MB/36 pages)
  • ANNEX D - PUBLIC HEALTH INTERVENTIONS (pages 201-230) (1.29 MB/30 pages)
  • ANNEX E - (STATE, LOCAL, TERRITORIAL AND TRIBAL SUPPORT) TO CDC INFLUENZA PANDEMIC OPLAN (pages 231-240) (433 KB/10 pages)
  • ANNEX F - PARTNERSHIPS AND STRATEGIC ALLIANCES) TO CDC INFLUENZA PANDEMIC OPLAN (pages 241-244) (200 KB/4 pages)
  • ANNEX G - COUNTERMEASURES (pages 245-258) (611 KB/14 pages)
  • ANNEX H - (SUPPORT SERVICES) TO CDC INFLUENZA PANDEMIC OPLAN (pages 259-260) (110 KB/2 pages)
  • ANNEX I - (CRISIS COMMUNICATION) TO CDC INFLUENZA PANDEMIC OPLAN (pages 261-278) (764 KB/18 pages)
  • ANNEX J - (INFORMATION MANAGEMENT) TO CDC INFLUENZA PANDEMIC OPLAN (pages 279-292) (595 KB/14 pages)
  • ANNEX K - (LEGAL CONSIDERATIONS) TO CDC INFLUENZA PANDEMIC OPLAN (pages 293-296) (191 KB/4 pages)
  • ANNEX L - (REPORTS AND PRODUCTS) TO CDC INFLUENZA PANDEMIC OPLAN (pages 297-336) (1.91 MB/40 pages)
  • ANNEX M - (ACRONYMS) TO CDC INFLUENZA PANDEMIC OPLAN (pages 337-350) (582 KB/14 pages)

Revised Canadian Pandemic Influenza Plan for the Health Sector released [Posted 07:18 Dec 10 Ottawa ON Canada]--The revised Canadian Pandemic Influenza Plan for the Health Sector was released today along with a summary booklet entitled Highlights from the Canadian Pandemic Influenza Plan for the Health Sector.

The updated Plan was released today at the annual meeting of federal, provincial and territorial health ministers in Moncton, New Brunswick.

The Plan – developed collaboratively by federal, provincial and territorial governments with input from health experts and officials – provides guidelines and recommendations to assist governments and organizations in planning their own responses.

Updated regularly since it was first published in 2004, the current version now includes new guidelines on influenza surveillance and public health measures. The Plan will continue to be updated with new information.

Both documents are available on the Public Health Agency of Canada website at http://www.phac-aspc.gc.ca. For more information about pandemic influenza, visit http://www.influenza.gc.ca

Guidance relating to suspected human cases of avian influenza returning to the UK [Dec 5 London England]--Health Protection Agency WHO Pandemic Alert Phase 3 Algorithms

Updates and changes (25 kB): a summary of updates and changes made to the HPA WHO Phase 3 algorithms

Case Management

A3: WHO Pandemic Alert Phase 3: Algorithm for the management of returning travellers and visitors from countries affected by avian influenza (H5N1) presenting with febrile respiratory illness Last reviewed 04 December 2006. The following changes were made: Korea (Republic of) was added into, and Serbia and Montenegro and Ukraine were removed from the algorithm according to OIE reports.

F3: WHO Pandemic Alert Phase 3: Algorithm for the management of persons resident in the UK or arriving from areas not known to have avian influenza H5N1 presenting with febrile respiratory illness after close contact with sick, dying or dead birds: recognition, investigation and initial management. (208 kB) Last reviewed 06 September 2006. The following change was made: Added “close contact with a confirmed H5N1 infected animal other than poultry or wild birds (e.g. cat or pig)” in section “(3) Exposures” according to WHO case definitions (see reference 2). 

