4/15/08-4/21/08|Weekly Bird Flu Thread:Bird Flu Spreading Towards Seoul

Link to last weeks thread:

HEALTH - 4/7/08-4/14/08|Weekly Bird Flu Thread:New bird flu outbreak in South Korea

http://www.timebomb2000.com/vb/showthread.php?t=283920


Johns Hopkins on influenza:

http://www.iom.edu/Object.File/Master/33/450/Rashid Chotani.pdf

National Avian Influenza Surveillance Information:

http://wildlifedisease.nbii.gov/ai/

CDC

http://www.cdc.gov/flu/avian/index.htm

WHO

http://www.who.int/csr/disease/avian_influenza/en/index.html

CIDRAP

http://www.cidrap.umn.edu/

Official U.S. Government Web site

http://www.pandemicflu.gov/

FAO

http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html

Public Health Agency of Canada

http://www.phac-aspc.gc.ca/influenza/avian_qa_e.html

European Union

http://ec.europa.eu/dgs/health_consumer/dyna/influenza/country_en.htm

The World Bank

http://web.worldbank.org/WBSITE/EXT...68427~piPK:64168435~theSitePK:1793593,00.html

Bird Flu Spreading Towards Seoul​

http://www.koreatimes.co.kr/www/news/nation/2008/04/113_22509.html

Bird flu outbreaks first reported early this month have spread to within 70 kilometers of Seoul despite efforts by local quarantine authorities to contain the disease, the government said Tuesday.

The Ministry for Food, Agriculture, Forestry and Fisheries said a chicken farm in Pyeongtaek, Gyeonggi Province reported sudden death of birds on Monday.

"Judging by the way the birds died off and the large numbers involved, there is a good chance that the Pyeongtaek chicken farm has been affected by the avian influenza," said Kim Chang-seob, the ministry's chief veterinary officer.

If it is confirmed that the birds at the chicken farm died from the the virulent H5 strain of the bird flu, it would be a clear sign that the outbreak centered in the Jeolla region in the southwestern part of the country has spread.

Kim said while detailed tests on the suspected Pyeongtaek outbreak won't be confirmed until later in the day, authorities culled the 26,000 birds at the farm.

"If there is confirmation that the H5 strain killed the chickens, all birds raised in poultry farms within 500 meters will be destroyed independent of tests," he said.

In addition to the suspected outbreak in Pyeongtaek, the ministry said three other cases were reported in the Jeolla region. This brings the total of reported cases to 36.

Of these 20 have tested positive for the bird flu virus, with 14 undergoing tests. Of the total two of the sites tested negative for bird flu.

Expert said they do not have not exact numbers of birds that have been culled so far this year, but hinted that it could exceed previous outbreaks.

In the winter of 2003, authorities culled around 5.6 million birds, while in the outbreak of 2006, about 2.8 million birds were destroyed. (Yonhap)

Bird flu outbreak confirmed in parts of Russia​

http://sify.com/news/fullstory.php?id=14649968

Tuesday, 15 April , 2008, 16:38

Vladivostok (Russia): Authorities in Russia's Far East Tuesday confirmed the presence of a deadly strain of bird flu in a village in the Primorye territory, where some birds have been found dead last week.

More than 40 birds have been slaughtered at the farm, and quarantine has been introduced in the area. A total of 350,000 birds have been vaccinated, a spokesman for the administration said.

The farm owner, who was hospitalised last week with suspected bird flu, has been released as tests showed no trace of the lethal H5N1 virus, the Russian Centre of Emergency Medicine said.

Local officials have so far introduced a hunting ban on ducks, geese and other waterfowl, although samples taken from more than 150 wild birds have proved negative.

Meanwhile, reports from Perm, in the Urals, said a total of 37,500 birds have died, and tests are being carried out for the virus.

No human fatalities or cases of humans infected with bird flu have been reported in Russia, where the first outbreaks were registered in southern areas of the country and Siberia in 2005.

According to the World Health Organization, avian influenza has so far killed 239 people worldwide.

Japan confirms another outbreak of H5N1 bird flu​

http://www.reuters.com/article/latestCrisis/idUST237513

TOKYO, Jan 31 (Reuters) - Japan has confirmed an outbreak of H5N1 bird flu in the western prefecture of Okayama, the third to be confirmed in the country since the beginning of the year, the Agriculture Ministry said in a statement on Wednesday.

The ministry also said a separate outbreak was suspected after 23 birds died at a poultry farm in the southwestern prefecture of Miyazaki, site of two earlier H5N1 flare-ups and Japan's biggest poultry-producing region.

The H5N1 virus has killed at least 164 people worldwide since 2003, most of them in Asia, and over 200 million birds have died from it or have been killed to prevent its spread.

There have been no reported cases of human infection from the virus in Japan.

Agriculture Minister Toshikatsu Matsuoka told reporters that his ministry would support local authorities if they were to call for help from troops to deal with bird flu-related situations.

Scientists unveil first libraries of avian flu virus antibodies​

http://www.thaindian.com/newsportal...s-of-avian-flu-virus-antibodies_10038205.html

April 15th, 2008 - 5:46 pm ICT by admin

Washington, April 15 (ANI): An international team of American and Turkish researchers has announced that it has created libraries of avian flue virus antibodies.

The research group, led by Sea Lane Biotechnologies, revealed that the antibody libraries had been created using samples from survivors of the 2005/2006 “bird flu” outbreak in Turkey.

This advancement has boosted the hope for the development of a therapy to stop a pandemic in its tracks, and for a treatment for those infected.

It may also be useful in the development of a universal flu vaccine, say the researchers.

The team insists that the expanded treatment and containment options offered by Sea Lanes antibody libraries might help provide healthcare officials and governments with unprecedented resources to combat the serious global health threat.

Three global influenza pandemics have occurred within the past 100 years, each with devastating consequences. Our study holds out the hope that a new outbreak could potentially be stopped at an early stage, and that effective treatment could be available to those infected, said Richard A. Lerner, the President of the Scripps Research Institute (La Jolla, CA) who collaborated with Sea Lane on the study.

So far, the new antibody libraries reported in the study have yielded more than 300 unique monoclonal antibodies that are active against H5N1 antigens, foreign substances that produce an immune system response.

Amongst them, the authors identified several broadly neutralizing antibodies that were effective against a number of contemporary subtypes of H5 (avian) flu. Three of the antibodies acatlogues were found to neutralize both the H1 (common seasonal flu) and H5 (avian) subtypes.

The antibodies we have isolated have the potential to be used directly as therapeutic agents against multiple influenza subtypes, permitting the resolution of infection upon administration to an infected individual, said Peter Palese, the Horace W. Goldsmith Professor & Chairman of Microbiology at The Mount Sinai School of Medicine (New York, NY), another collaborator on the project.

Perhaps most importantly, these antibodies may be used to identify cross-reactive epitopes on the hemagglutinin protein of an influenza virus. Identification of such epitopes may allow the rational design of vaccines with cross-subtype neutralizing activity. Such vaccines would constitute a major advance on current technology, and would be a first step towards the design of a universal influenza vaccine, Palese added.

During the study, the researchers were able to obtain the entire immunologic history of an individuals response, which offered a clearer picture of the relationships between antibodies and their relative effectiveness.

These insights may help scientists determine prescient strategies for therapies as the virus mutates in the future.

Our libraries create a roadmap for improving the efficacy and/or specificity of therapeutic influenza antibodies. As a result, we might be able to engineer the best features of different antibodies into a single antibody that may not only treat contemporary strains of influenza, but also future influenza strains which normally would escape through simple mutations,” said Arun Kashyap, Director of Influenza and Antibody Libraries for Sea Lane. (ANI)

Indonesia, US must cooperate on bird flu: US official​

http://afp.google.com/article/ALeqM5hf5ny8CpIK41d3CxQNITmKfqyLhQ

JAKARTA (AFP) — Indonesia and the United States must work together to prevent a global bird flu pandemic, the top US health official said here Monday.

US Secretary of Health and Human Services Michael Leavitt said bird flu was a danger to the whole world and stressed the importance of international cooperation.

Indonesia, the nation worst hit by the disease, has been reluctant to share information with international scientists battling the constantly mutating virus without in return being guaranteed access to vaccines.

"To enhance cooperation is vital amongst all nations," said Leavitt after meeting President Susilo Bambang Yudhoyono.

"The United States has very important relationships here in Indonesia, that involve joint work in laboratories in various levels of research, and we have pledged to continue that.

"We have the same concerns about a global pandemic. If (flu) is present everywhere then there is danger everywhere, and we must work together."

Indonesia has the highest number of human bird flu victims, with 107 people known to have died from the disease, 13 of them this year.

Experts fear the virus, which is usually spread directly from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.

Israel H5N1 Matches Vaccine Resistant Egyptian Strain​

http://www.recombinomics.com/News/04140802/H5N1_Israel_2008.html

Recombinomics Commentary 18:30
April 14, 2008

Full sequences from a 2008 isolate from Israel, A/chicken/Irsael/1055/2008(H5N1) have been released. Since Israel has only filed one OIE report on H5N1 in 2008, it is likely that this isolate is from the outbreak near the petting zoo in northern Israel (see satellite map). The HA sequence from this isolate is closely related to the 2008 sequences released by the National Veterinary Labs (NLQP) in Egypt, which were from vaccinated stocks.

The Egyptian isolates had a large number of non synonymous changes, including the receptor binding domain change M230V. The changes are also found in the Israeli isolate, which also has N159S, which is adjacent to the change (N158S) that abolished the clade 1 glycosylation site. However, the Israeli isolate, like other clade 2.2 isolates did not have a glycosylation site at either positions 158 or 159 prior to recent changes at those positions.

The Israeli match with the vaccine resistant strains in Egypt is cause for concern. That strain was widely detected in Egypt, and has also spread to northern Israel. The large number of changes highlights the ability of H5N1 to rapidly change and spread to adjacent areas. The added diversity to the H5N1 gene pool suggests future vaccination measures will be difficult.

South Korean troops sent to slaughter poultry​

http://news.yahoo.com/s/ap/20080416/ap_on_re_as/skorea_bird_flu

SEOUL, South Korea - South Korea dispatched 200 soldiers to chicken farms Wednesday to slaughter poultry infected with bird flu, as the government confirmed another outbreak of the disease.
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The Defense Ministry dispatched the troops to chicken farms in Gimje, about 160 miles south of Seoul, a ministry official said on condition of anonymity, citing ministry policy.

The Defense Ministry will dispatch additional troops to other poultry farms if they ask for it, he said.

The move came as the Agriculture Ministry also confirmed the 12th outbreak of the deadly H5N1 bird flu virus Wednesday since the country's first outbreak of the disease in a year broke out two weeks ago in Gimje.

Governments test confirmed the latest outbreak at a chicken farm in Pyeongtaek, 44 miles south of Seoul, was caused by the deadly H5N1 virus, Agriculture Ministry spokesman Yoon Young-ku said.

About 2.2 million poultry have been slaughtered since the outbreak two weeks ago as the disease has spread to other farms in the city and other areas, according to the Agriculture Ministry.

The ministry said it hasn't counted how many chickens have been infected with and died of the disease.

The Agriculture Ministry issued a nationwide high alert Wednesday to prevent the disease's further spread, ministry spokesman Yoon said.

At least 239 people worldwide have died from bird flu since 2003, according to the World Health Organization. So far, most human cases have been linked to contact with infected poultry.

The disease is relatively difficult for humans to catch, but health authorities fear it could mutate into a form that is easily spread among humans, which could cause a flu pandemic.

Firm gets go-ahead on bird flu patch​

http://tvnz.co.nz/view/page/1320238/1718553

A small biotechnology company trying to develop needle-free vaccines won a boost to its efforts on Tuesday with US government approval to test a bird flu skin patch on more people.

Iomai's patch is not a vaccine, but rather delivers what is called an adjuvant - an immune boosting agent that will be delivered along with a vaccine to try to make it work better.

The vote of confidence from the Health and Human Services Department adds impetus to all of the company's projects.

"The Iomai immunostimulant patch has the potential to change how we react to an influenza pandemic, and we will move ahead quickly with the development of this technology," Stanley Erck, president and chief executive officer of Iomai, said in a statement.

HHS, which gave Iomai $128 million to work on the patch last year, said the company could do a phase 2 safety trial - typically involving a few dozen people to see if a product is safe and whether there is any indication it works.

If a phase 2 trial succeeds, companies can move to phase 3 studies, which are carefully designed to prove a product has the intended effect and are needed for final approval by the US Food and Drug Administration.

Last month, the company reported the skin patch helped boost a bird flu vaccine so well that people appear to be protected by a single dose.

This could help stretch vaccine supply during a pandemic.

Often, adjuvants are mixed right in with a vaccine but Dr. Anthony Fauci of the National Institute for Allergy and Infectious Diseases said there is reason to believe a patch may work better.

"Right beneath the skin are a group of cells called Langerhans cells," Fauci said in a telephone interview.

"When you put the patch on the skin, they take up the adjuvant and go directly to the lymph nodes. The thought is that ... you will get a more robust response."

Current approved vaccines against the H5N1 avian influenza virus require two doses to be fully effective.

The patch, applied after gently scraping the skin with a light, sandpaper-like device, is being used to boost an H5N1 vaccine made by the Belgian drug company Solvay.

The H5N1 avian flu virus is sweeping through flocks of poultry in Asia and sometimes Africa and Europe. It has infected 380 people in 14 countries and killed 240 of them since 2003.

The fear is that the virus might change just enough to pass easily from one person to another, sparking a deadly pandemic.

At least 16 companies are testing H5N1 vaccines. But global flu vaccine production capabilities are limited and if larger doses are needed, fewer people could be vaccinated in a pandemic.

Iomai is also working to use its needle-free technology to make vaccines against anthrax, seasonal influenza and traveler's diarrhea.

Last week, it won a grant of up to $943,856 from the US Army Medical Research and Materiel Command to do preclinical work on a patch-based version of the anthrax vaccine.

The current anthrax vaccine licensed in the United States is given in six different injections over 18 months and must be refrigerated.

US: Indonesia endangering world by not sharing bid flu samples​

http://news.yahoo.com/s/ap/20080416/ap_on_he_me/indonesia_us_bird_flu

HANOI, Vietnam - The world is less safe because Indonesia is withholding samples of the bird flu virus from the international community, the top U.S. health official said Wednesday, adding that he is hopeful the issue can be resolved soon.
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U.S. Health and Human Services Secretary Mike Leavitt told The Associated Press that Indonesia's refusal to cooperate with the World Health Organization's long-standing virus-sharing system without compensation is disappointing.