Interim HPA guidelines for investigation and reporting of suspected human cases of avian influenza
Last reviewed 10 January 2006 

AI SOP: Health Protection Agency actions for dealing with human health implications of avian influenza in poultry and wildfowl (211 kB) Last reviewed 06 April 2006 

E3: WHO Pandemic Alert Phase 3: Draft Algorithm for the management of personnel involved in the response to an occurrence of highly pathogenic avian influenza (H5N1 only) in wild birds in the UK, presenting with febrile respiratory illness (165kB) Last reviewed 02 May 2006. The following change was made: title changed to more accurately reflect situation in which algorithm should be used.  

B3: WHO Pandemic Alert Phase 3 Draft Algorithm: Post-exposure prophylaxis (PEP) for contacts of confirmed human cases of avian influenza (H5N1) in the UK (155 kB) Last reviewed 19 June 2006. The following changes were made: action for contact type 4 (travel contact) clarified to include passive follow up. Actions for contact types 4 and 5 (holiday contact) expanded to include provision of information. Footnote 4: requirement for duration of travel lasting more than four hours removed due to practical difficulties in determining this.

C3: WHO Pandemic Alert Phase 3 Draft Algorithm: Post-exposure prophylaxis (PEP) for farm workers/residents, SVS staff, and cullers involved in confirmed or suspected outbreaks of highly pathogenic avian influenza suspected or known to be due to H5N1 in poultry in the UK (178 kB) Last reviewed 19 September 2006. The following change was made: ‘exposure to infected poultry/environment’ added to actions necessary for contact types 1 and 2. Footnote 1 altered to read " …in the 48 hours prior to onset of clinical signs in poultry".

D3: WHO Pandemic Alert Phase 3 Draft Algorithm: Management of human contacts in the event of confirmed highly pathogenic avian influenza [HPAI] (H5N1) in one or more wild birds in the UK (185 kB) Last reviewed 03 May 2006. The following change was made: clarification provided regarding PPE and PEP for veterinary workers handling wild birds confirmed to be infected with HPAI (H5N1) within a 10k Defra wild bird surveillance zone.  

This is the report form for health care professionals investigating respiratory illness in individuals meeting the avian influenza infection case definition.

HPA case report form for suspected human cases of avian influenza (93kB) Last reviewed 11 October 2006

The form is also available as a word document (241kB) that can be completed and emailed to Dr Hongxin Zhao.  

Laboratory Guidance

Microbiological guidance for taking and handling specimens for avian influenza testing Last reviewed 10 January 2006

Advisory Committee on Dangerous Pathogens (ACDP) laboratory advice (ACDP website)

Travel Advice

Travel Advice Page Last reviewed 07 April 2006

Frequently asked questions on travelling to zones affected by avian influenza (H5N1) Last reviewed 04 October 2006

Australian Capital Territory Health Management Plan for Pandemic Influenza [Nov 13 Canberra ACT Australia]--ACT Health invites members of the Capital Region community to comment on the draft ACT Health Management Plan for Pandemic Influenza (The Plan).

Download: Pandemic Plan consultation draft (PDF File - 431k)

The Plan outlines how the health sector is preparing and draws together what the residents of the ACT may need to know about that planning effort for a possible future outbreak of pandemic influenza. It also explains how people can protect themselves and others from infection, with much local information.

Download: Pandemic Plan consultation details (Microsoft Word Document - 54k)

Information on bird flu cases poorly recorded, scientists say [Nov 1 Washington DC USA]--The highly pathogenic H5N1 avian influenza has been detected in at least 55 countries in Asia, Europe, and Africa. This often fatal disease is of pressing concern because it can be transmitted from birds to humans, although such transmissions have been rare so far.

 Unfortunately, according to a Roundtable article in the November 2006 BioScience, the journal of the American Institute of Biological Sciences (AIBS), critical information about incidence of the disease in wild birds--even the species of the infected bird--is often recorded inaccurately or not recorded at all.

The deficiencies in data collection, the authors write, "can lead to unwarranted assumptions and conclusions that in turn affect public perceptions, practical control and management measures, and the disposition of resources."

Bird flu is typically studied by veterinarians and virologists. The article's authors, Maï Yasué, Chris J. Feare, Leon Bennun, and Wolfgang Fiedler, made use of the Aiwatch (avian influenza watch) e-mail forum to gather information for their article from sources worldwide.

They describe several instances in which the species of an infected wild bird was incorrectly or inadequately recorded--sometimes just as "wild duck," for example--and others in which the bird's sex and age were misidentified.

Likewise, reported details of the location and time of discovery of an infected bird often lack specificity, yet they are crucial for a good understanding of the virus's spread. Information about capture and sampling methods and other species in the vicinity of an infected bird has also often been inadequately described.

The authors end their article with a plea for greater involvement by ornithologists and ecologists in H5N1 research and monitoring.

Control measures fail to stop spread of new H5N1 virus [Oct 31 Memphis TN USA]--A new variant of the bird flu virus H5N1 emerged in late 2005 and replaced most of the previous variants across a large part of southern China, despite an ongoing program to vaccinate poultry, according to researchers at the University of Hong Kong in collaboration with scientists at St. Jude Children’s Research Hospital.

The new virus, called Fujian-like (FL), appears to be responsible for the increased occurrence of H5N1 poultry infections since October 2005, as well as recent human cases in China, the researchers said. FL has now also been transmitted to Hong Kong, Laos, Malaysia, and Thailand, resulting in a new bird flu outbreak wave in Southeast Asia that has caused human infections as well, according to the Hong Kong/St. Jude team.

The investigators also warned that it is possible that this new H5N1 variant will spread further through Asia and into Europe, as it evolves to form other sublineages that vary from place to place. This evolution into different sublineages also occurred during the previous two waves of H5N1 transmission that occurred during the past several years, according to the investigators. A report on these findings appears in the November online edition of the Proceedings of the National Academy of Sciences (PNAS).

The findings are significant because experts believe that H5N1 is the most likely virus to trigger a human influenza pandemic (worldwide epidemic). Moreover, the increasing number of transmissions from birds to humans in the past year supports this opinion, said Robert G. Webster, Ph.D., a co-author of the PNAS paper. Webster is a member of the Infectious Diseases department and holder of the Rose Marie Thomas Chair at St. Jude.

Based on their study of vaccinated poultry the Hong Kong/St. Jude team suggested that the vaccination itself might have facilitated emergence of this new variant.

This emergence and rapid distribution of FL, despite the vaccination program that was started in September 2005, also suggests that the current H5N1 control measures are still inadequate, Webster said.

Moreover, since November 2005, some of the 22 H5N1 human infections reported from 14 provinces in China were from infected residents of metropolitan areas such as Shangai, Wuhan and Guangzhou, which are remote from poultry farms.

“We don’t know yet whether the people in those metropolitan areas were infected locally by contact with poultry or by contact with other humans,” Webster said, “but we suspect from the studies they are being infected by contact with poultry.”

The researchers found the virus in samples taken from infected chickens in 11 of the last 12 months of the present study, compared with only four months during 2004-05. This indicates an increase in the incidence of H5N1 infection in 2005-2006 compared with previous years, which suggests that H5N1 viruses have not been effectively contained.

The investigators also conducted genetic studies of 390 H5N1 viruses isolated from poultry in the current study (30 percent of the total found in southern China) and found that 68 percent were of the FL sublineage.

The emergence of FL-like viruses and their success in replacing other H5N1 variants in such a short time demonstrates how difficult it is to control H5N1 in China, Webster said.

The other authors of this paper are Gavin Smith, X. H. Fan, J. Wang, K. S. Li, K. Qin, J.X. Zhang, D. Vijaykrishna, C.L. Cheung, K. Huang, Marik Peiris, Honglin Chen and Yi Guan (University of Hong Kong), and J.M. Rayner (formerly of St. Jude).

This work was supported in part by the Li Ka Shing Foundation, the National Institute of Allergy and Infectious Diseases and ALSAC.