"If Indonesia decides to not be part of the world community and the international mainstream on this for a time, that would be regrettable," he said. "The world will be slightly less safe, but at some point we have to move onto finding other ways to make the world safe."

Leavitt, on a Southeast Asian trip this week to promote food safety, met with Indonesia's president and health minister in Jakarta before making stops in Singapore and Vietnam. Indonesia has withheld nearly all of its bird flu samples from WHO since January 2007, arguing that poor countries should retain the rights to any vaccines made from their viruses.

Leavitt said both sides agreed to work toward finding a solution within the next two months. Otherwise, the U.S. will move on and concentrate its efforts elsewhere, he said.

The H5N1 bird flu virus began ravaging Asian poultry stocks in late 2003. It remains hard for people to catch, but 107 people have died in Indonesia, nearly half the 240 recorded human deaths worldwide, according to WHO.

Scientists say it is crucial to receive fresh bird flu specimens to ensure the virus is not mutating into a form that could easily spread among people, potentially sparking a pandemic that might kill millions worldwide.

Indonesia to launch bird flu plan this week​

http://www.vnanet.vn/Home/EN/tabid/119/itemid/245176/Default.aspx

Jakarta (VNA) – Indonesia’s national commission for bird flu control has announced it will launch a plan later this week to fight against the avian influenza pandemic, which has so far claimed 107 lives out of 123 bird flu cases in the country.

Addressing the bird flu conference on April 14, Head of the National Commission on Avian Influenza Heru Setijanto said the plan would be followed up a week later by a three-day pandemic simulation involving several villages on the resort island of Bali .

In the case of a widespread pandemic, an estimated 5 million Indonesians could be infected with the virus, he said. The mortality rate of those infected would be between 5 and 10 percent.

Setijanto had earlier described the current situation in Indonesia as concerning. According to the national bird flu commission, only two out of the country's 33 provinces were free from bird flu and five provinces had not reported new cases in the past six months.- Enditem

Bird Flu Epidemic Still Shrouded in Mystery ​

http://english.chosun.com/w21data/html/news/200804/200804160016.html

A case of bird flu was reported in Pyeongtaek, Gyeonggi Province near Seoul on Tuesday. It comes two weeks after the first reported case on April 1 in Gimje, North Jeolla Province, from where the outbreak has since spread to South Jeolla Province. Two weeks after the first outbreak, a total of 20 cases were reported of the highly pathogenic H5N1 strain of virus that can be transmitted to humans.

According to the Ministry for Food, Agriculture, Forestry and Fisheries, test results of the National Veterinary Research and Quarantine Service showed that chickens at a poultry farm in Pyeongtaek, which reported their sudden death on Monday, tested positive for the H5 strain.

Quarantine authorities have already culled a total of 23,000 chickens from this farm and prevented movement of all chickens and ducks within a 10-km radius. If further tests confirm the chickens died from a highly pathogenic strain of H5 that is transmissible to humans, 315,000 chickens raised in the nine poultry farms within 3 km will also be culled as a preventative measure.

But quarantine authorities have failed to come up with a persuasive answer to the basic questions why bird flu broke out and how the virus spread. Nor have they explained why the epidemic comes in April, much later than the usual November-February period.

They have offered presumptions only, the first of which is that the outbreak was caused by droppings of migratory birds that have not yet returned to Russia and other areas, which they usually do in February, apparently due to global warming or the peculiar phenomenon of migratory birds turning sedentary.

Yoon Moo-boo, a professor emeritus of the Department of Biology at Kyunghee University, says the first is conceivable. "It's possible to hypothesize that winter arrives late in Russia, the home of winter migratory birds, as a result of global warming, and that therefore migratory birds arrive in Korea later, and leave later too."

Others speculate that the first outbreak of bird flu at the chicken farm in Gimje on April 1 may have something to do with Chinese, Mongolian and Vietnamese workers there. The three countries have all seen heavy earlier outbreaks. But this is improbable since bird flu has also broken out at other poultry farms without foreign workers.

Quarantine authorities presume that the first outbreak in Gimje did not spread to Jeongeup but the cases occurred separately. Kim Chang-seob, the ministry's chief veterinary officer, said, "Despite the geographical proximity of Gimje and Jeongeup, both in North Jeolla Province, it's hard to believe that the epidemic in one place spread to the other given that both occurred almost simultaneously."

However, they speculate it may then have been spread to other areas in both North and South Jeolla provinces by vehicles. After moving chickens and ducks was banned in Gimje on April 3, some chicken and duck distributors crossed the quarantine line and traveled to other areas.

In other words, there was a loophole in the measures. Quarantine authorities do not rule out that the flu epidemic will spread to South Chungcheong Province, since distributors' vehicles were confirmed to have gone to Nonsan and Cheonan in the province.

That still leaves the question why bird flu struck Pyeongtaek, an area more than 200 km from the Jeolla provinces where there has been no confirmed contact with vehicles from the other areas.

Mammalian PB2 in Israel H5N1 Increases Pandemic Concerns​

http://www.recombinomics.com/News/04150801/H5N1_Israel_PB2.html

Recombinomics Commentary 12:33
April 15, 2008

Full H5N1 sequences from a 2008 isolate from Israel, A/chicken/Israel/1055/2008, have been released. The HA sequence is closely related to sequences from vaccinated flocks in Egypt. The Egyptian isolates were collected between mid-December, 2007, and mid-January, 2008, which is the same timeframe as the Israeli isolate. The HA sequences contained a large number of non synonymous polymorphisms, including M230V.

However, the PB2 sequence also has a number of recent acquisitions, which include mammalian polymorphisms. One set of three consecutive polymorphisms are found in H1N1 isolates, including the 1918 pandemic strain (see list here).

The acquisition of mammalian polymorphisms is cause for concern. Earlier (2006) isolates from Egypt and Israel had a series of PB2 mammalian polymorphisms, which were regionally localized. However, the 2008 isolate has additional acquisitions, including the three linked above.

Like most clade 2.2 isolate, the Israeli isolate also has E627K, a polymorphism found in H1N1 and H3N2 seasonal isolates, including the 1918 pandemic strain. The fixing of E627K has been noted previously as has the associated increase in activity at lower temperatures, which are close to the temperature of a human nose and throat in the winter.

The series of three polymorphisms linked above are clearly acquired via recombination. Other sequences with that series are distinct from PB2 in clade 2.2 and the Israeli sequence has the Egypt/Israel regional markers that are present in 2006. Thus, the new acquisitions are appended onto an Egyptian clade 2.2 genetic background. The likelihood of the acquisitions by selection of random mutations is remote. However, acquisitions via homologous recombination increase as regions of identity increase due to prior mammalian acquisitions, which are in 2006 isolates.

The presence of a mammalian PB2 in a highly pathogenic H5N1 with a rapidly evolving H5 significantly increases pandemic concerns.

RoK extends bird flu risk level to second highest​

http://www.vnanet.vn/Home/EN/tabid/119/itemid/245287/Default.aspx

Seoul (VNA) – The Republic of Korea has upgraded its avian influenza risk alert to level two amid rising concerns bird flu could spread across the country following a series of outbreaks this month.