Media seminar on flu pandemic preparedness and avian influenza [Oct 25 Brussels Belgium]--On 17 October 2006, the European Commission’s Directorate-General for Health and Consumer Protection organised a media seminar bringing together a number of leading experts from the European Commission, the European Centre for Disease Prevention and Control, the pharmaceutical industry and the World Health Organisation, with journalists from across the EU Member States. The aim of the seminar was to provide participants with a deeper understanding of pandemic preparedness planning and the steps being taken by the European Commission and the international community to tackle and prevent avian influenza in wild birds and poultry. The seminar also sought to clarify technical aspects such as the difference between flu and human seasonal flu; the different aspects of transmission and the relative properties of vaccines and anti-virals. Please find below further information, presentations and information on the speakers http://ec.europa.eu/food/press/index_en.htm

Study identifies North American wild bird species that could transmit bird flu [Oct 23 Athens GA USA]--University of Georgia researchers have found that the common wood duck and laughing gull are very susceptible to highly pathogenic H5N1 avian influenza viruses and have the potential to transmit them.

Their finding, published in the November issue of the journal Emerging Infectious Diseases, demonstrates that different species of North American birds would respond very differently if infected with these viruses. David Stallknecht, associate professor in the department of population health at the UGA College of Veterinary Medicine and co-author of the study, said knowing which species are likely to be affected by highly pathogenic H5N1 viruses is a vital component of efforts to quickly detect the disease should it arrive in North America.

"If you're looking for highly pathogenic H5N1 in wild birds, it would really pay to investigate any wood duck deaths because they seem to be highly susceptible, as are laughing gulls," said Stallknecht, a member of the UGA Biomedical and Health Sciences Institute. "It was also very interesting that in some species that you normally think of as influenza reservoirs – the mallard, for instance – the duration and extent of viral shedding is relatively low. This may be good news since it suggests that highly pathogenic H5N1 may have a difficult time surviving in North American wild birds even if it did arrive here."

Working under controlled conditions in an airtight biosecurity lab at the USDA Agricultural Research Service's Southeast Poultry Research Laboratory, the researchers determined how much of the virus was shed in the feces and through the respiratory system of several species of wild birds. The work was jointly funded by the United States Poultry and Egg Association, the Morris Animal Foundation and the USDA.

"We chose birds that, because of their behavior or habitat utilization, are most likely to transmit the virus or bring the virus here to North America," said lead author and doctoral student Dr. Justin Brown.

The species studied were: Mallards, which are often infected with commonly circulating, low-pathogenic avian influenza viruses in North America and Eurasia; Northern pintails and blue-winged teal, which migrate long distances between continents; redheads, a diving species; and wood ducks, which breed in Northern and Southern areas of the United States. The laughing gull is a common coastal species ranging from the Southern Atlantic to the Gulf Coast.

Stallknecht explained that in low-pathogenic avian influenza, most of the virus is shed in the feces of birds. The virus then spreads as other birds drink from contaminated water. The study found that in highly pathogenic H5N1 avian influenza, however, the birds shed most of the virus through their respiratory tract.

Stallknecht said that with this knowledge, scientists can more effectively detect the virus in live birds by swabbing the birds' mouths and throats.

"Doing avian influenza surveillance is pretty tricky because there are a lot of species differences and there are also seasonal differences," he said. "So you've got to pick the right species at the right time and you've got to collect the right samples."

In a related study scheduled to be published in December issue of the journal Avian Diseases, the researchers have quantified how long the virus persists in water samples. They found that highly pathogenic H5N1 avian influenza viruses don't persist as long as common low-pathogenicity strains. In some cases, persistence times were reduced by more than 70%. This could affect transmission and supports the idea that these viruses may not have much of chance of becoming established in North America.

Stallknecht said the finding is encouraging, but cautions that it's difficult to put it into context without results from a study his team is currently working on that will assess the minimum amount of virus it takes to infect a bird.

This month the researchers also received the first $875,000 of a planned three-year grant totaling $2.6 million from the Centers for Disease Control and Prevention. The grant will be used for an ambitious project that will take a broad look at the possibility of human contact with avian influenza viruses.

In the first phase of the project, the researchers will examine the prevalence, persistence and distribution of the viruses in various environments. In the next phase, they'll work with state public health departments to determine the groups of people who – by virtue of their occupation or recreational activities – are likely to come into contact with the viruses. The researchers will then assess the ability of low-pathogenic avian influenza viruses to infect mammals so that the risk of human contact can be put into perspective.

"With this information, public health officials will be able to better understand the human health risks associated with both low-pathogenic and highly pathogenic avian influenza viruses in both domestic and wild bird populations," Stallknecht said. "Many of these potential risks are not very well understood or even defined, and it is possible that they could be very effectively controlled with simple preventive measures."

Effective booster shot a bit of good news against bird flu [Oct 12 Toronto ON Canada]--An initial priming shot given in advance of a booster shot may be an effective way to protect people against bird flu, researchers say in a presentation at the annual meeting of the Infectious Diseases Society of America.

The findings help address a major question facing public health officials: How to protect against a possible pandemic caused by a virus whose precise viral make-up won't be known until it has already become a threat?

The team from the University of Rochester Medical Center is addressing the question by taking advantage of a small group of people in Rochester who were among the first Americans to be vaccinated against bird flu when the disease first became a human threat in Hong Kong back in 1997 and 1998.

Shortly after the Hong Kong threat, the National Institute of Allergy and Infectious Diseases funded a study in Rochester of an experimental vaccine designed against that form of bird flu. Last year scientists turned to the same group of volunteers, who represent a unique pool of knowledge about bird flu, in a study to determine the effects of giving a booster shot years after a person was originally immunized.

Officials were able to track down 37 people who agreed to take part. Each had received two shots as part of the vaccine study in 1998 against the form of the virus that had emerged in Hong Kong. Earlier this year each was again vaccinated with another shot targeting a different form of bird flu, the variant that swept through Vietnam in 2004 and 2005. Their immune response to the second shot was compared to the response in people who received shots for the first time in 2005. More than twice as many people who also received the shot in 1998 developed a protective antibody response against bird flu compared to people who had never been immunized against bird flu previously.

"We studied a relatively small group, so that certainly, this issue needs to be studied more thoroughly in a larger group of people," said John J. Treanor, M.D., professor of medicine and director of Rochester's Vaccine and Treatment Evaluation Unit. If the findings hold up, then it might open up a number of options beneficial for planning. One might consider giving a priming shot to members of the community who would be a central part of the response if a pandemic were to occur, such as health care workers. You'd have people who were prepared as much as possible in advance."

The work is being presented at IDSA by research fellow Nega Ali Goji, M.D., who did the study with Treanor

The work addresses one of the features of bird flu that makes a potential pandemic so hard to fight: Like human flu viruses, bird flu mutates constantly, and by the time a vaccine has been produced to protect against one form of bird flu, it's very possible that another form, requiring a different vaccine, will have emerged that can move from person to person.

The results of the new study are similar to what doctors already know about giving "regular" flu shots. Every year millions of adults get an updated flu shot every year – one shot is enough, because their immune systems "remember" previous forms of the flu and help make the new shot each year effective. But small children who have never seen the flu before typically need two shots, a primer and a booster. The results from the new study indicate that, like small children who receive a regular flu shot, adults who have never encountered bird flu would benefit from a booster shot.

The two vaccines used in the study target viruses belonging to different "clades" or viral families. Both are H5N1 bird flu viruses, but the Hong Kong strain from 1997 belongs to clade 3, while the Vietnam strain from 2004 belongs to clade 1. Goji and Treanor found that the shot targeting clade 3 helps the body maximize the immunization against a virus in a different clade, clade 1. In other words, using the vaccines that are available now might help improve the response to the vaccines developed for a future strain of bird flu.