The RoK’s Ministry for Food, Agriculture, Forestry and Fisheries decided to extend the risk level to “orange” nationwide, Yonhap News Agency reported.

Orange is the second highest risk level in South Korea's four-tier alert system that rises from blue and yellow to the highest, red.

Meanwhile, the country’s Ministry of National Defense will send additional soldiers to cull tens of thousands of fowl infected with the deadly avian influenza, Yonhap said.

“The military has set up 23 quarantine and inspection posts at various areas in North Jeolla Province, such as the Gimje area where outbreaks have been most serious, and mobilised an average of 185 troops a day to help stop the spread of avian influenza,” the ministry told the media.

The moves come as the government intensifies quarantine efforts to stem further spread of bird flu after a outbreak was confirmed in Pyeongtaek on April 15, around 70km from Seoul.-Enditem

India fails to contain bird flu​

http://www.dawn.com/2008/04/17/int15.htm

NEW DELHI: Outbreaks of H5N1 bird flu in India’s eastern state of West Bengal, which shares a long border with Bangladesh, have not yet been contained, a senior health official in India said on Wednesday.

“West Bengal is an area of concern because we have had outbreaks with some regularity, it is not fully under control yet,” federal Health Secretary Naresh Dayal said in an interview.

Unlike outbreaks in commercial poultry farms in central Maharashtra state in 2006 and eastern Manipur in 2007, which were more easily reined in, outbreaks in West Bengal involved backyard poultry and these were much harder to control, he said.

“They have not been able to completely depopulate (the infected areas) of birds,” Dayal said, without giving details.

West Bengal has culled nearly four million birds in 14 of its 19 districts since the virus surfaced there early this year, but the virus has proved to be hardier than thought.

Tripura, another Indian state which also borders Bangladesh, reported a H5N1 outbreak in poultry in early April, but Dayal said the virus was detected in only one duck sample while samples from chickens were negative.

In Bangladesh, the virus has spread through 47 of its 64 districts since March 2007 and forced the killing of more than 1.5 million birds but authorities have still been unable to control the virus.

READY TO HELP: While Dayal declined to speculate if the virus might have been reintroduced to India from Bangladesh early this year, he said India was ready to help with sample testing, anti-virals and surveillance training.

“We would be very happy to have regional cooperation. That is an infection that can spread very fast across boundaries,” he said.

Despite surging temperatures in Asia, the H5N1 virus has re-emerged in recent weeks, with outbreaks in poultry seen in South Korea and even a village in the far east of Russia.

The disease has killed two Egyptians so far this month, and two youths in Indonesia, where the virus is endemic, late in March.

The timing is not lost on experts, who believe the virus has adapted to hotter climates. Until a few years ago, it was mainly active, and caused trouble, in the cooler months of October to March.

“It has adapted to hotter climates. Look at Indonesia and the southern parts of Vietnam, they are hot all year round but the virus has become endemic in these places,” said Hong Kong-based microbiologist Guan Yi, a leading expert on the virus.Apart from temperature, other factors sustaining the virus were animal density and humidity, Guan said.

“If the bird population is very high and dense, then the virus can pass from bird to bird, and the weather becomes less important,” Guan told Reuters by telephone.—Reuters

AI infects poultry in Banyumas, C. Java​

http://www.antara.co.id/en/arc/2008/4/17/ai-infects-poultry-in-banyumas-c-java/

Banyumas, Central Java (ANTARA News) - Bird Flu virus or Avian Influenza (AI) has infected a total of 65 poultry from January to March 2008, according to data of the Banyumas husbandry and fishery services.

"In April alone, 42 chickens are positive of being infected with bird flu virus," Head of the Banyumas husbandry and fishery services Sentot Sasmito Eko said here on Thursday.

Most of the bird flu cases were found in rural areas where there were many back-yard poultry farms, he said.

To cope with the bird flu infection problem, the local husbandry service had culled a number of poultry, conducted disinfectant spraying and launched a bird flu awareness campaign.

Egyptian 2-year-old boy infected with bird flu​

http://africa.reuters.com/wire/news/usnL16742626.html

CAIRO, April 16 (Reuters) - A 2-year-old Egyptian boy has been infected with the deadly H5N1 bird flu virus, bringing the number of cases in the most populous Arab country to 50, state news agency MENA said on Wednesday.

MENA identified the child as Mahmoud Ibrahim Ramadan from the Nile Delta province of Sharkia, quoting Egypt's health ministry. It said he had been infected after exposure to household birds.

MENA said the boy started showing symptoms of the illness on Sunday and was taken to hospital the next day where he was treated with the anti-viral drug Tamiflu. He was in stable condition.

A total of 22 Egyptians have died of the H5N1 strain of bird flu since it first appeared in Egypt in February 2006.

About 5 million households in Egypt depend on poultry as a main source of food and income, and the government has said this makes it unlikely the disease can be eradicated despite a large-scale poultry vaccination programme.

Deaths from bird flu total more than 230 worldwide since 2003 and have been reported in several African and Asian countries. Egypt has been the worst-hit country outside of Asia. (Writing by Cynthia Johnston; Editing by Giles Elgood)

http://www.straitstimes.com/Latest+News/Asia/STIStory_228523.html

JAKARTA - MORE than 60 million Indonesians could be infected with deadly bird flu if the virus mutates into a form transmissible between humans, an official said on Friday.

Indonesia is the country worst hit by bird flu, with 107 people known to have died from the disease, 13 of them this year.

Experts fear the virus, which is usually spread from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.

'Some 65 million people or 30 per cent of the country's population will be infected if a bird flu pandemic strikes Indonesia,' Bayu Krisnamurthi, head of the national committee for control of avian influenza told reporters.

He said the estimated figure was based on the number of fatalities from flu pandemics last century.

Mr Krisnamurthi said Indonesia would hold an emergency drill next week on the resort island of Bali as part of preparations for any such outbreak.

'We never know when it (a pandemic) will happen. This kind of drill will enable us to cope with the situation should one day avian influenza virus mutate into a form that is easily transmitted between humans,' he added.

The drill will involve about 1,000 people and Indonesia 'will be the first country in the world that tests its pandemic preparedness plan in full scale', said Mr Krisnamurthi. -- AFP

S. Korea probes three new suspected bird flu cases​

http://www.straitstimes.com/Latest+News/Asia/STIStory_228514.html

SEOUL - SOUTH Korea said on Friday it was investigating three new reports of suspected bird flu and sent more soldiers to cull poultry as the worst outbreak in four years spread.

The Farm Ministry said there were two more suspected cases at poultry farms in North and South Jeolla provinces, some 320km south of Seoul, where the first bird flu recurrence for a year was reported this month.

It also said a suspected case had been reported at a duck farm in Gongju in South Chungcheong province, 130km south of Seoul, suggesting the virus is spreading at its fastest rate since the country reported its first case in 2003.

South Korea has confirmed 15 cases of the deadly H5N1 strain in just two weeks.

'We are stepping up quarantine work even in unaffected areas and will slaughter hundreds of thousands of birds in the confirmed sites,' the ministry said in a statement.

It has culled 3.3 million chickens and ducks, the largest since the country killed 5.3 million between late 2003 and early 2004, and said it would send 450 soldiers to help quarantine work on Friday.

Authorities have come under heavy criticism for failing to provide explanations for the fast spread of the virus.