The work was possible thanks to the availability of volunteers in Rochester who took part in the nation's first U.S. human bird flu study, back in 1998, at the University of Rochester Medical Center. At the University's VTEU, thanks to funding from NIAID, more than 450 people have taken part in studies of bird flu vaccine, more than nearly any city in the world.

Updates on pandemic flu vaccine trials to be presented at 44th annual IDSA meeting [Oct 12 Toronto ON Canada]--Preliminary results from clinical trials testing two different pandemic flu vaccine approaches--one a prime-boost strategy using different subtypes of H5N1 vaccines, the other an H5N1 vaccine delivered into the skin (intradermal) rather than the muscle--will be presented at the 44th Annual Meeting of the Infectious Diseases Society of America being held in Toronto Oct. 12-15. The presentations are scheduled for a late-breaker session on Friday afternoon, Oct. 13th (see http://www.idsociety.org).

Funding for the trials comes from the National Institute of Allergy and Infectious Diseases (NIAID), one of the National Institutes of Health. Reporters may call the NIAID News Office at 301-402-1663 to speak with NIAID Director Anthony S. Fauci, M.D., who is available to comment and provide perspective on these preliminary findings.

Preliminary Results Suggest Priming Boosts Immune Responses to Variant H5N1 Vaccine

Presentation time: Late-Breaker Session, Friday, Oct. 13, 2006, 5:00 p.m. Presenter: Nega Ali Goji, M.D., University of Rochester Medical Center, Rochester, NY

If a pandemic influenza strain was identified, it would likely take several months to make a vaccine against it, and stimulating protective immunity with the vaccine would likely require more than one dose. Giving people two doses of H5N1 influenza vaccine as a pandemic is evolving would be logistically difficult, however, so researchers have been urgently investigating alternative strategies.

One such alternative is to prime people ahead of time with a related vaccine so that only a single dose of vaccine is required when the pandemic emerges. A team of researchers led by University of Rochester Medical Center investigators Nega Ali Goji, M.D., and John J. Treanor, M.D., recently tested this hypothesis. They compared the immune response to a single 90-microgram dose of one variant of avian flu vaccine in two groups of adults: those who had received a different variant of H5N1 avian flu virus vaccine some eight years earlier and those without pre-exposure to any H5N1 virus or vaccines.

In late 1997-98, soon after the first case of direct bird-to-human transmission of an H5N1 flu virus occurred in Hong Kong, NIAID funded the production of an experimental vaccine made from the Hong Kong virus and tested it in a small clinical trial conducted at the University of Rochester in healthy adults (see reference). Thirty-seven individuals who received two doses of the Hong Kong H5N1 vaccine in that trial served as the "primed" population in the current study.

The booster dose in the current study--an experimental inactivated H5N1 virus vaccine produced for NIAID by sanofi pasteur, the vaccines business of the sanofi-aventis Group of Paris--is based on an H5N1 flu virus from Vietnam. The Hong Kong virus is related to the Vietnam virus but belongs to clade 3, which refers to its branch on an evolutionary tree of the H5N1 viruses in Asia, while the Vietnam virus belongs to clade 1.

In their trial, the Rochester team found that more than twice as many of the individuals who had received the priming dose of clade 3 H5N1 vaccine responded with substantial antibody levels to a single dose of clade 1 H5N1 vaccine than did those with no prior H5N1 exposure. Dr. Treanor says that these early but promising data indicate that priming with an antigenic variant vaccine before a pandemic occurs may be one strategy used to help control a pandemic.

"These preliminary findings need to be confirmed in larger studies, but they offer the intriguing possibility that pre-pandemic priming with existing H5N1 vaccines may boost the immune response to a different H5N1 vaccine tailor-made years later to thwart an emerging human influenza pandemic," says Dr. Fauci.

Third Dose of Intramdermal H5N1 Vaccine Well-Tolerated but does Not Improve the Immune Response

Presentation Time: Late-Breaker Session, Friday, Oct. 13, 2006, 5:15 p.m.

Presenter: Shital M. Patel, M.D., Baylor College of Medicine, Houston, TX

Previous studies have suggested that lower dosages of seasonal flu vaccine given intradermally may work as well as higher dosages of the same vaccine given intramuscularly, enabling public health officials to "stretch" available doses of vaccine in a time of shortage. To test this principle with an H5N1 pandemic flu vaccine, NIAID initiated a vaccine trial to compare immune responses generated by an H5N1 vaccine given by the intradermal or the intramuscular route. The H5N1 vaccine formulations were produced for NIAID by sanofi pasteur.

Wendy Keitel, M.D., Shital M. Patel, M.D., and their Baylor College of Medicine colleagues conducted the trial. Results of their initial two-dose study among 100 participants indicated that antibody responses among volunteers given 3 or 9 micrograms of vaccine intradermally were similar to the antibody responses seen among volunteers given 15 micrograms intramuscularly: 4 percent, 5 percent, and 12 percent of volunteers, respectively, had a significant increase in antibody levels after two doses. Those given 45 micrograms by the intramuscular route, however, showed a significantly higher response rate: 56 percent of volunteers in this group responded.

In the current study, the Baylor team enrolled 77 healthy adults between the ages of 18 and 40 who had previously received two doses of the same vaccine one month apart and gave them a third dose of vaccine 6 months later to see if it boosted their antibody response. The participants, again divided into four groups, received either 3 or 9 micrograms intradermally or 15 or 45 micrograms intramuscularly. The dosages of vaccine were limited by the formulations available.

According to Dr. Patel, a quarter or less of the participants in the study groups given the vaccine intradermally or intramuscularly at 15 micrograms had a significant antibody response after the third dose, while nearly two-thirds of the volunteers in the group that received 45 micrograms intramuscularly had a similar response. For each dosage by either route of administration, the results show that giving a third dose of the vaccine 6 months later increased antibody titers to levels similar to those achieved after the first two doses.

"This small pilot study demonstrates that multiple doses of an inactivated H5N1 vaccine given by either the intradermal or the intramuscular route are safe and well tolerated," says Dr. Fauci. "It also provides a strong rationale for testing higher dosages of H5N1 vaccine given intradermally." Plans are under way to directly compare the immune responses generated by vaccinating either into the skin or into the muscle with an H5N1 vaccine containing higher levels of the same amount of antigen.

NSW human influenza pandemic plan [Oct 4 Sydney NSW Australia] http://www.health.nsw.gov.au/pandemic/docs/nswplan.pdf

Live H5N1 avian flu virus vax show protection in animal studies [Sep 12 Gaithersburg MD USA]--When tested in mice and ferrets, experimental vaccines based on live, weakened versions of different strains of the H5N1 avian influenza virus were well-tolerated and protected the animals from a deadly infection with naturally occurring H5N1 flu viruses. The findings, which appear in the September 12 issue of PLoS Medicine, are also encouraging, the researchers say, because they demonstrate the ability to create a vaccine based on one particular strain of the H5N1 flu virus that could potentially protect against different emerging H5N1 flu strains.

Senior investigator Kanta Subbarao, M.D., M.P.H., and co-chief Brian Murphy, M.D., both of the Laboratory of Infectious Diseases at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), led the research. The study was the result of a cooperative research and development agreement between NIAID and MedImmune Inc., of Gaithersburg, Md.

“This is an excellent example of the NIH and industry working together to find scientific solutions to potential public health problems,” notes NIH Director Elias A. Zerhouni, M.D. “Developing a vaccine that could protect against a potential influenza pandemic is a top priority for all of us.”