South Korea had seven bird flu outbreaks between November 2006 and March last year. No human deaths have been reported.

Some 240 human deaths have been reported globally from the H5N1 strain and 381 confirmed cases of infection since 2003, according to World Health Organisation data. -- REUTERS

Bird flu showing signs of mutation: China expert​

http://www.canada.com/topics/bodyandhealth/story.html?id=c9dd1d5e-c3ea-4948-9294-100f240164f1

Reuters

HONG KONG (Reuters) - One of China's top doctors has said that the H5N1 bird flu virus has shown signs of mutation and can kill human victims more easily if treatment is not given early enough, newspapers reported on Tuesday.

Zhong Nanshan, an expert on respiratory diseases, told reporters in Beijing that vigilance should be kept up, especially when H5N1 human cases are surfacing at a time when seasonal human influenza is at a peak.

"When avian flu is around and human flu appears, this will raise the chances of avian flu turning into a human flu. We have to be very alert and careful in March," Zhong was quoted by the Ming Pao newspaper as saying.

One of China's top doctors has said that the H5N1 bird flu virus has shown signs of mutation and can kill human victims more easily if treatment is not given early enough.

"People who were killed by bird flu last year and this year were too poor to seek treatment. If you happen to have high fever and pneumonia, you must seek treatment fast."

Although the H5N1 virus has infected only 368 people around the world since 2003, its mortality rate has been worryingly high, killing 234 of them.

Experts fear it could trigger a pandemic killing millions if it ever learns to transmit efficiently among people.

"The bird flu virus has shown signs of mutation. If infected people don't get treatment in a timely manner, they can die easily," Zhong was quoted as telling Hong Kong reporters on the sidelines of the Chinese parliament's annual meeting.

Three Chinese died this year of H5N1 bird flu and they were infected probably through contact with sick poultry. The World Health Organisation said there was no evidence of transmission between humans in all three cases.

Hong Kong, which lies at the south of China, is going through a seasonal flu peak, with outbreaks reported in a growing number of schools.

A 3-year-old girl died last week of human H3N2 flu and authorities have ordered schools to conduct fever checks and advise those who are unwell to stay home.

A 7-year-old boy died around noon on Tuesday after being admitted to hospital last week with flu-like symptoms, a health department spokesman said. Authorities are still trying to determine the cause of his illness.

Tamiflu Resistance in H1N1 in Turkey​

http://www.recombinomics.com/News/04170803/H274Y_Turkey.html

Recombinomics Commentary 18:50
April 17, 2008

Five NA sequences from H1N1 isolates in Turkey were just released. All five were collected in 2008, and one of the five, A/Bursa-TR/28/2008(H1N1), had the oseltamivir (Tamiflu) resistant marker, H274Y. The sudden appearance of H274Y this season has startled influenza experts. The frequency was highest in Europe, where levels exceeded 40% in Norway, France, and Russia, which are countries not known to commonly use Tamiflu. In contrast, the level in the country that regularly uses Tamiflu, Japan, was only at 2%. All of the above resistance has been in H1N1 seasonal flu.

The resistance marker on H1 of H1N1 is identical to the major resistance marker on H1 in H5N1. Tamiflu use to treat H5N1 has increased markedly since 2005, and H274Y was found in wild birds in Astrakhan in late 2005. In early 2006, H5N1 was confirmed in humans in Turkey, and Tamiflu usage was widespread. Thus, the increase in H274Y in H1N1 seasonal flu follows widespread use of Tamiflu to treat H5N1 and the detection of H274Y in wild birds infected with clade 2.2 H5N1.

Similarly, the data for transfer of mammalian polymorphisms to H5N1 is also increasing. The recently released H5N1 sequence from Israel had acquired a number of mammalian polymorphisms in PB2, including three consecutive polymorphisms. These acquisition patterns are most easily explained by recombination between avian H5N1 genes and human seasonal flu. The series of three polymorphisms is also found in 1918 H1N1.

Papers coming out this week in Nature and Science describe the movement of seasonal flu from Asia to the rest of the world. However, these studies fail to track individual polymorphisms, which identify animal reservoirs for these new acquisitions. The reservoirs include bird and swine sources in Asia.

Thus, the role of recombination in the evolution of influenza is being increasingly obvious, as more influenza sequences are released. An understanding of this mechanism would reduce the number of influenza experts who are startled by the appearance of avian polymorphisms in human seasonal flu.

Thousands of dead chickens at Ukraine poultry farm​

http://news.monstersandcritics.com/...ands_of_dead_chickens_at_Ukraine_poultry_farm

Kiev - Health inspectors discovered thousands of dead chickens at a Ukrainian poultry farm, with bird flu suspected as the cause, the Interfax news agency reported Thursday.

The die-off took place at a poultry-processing plant near the city Shpol, in the northern Cherkassy province.

It was the second reported case of an apparent mass bird infection this year, following the January death of dozens of chickens to the H5N1 bird-flu virus in a Crimea province poultry factory.

Health officials were testing carcasses and live birds to determine the cause of the mass sickness at the Shpol factory. H5N1 however was not yet confirmed, according to the report.

State inspectors were sampling domestic and wild bird populations for presence of the disease in the region, and destroying the dead chickens.

Thousands more live chickens will also be destroyed at the factory if the present of the bird flu virus is confirmed, according to the report.

The last incident of bird flu in Ukraine prior to 2008 was registered in July 2006, when health inspectors detected the disease in domestic poultry in the eastern Sumy region, resulting in the destruction of more than 12,000 chickens, ducks and geese.

The outbreak and a government programme to destroy potentially infected birds brought economic hardship on thousands of lower- income Sumy region rural residents dependant on household fowl for eggs and meat.

Bird flu in 2006 also was found in pelicans living in the marshy Sivash wetland of the Crimean peninsula, but that outbreak did not make the jump to domestic birds, the Health Ministry said at the time.

The disease is a major threat to domestic and wild bird populations in the former Soviet republic, lying directly on a flyway for migratory bird populations moving from Siberia to the Middle East and Africa.

PANDEMIC: Not matter of if, but when​

http://www.al.com/news/mobileregister/index.ssf?/base/news/1208596556127690.xml&coll=3

Seminar informs local authorities about emergency preparations
Saturday, April 19, 2008
By SUSAN DAKER
Staff Reporter

About 168 people could die each day for eight straight weeks if a flu pandemic -- similar to that of the infamous Spanish Flu in 1918 -- struck Alabama, according to the Alabama Department of Public Health.

"It's not a matter of if, it's a matter of when," was the echo of some of the speakers at the state agency's flu pandemic emergency preparedness meeting this week in Mobile. The daylong seminar, held on the Brookley Complex alongside Mobile Bay, is part of a series of 11 conferences across the state aimed at providing instructions for pandemic readiness and continuing education courses for nurses, social workers, paramedics, and law enforcement.

In 1918, the Spanish Flu, the most destructive pandemic in recorded history, killed 500,000 in the U.S. and millions more around the world. Today that could mean up to one-third of the population could fall ill, and 1.9 million people in the U.S. could die, The Associated Press has reported. In recent years, President Bush's administration has called on everyone to prepare for the next flu outbreak.

Many of those preparations are similar to those made for natural disasters such as hurricanes, speakers told a room full of people at the Brookley Convention Center ballroom.

Officials will open local emergency operations centers and the governor and other high-ranking state officials will likely stand by in the bunker in Clanton, Ala., said David Coggins, a regional coordinator for the Alabama Emergency Management Agency.

But there will be some critical differences.

To demonstrate, Crowley showed a picture of the Mobile County EMA bunker with former Mayor Mike Dow, Fire Chief Steve Dean and other local officials crowded around the meeting table, some alertly holding coffee while staring at the projector screen.

"There may be only two people in this picture," Coggins said. The rest would be too sick to help.

Lt. Joseph McClellan of the Alabama Department of Homeland Security said that law enforcement agencies and other first responders have to prepare to lose about half their work force because they will either be sick or caring for dying relatives.

It's unclear if crime will increase, but it certainly won't decline, he said.

Bad people will take advantage of good people during bad times," McClellan said.

Security will need to be provided for mass burial sites, hospitals and pharmacies as fear and chaos could take hold of the community, McClellan said. Officers will have to reprioritize their calls; burglaries and robberies may not be on the top of the list.

While looking over various agencies' plans, McClellan said he's found that too many call for support from Alabama State Troopers.

"There aren't enough state troopers to fill those spots," he said. Those plans need to be changed, he said.

Typically in natural disasters, other states and agencies may help, but in a flu pandemic those offers may not be extended for fear of spreading the infection further, Coggins said.

"Don't expect Baldwin County to come over and do your day-to-day operations," Coggins said.

Elmer Sellers, the assistant administrator for University of South Alabama Medical Center, said in the event of the pandemic barricades will go up at the facility's entrances to keep people who don't need to be there from entering the hospital and exposing themselves to germs.

A triage center will be set up outside complete with x-ray machines, so health workers can assess whether patients need to be hospitalized.

The hospital has one refrigerator truck ready to keep bodies once the morgue fills up, he said. "We are going to have a lot of fatalities," Sellers said.

While there will be a need for mass burial that doesn't mean people's religious and cultural beliefs shouldn't be taken into account, Joseph Ellington III told the crowd.

"Individual burials may not be possible," Ellington said. "This will cause stress and intensify grief."

Religious leaders will need to prepare for such occasions, especially if ministers are too sick to tend to their congregations.

"An ounce of preparedness is better than a pound of panic," Ellington said. "These will be very emotional times."

The Alabama Department of Health says a two-step process can kill the flu virus:

Clean: Use a household detergent, like dishwashing liquid, laundry detergent or hand soap to wipe surfaces such as desks, phones, food preparations area, door knobs, faucets and other frequently used items.

Sterilize. Use household bleach, dilute a cm TQTR cup of bleach into one gallon of water or using rubbing alcohol with 70 percent isopropyl or 60 percent ethyl alcohol. Products with lower alcohol concentrations will not work. Disinfect material and areas contaminated by flu virus. Follow label warnings. When using bleach, remember to work in a well-ventilated area and wear gloves. Do not inhale. Keep bleach and alcohol away from heat sources, children and pets.

S.Korea culls 3 million birds as bird flu spreads​

http://www.nzherald.co.nz/section/2/story.cfm?c_id=2&objectid=10504864

11:51AM Friday April 18, 2008
By Miyoung Kim

SEOUL - South Korea said on yesterday it had culled 3 million farmed birds and confirmed three more outbreaks of bird flu, as the country grapples with its worst avian influenza outbreak in four years.

In just two weeks South Korea has confirmed 15 cases of the deadly H5N1 strain, raising alarm as the highly virulent virus is spreading at its fastest rate since the country reported its first case in 2003.

The farm ministry said yesterday it had seven new reports of suspected bird flu outbreaks at poultry farms in North and South Jeolla provinces, some 320km south of Seoul, where the first bird flu recurrence for a year was reported earlier this month.

It also said it would slaughter hundreds of thousands of birds in the most severely affected southwestern part of the country, as it confirmed three new outbreaks of the deadly H5N1 in the area late yesterday.

The country raised the risk level for bird flu to the second highest on Wednesday and sent 200 soldiers to kill and bury birds, as an outbreak was confirmed at a farm in Pyeongtaek, just 60km south of Seoul, bringing the disease closer to the capital.

But South Korean authorities have come under heavy criticism as the highly pathogenic virus continues to spread, despite their rigorous efforts, and as they have failed to provide clear explanations for the cause of the fast spread.

The farm ministry said its quarantine work would focus on speeding up slaughtering and investigating possible causes of the spread such as migrating birds and transport workers who have been moving around affected sites and other parts of the country.

The fast-spreading outbreak has hit poultry consumption, posing a big threat to farmers already struggling with high animal feed prices.
Han told related ministers to consider helping farmers with tax benefits, financial assistance and budget spending.

South Korea, which estimates it will spend 32 billion won $NZ41.48 million) on quarantine work in the current outbreak, also plans to introduce insurance products that offer up to 2 billion won compensation if a human infection is reported following poultry consumption.

Chicken sales in the past 15 days have dropped 60 percent at four major retailers surveyed by the farm ministry, while prices of chicken and duck dropped up to 10 percent.

The country had seven bird flu outbreaks between November 2006 and March last year and 19 cases between December 2003 and March 2004, when it had to kill 5.3 million birds. No human deaths have been reported.

Some 240 human deaths have been reported globally from the H5N1 strain and 380 confirmed cases of infection since 2003, according to World Health Organisation data.

Myanmar declares itself bird flu free​

http://news.yahoo.com/s/afp/2008042...lu_080420102532;_ylt=A9G_R3BhKgtIkmcBnTKTvyIi

YANGON (AFP) - Myanmar's military government on Sunday declared the country bird-flu free after three months without an outbreak of the deadly virus, state media reported.

The Myanmar-language Mirror newspaper said authorities had "sent the announcement of a bird flu-free Myanmar" to the UN's Food and Agriculture Organisation, and supplied evidence.

The last known outbreak of the deadly H5N1 virus was in eastern Shan State last November, the paper said, and was under control by January this year.

Myanmar last declared itself free of avian influenza in September 2006 after outbreaks in the central city of Mandalay.

But in early 2007, thousands more chickens, birds and ducks had to be killed after fresh outbreaks in and around the economic hub Yangon and in the central region of Bago.

In December, Myanmar and the World Health Organisation announced that a seven-year-old girl from Shan state had become the first confirmed human case of bird flu in the country.

She was hospitalised in late November before being discharged in December after showing signs of recovery.

Myanmar's military rulers normally operate behind a veil of secrecy, but the regime has won praise from the United Nations for its openness in tackling bird flu, despite its run-down health system.

The H5N1 strain of bird flu has killed 240 people worldwide, mostly in Southeast Asia, since late 2003, World Health Organisation figures show.

The strain is mainly an animal disease, but scientists fear it could mutate to easily jump from human to human, sparking a deadly global pandemic.

SKorea culls 5 million poultry over bird flu​

http://orange.advfn.com/news_SKorea-culls-5-million-poultry-over-bird-flu_25877528.html

SEOUL (Thomson Financial) - Almost 5 million poultry have been slaughtered
in South Korea to contain the spread of bird flu since it hit the country
earlier this month, the agriculture ministry said Sunday.