“If an influenza pandemic were imminent or under way, we would need a vaccine that could stimulate immunity quickly, preferably with a single dose,” says NIAID Director Anthony S. Fauci., M.D. “The encouraging findings of this study suggest that vaccines based on live but weakened versions of the H5N1 avian influenza virus may quickly stimulate protective immunity. We are further exploring this live, attenuated vaccine strategy as one of several tools that we hope to have available in the event of an influenza pandemic.”

As of September 8, 2006, there have been 244 confirmed human cases of H5N1 infection and more than half of those were fatal, according to the World Health Organization (WHO). Public health officials worry that the H5N1 virus will evolve to become easily transmissible among people, potentially sparking an influenza pandemic, because humans have no pre-existing immunity to the H5N1 viruses.

The NIAID and MedImmune research team created three vaccines by combining modified proteins derived from virulent H5N1 flu viruses with proteins from an artificially weakened (attenuated) flu strain. The virulent H5N1 viruses were isolated from human cases in Hong Kong in 1997 and 2003, and Vietnam in 2004. The attenuated flu vaccine strain, which also serves as the basis for MedImmune’s FluMist® influenza vaccine, was lab-grown in progressively colder temperatures (“cold-adapted”) to prevent the resulting vaccine viruses from spreading beyond the relatively cool upper respiratory tract. Large quantities of the resulting cold-adapted viruses were grown in chicken eggs.

The safety of the vaccine viruses was evaluated in chickens and mice. In chickens, the H5N1 vaccine viruses were not lethal, while each of the three strains of the “wild-type” (naturally occurring) H5N1 viruses were. Similarly, the vaccine viruses were not lethal in mice, but the 1997 and 2004 strains of the wild-type H5N1 viruses were. The 2003 strain of the H5N1 wild-type virus was not tested in mice because the researchers found that the virus was lethal in those animals only at very high doses. Because the wild-type H5N1 viruses have been shown to replicate in animal lungs and brains, the researchers tested the ability of the 1997 and 2004 strains of the vaccine viruses to replicate in mice and ferrets as an additional safety measure In mice, the vaccine viruses replicated in the respiratory tract but did not spread to the animals’ brains. In ferrets, the H5N1 vaccine viruses did not replicate in the lungs or the brain.

To evaluate the protective ability of the vaccines, the researchers gave the mice a single dose of vaccine virus via nose drops. All of these mice survived infection with the 1997 and 2004 H5N1 wild-type viruses, including two more recent strains of the H5N1 virus found circulating in Vietnam and Indonesia in 2005. Further, mice that received a second dose of vaccine 28 days after the initial inoculation demonstrated a stronger and more rapid immune response and almost complete protection from respiratory infection when exposed to the naturally occurring H5N1 viruses. Ferrets exhibited similar results when given two doses of the vaccine viruses.

“It is impossible to predict how the H5N1 virus will evolve or which strain, if any, will cause an influenza pandemic. To be prepared, we need to select a vaccine capable of inducing an effective human immune response against a range of H5N1 viruses that may emerge in the future. This study shows that such cross-protection can be achieved in small animals,” says Dr. Subbarao. “The next step is to evaluate in people the safety and immune response induced by these vaccines to see if they produce cross-reactive antibodies that are likely to protect against different H5N1 viruses.”

In June 2006, NIAID and MedImmune launched a Phase 1 study to evaluate the safety and immunogenicity of a live, attenuated H5N1 vaccine based on the 2004 H5N1 virus strain. The study, which is being performed in an isolation unit at Johns Hopkins Bloomberg School of Public Health Center for Immunization Research in Baltimore, is evaluating the safety and immunogenicity of the vaccine in approximately 20 healthy individuals between the ages of 18 and 49. Results from that study are not yet available.

The concept of using cold-adapted flu viruses to create flu vaccines, as detailed in the study in PLoS Medicine, was developed by scientists at NIAID and the University of Michigan School of Public Health (http://www3.niaid.nih.gov/news/focuson/flu/research/prevention/flumist.htm).