The avian influenza has hit 25 farms with 4.85 million chickens and ducks
culled since the first outbreak on April 1, the ministry said in a statement.
The ministry statement on Sunday did not specify how many of the 25
outbreaks, though all involving the H5 virus, were of the "deadly" H5N1 strain
that sometimes claims human lives.

"We have not made a full count of H5N1 outbreaks yet, which should be
released after putting this epidemic under control first," Kim Chang-Sup, a
director handling bird flu at the ministry, told Agence France-Presse Sunday.
"Simple test kits we use now in the field can verify if it is of avian
influenza or not, but not of a subtype. If we confirm outbreaks, our priority
goes to culling, not testing."

But Kim denied some news reports that 25 outbreaks were all of the H5N1
strain. Officials have privately confirmed at least seven H5N1 outbreaks.

South Korea reported seven cases of H5N1 infection between November 2006 and
March last year, resulting in the temporary suspension of poultry exports to
Japan, Hong Kong, Taiwan and elsewhere.

But last June the World Organization for Animal Health classified the
country as free from the disease.

The H5N1 strain has killed more than 240 people worldwide since late 2003.
No South Koreans are known to have contracted the disease.

Vietnam begins second human trial of bird flu vaccine​

http://www.thanhniennews.com/healthy/?catid=8&newsid=37819

The Ministry of Health Saturday started the first stage of a second human trial for a human vaccine for the H5N1 virus.

An official from the ministry said 30 volunteers from the Military Medical Academy in Ha Tay Province near Hanoi were injected with a one millimeter dose of the vaccine.

Stage One of the trial is expected to last for 56 days.

After the first injection, the volunteers’ health will be closely monitored and they will undergo blood tests.

Tamiflu Resistance in Turkey Exactly Matches US and UK​

http://www.recombinomics.com/News/04190803/H274Y_Turkey_UK_US.html

Recombinomics Commentary 16:23
April 19, 2008

A full NA H1N1 sequence from England was just released at Genbank which had the Tamiflu resistance marker, H274Y. That sequence was an exact match of three sequences from the United States, indicating the sequence was evolutionarily fit and widespread.

A few days earlier, a partial (495 BP) NA H1N1 sequence was released from Turkey. That sequence also had the H274Y. The partial sequence represent more than 1/3 of the NA gene and it was an exact match of the sequences from the United States and England described above. It was also an exact match of additional sequences from the United States from Arizona and New Jersey. Thus, the total number of public sequences that exactly match the partial sequence from Turkey is eight (one from England and seven from the US – see list here).

Thus, it is clear that the above Brisbane sequences are widespread. However, earlier isolates from the US, which were New Caledonian-like and isolated last season also had the H274Y. Thus, the acquisitions began in the 2006/2007 season and were on a New Caledonia genetic background, but the frequency increased dramatically in the 2007/2008 season, where most of the acquisitions are on a Brisbane genetic background.

Thus, H274Y has been reported recently on four distinct genetic backgrounds. Initial reports were in early 2005 on human clade 1 H5N1 in Vietnam. This was followed by clade 2.2 in wild birds in Astrakhan in late 2005, which was then followed by human New Caledonian-like H1N1 in the United States in 2006/2007, followed by Brisbane-like H1N1 worldwide (but highest in Norway, Russia, and France) in 2007/2008.

This movement is easily explained by acquisitions via recombination.

Record Levels of H5N1 in South Korea​

http://www.recombinomics.com/News/04200801/H5N1_Korea_Record.html

Record Levels of H5N1 in South Korea

Recombinomics Commentary 12:17
April 20, 2008

The avian influenza has hit 25 farms with 4.85 million chickens and ducks culled since the first outbreak on April 1, the ministry said in a statement.

The ministry statement on Sunday did not specify how many of the 25 outbreaks, though all involving the H5 virus, were of the "deadly" H5N1 strain that sometimes claims human lives.

"We have not made a full count of H5N1 outbreaks yet, which should be released after putting this epidemic under control first," Kim Chang-Sup, a director handling bird flu at the ministry, told Agence France-Presse Sunday.

But Kim denied some news reports that 25 outbreaks were all of the H5N1 strain. Officials have privately confirmed at least seven H5N1 outbreaks.

The above comments indicate South Korea is playing fast and loose with the facts regarding H5N1 infections throughout the southwestern portion of the country (see satellite map). The government has already filed OIE reports detailing 11 outbreaks by April 15. 6 were confirmed H5N1 and five were confirmed HPAI H5. HPAI H5 in South Korea in the proximity of HPAI H5N1 is H5N1. Although technically the N1 had not yet been determined, the HPAI would indicate that the cleavage site of H5 had been sequenced and it had a polybasic cleavage site, which would indicate the H5 was from H5N1 and probably the Uvs Lake strain of H5N1 (a more evolved version of the clade 2.2 Qinghai strain, which was reported for South Korea in the 2006/2007 outbreak.

An April 19 (Stars and Stripes) report from the US military in Korea indicates 20 outbreaks have been classified as HPAI H5 and 16 more farms were suspected H5N1, once again strongly suggesting that all 25 H5 outbreaks have been classified as HPAI H5, which means they will all be classified H5N1 after the N1 is determined.

Thus, stating that not all H5 outbreaks have been classified as H5N1 in the absence of a statement saying that not all H5 have been classified as HPAI H5 (which would subsequently be classified as H5N1) is at best misleading.

It is extremely likely that all 25 H5 outbreaks have already been classified as HPAI H5 and it is also extremely likely that the 15-20 suspect H5N1 outbreaks will test as HPAI H5, followed by the H5N1 Qinghai strain.

Thus, this outbreak will almost certain be the largest outbreak reported to date in South Korea (almost 5 million birds have already been culled), and would also highlight significant surveillance detection / reporting failures in neighboring countries, including Japan which has announce plans to implement a pre-pandemic vaccine program targeting 10-20 million citizens, beginning with first responders.

Guidance offered for protecting vulnerable groups in flu pandemic​

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/apr1608atrisk.html

Robert Roos * News Editor

Apr 16, 2008 (CIDRAP News) – Acting on the premise that "disasters discriminate," the Association of State and Territorial Health Officials (ASTHO) and several partner groups yesterday released a lengthy set of proposed guidelines for protecting the most vulnerable people during an influenza pandemic.

The 105-page document posted on the ASTHO Web site contains recommendations on how state, local, territorial, and tribal health agencies can prepare to help "at-risk" groups—such as people who can't afford to stockpile food, don't speak English, or need assistance with daily activities—get through a pandemic.

"In the face of a pandemic we have to recognize that some of those services that serve them [vulnerable groups] today may be able to expand to meet the need, but some of them will break down," ASTHO Executive Director Paul E. Jarris, MD, MBA, told CIDRAP News. "How will we provide basic services to people who are homebound, for example, making sure they have food and water and care? This won't happen by accident."

The guidance document, called "At-Risk Populations and Pandemic Influenza: Planning Guidance for State, Territorial, Tribal, and Local Health Departments," was developed with input from representatives of the groups the recommendations are intended to help. ASTHO and its partner organizations held public engagement meetings recently in Boston and Kansas City to gather those groups' suggestions.

"The At-Risk Populations Project is a ground-breaking endeavor for the nation,” Jarris said in a news release. “The process is being brought directly to the at-risk populations who will be affected, as well as to the public health planners and other experts who will have responsibility for implementing the policies. Their vital feedback will help to ensure that those facing the most danger during a pandemic are protected."

ASTHO's partners in the project are the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News; the National Association of County and City Health Officials (NACCHO); and The Keystone Center. The Centers for Disease Control and Prevention (CDC) proposed the project and funded it with a grant to ASTHO.

ASTHO seeks public comments
ASTHO is inviting the public to comment on the guidance document for 30 days. After that, plans call for editing the document and releasing the final version by May 31, according to Anna DeBlois, ASTHO's senior director for immunization and infectious disease. The project has been on a tight schedule because of CDC budgetary considerations, said Jarris.

The guidance consists of five chapters that discuss how to identify and collaborate with at-risk populations, communicate with and educate them about pandemic flu, provide clinical and non-clinical services to them, and how to test, exercise, measure, and improve their preparedness.

At-risk groups are defined as those that have the highest risk of suffering severe consequences from a pandemic or from measures used to fight the pandemic, such as community mitigation strategies. Examples include those who can't afford to stockpile food or stay home from work for even a short time; those who have no support network, such as homeless people and those who are socially or geographically isolated; and those who need help with daily activities because of physical disabilities, blindness, hearing impairment, medical conditions, or other factors.

Each chapter offers detailed background information and a list of recommendations for public health agencies. For example, a section on communicating with at-risk groups discusses potential barriers to communication, the need to develop audience-appropriate messages, possible message content, and the need to find "trusted messengers." The chapter suggests a wide variety of potential message vehicles, ranging from church bulletins and radio announcements to cars with loudspeakers and "telenovelas," described as Spanish television mini-series that can be powerful health education vehicles.

A few other examples of the many recommendations in the guidance:

* To identify at-risk groups, use data from transportation and mass-transit planners to find local groups who need help to use public transit.
* To build collaborations, reach out to community leaders without formal roles, such as elderly people or hairdressers.
* Offer mini-grants to community-based and faith-based organizations for pandemic preparedness planning, if budgets permit.
* Provide preparedness workshops for people who support at-risk individuals, including family, friends, and paid caregivers.
* Encourage community-based and faith-based organizations to develop contracts or memoranda of understanding to provide essential services and supplies during a pandemic.
* Consider the pros and cons of developing a community registry in which at-risk groups would describe the services and equipment they would need during a pandemic, and work with first responders to make sure the registry provides them useful information.

Each chapter also includes a chart of existing tools and resources—most of them accessible online—that may be helpful in carrying out the recommendations.

Developing federal guidance outside the government
ASTHO officials credit Toby Merlin, MD, deputy director of the CDC's Influenza Coordinating Unit, for coming up with the idea for the At-Risk Populations Project, which they describe as unique because it is federal guidance developed by non-federal groups.

"Toby Merlin came to us to ask ASTHO to organize, with CIDRAP and Keystone, a process for developing guidance outside the federal government, and also including the very important component of community engagement," said Jarris. "We've had community engagements around pandemic community mitigation measures and vaccine prioritization before, but what was really new was moving the engagement outside the federal government."

ASTHO set up an advisory panel of experts to guide the project and organized five working groups consisting of about 70 people, including academicians and public health practitioners, from around the country to develop the chapters. To get at-risk groups involved, public engagement meetings were held Mar 8 in Boston and Mar 15 in Kansas City, drawing a total of more than 100 people. In addition, a stakeholders meeting was held Mar 20 in Washington, DC, to gather input from groups ranging from the CDC to volunteer organizations that serve vulnerable people.

Comments gathered at the meetings led to various additions and adjustments to the guidance, according to Caroline Barnhill, MPH, ASTHO's senior analyst for infectious diseases. One important point influenced by the feedback was the definition of at-risk groups.

"We asked if the groups we had identified were sufficient, and they had some thoughts on the words we used," Barnhill said. "We took that information into consideration and changed some of the wording to reflect their feedback. It was very helpful."

Overall, the comments didn't prompt any big changes in direction, but they "enhanced what we were already doing," Barnhill said. "We got a lot of good anecdotes and points that we hadn't thought of."

Public engagement
One of those who attended the Boston public meeting is David Mortimer, a Sudbury, Mass., resident who has been in a wheelchair since he was injured in a car accident in 1993. He chairs the city's disability commission and represents that group on the city emergency planning committee.

"My intent [in attending the meeting] was hoping I would find people similar to myself and find out what success they were having in convincing commissions to be more inclusive in their emergency planning," Mortimer told CIDRAP News.

He said the Boston meeting, held at Boston University, drew at least 50 people, consisting mostly of people with limited mobility, those with hearing impairments, and people working with the homeless and those with mental health problems.

After being briefed on the project, those attending broke into subgroups and, with the help of facilitators, came up with the suggestions for things to include in the guidance. "There was something in the neighborhood of 15 recommendations that were brought to the full group for comment and feedback," Mortimer said.

He said he was impressed by "the willingness to work from the ground up, not coming in and dictating what people need but going out and asking the affected groups what are their major needs regarding treatment in a pandemic. The process is remarkable and hopefully will be a model."

Mortimer also attended the Washington stakeholders meeting after he was asked to report there on the Boston meeting. In the wake of the meetings, he said, "I think I'll be bringing a lot more focus to our local emergency planning people about pandemic flu."

He said it was hard to tell how well local planners would heed concerns about pandemic preparedness, since Sudbury is small and has no public health department. "It'll get added to the many things that I'm a voice crying in the wilderness about," he said.

Filling a need
Various groups have recognized a need for guidance to help protect vulnerable people during a pandemic and have worked on aspects of the problem, but there has been no comprehensive effort until now, according to Jarris and DeBlois.

"There's a recognition that there's a huge need, but there's been a real gap in planning guidance for state and local agencies," said DeBlois. "This project really fills that gap and provides consistent guidance to all the states as to what the best practices and key recommendations are."

The large number and variety of groups that serve vulnerable people made development of the guidance a complex challenge, said DeBlois.

"There's such a huge network of organizations and individuals that serve at-risk populations that it all works together right now like a web of different agencies that are truly the most connected to these folks," she said. "Understanding how that works and what would need to happen to ensure that at-risk populations continue to be served in such an intense public health emergency was really challenging."

Jarris said he couldn't predict to what extent public health agencies will use the guidance, but he expressed hope that it would induce them to build relationships with vulnerable groups.

"I think there are people who are very hungry for guidance around this [issue]," he said. "So much of this work is building relationships with people in the community and those who are serving them that guidance is only the beginning. . . . There's no substitute for getting out there and building those relationships."

See also:

Full text of "At-Risk Populations and Pandemic Influenza: Planning Guidance for State, Territorial, Tribal and Local Health Departments"
http://www.astho.org/pubs/ARPP_Guidance_041508.pdf

ASTHO's At-Risk Populations Project site
http://www.astho.org/index.php?template=at_risk_population_project.html

Project information on CIDRAP's Promising Practices site, with opportunity for public comment
http://www.pandemicpractices.org/practices/article.do?path=pubcom.html

South Korea has new bird flu case​

http://news.yahoo.com/s/nm/20080421/hl_nm/birdflu_korea_dc

SEOUL (Reuters) - South Korea on Monday said it planned to cull a record 5.3 million birds as it announced its 17th case of bird flu in three weeks, in what has become the country's fastest and biggest outbreak of avian influenza.
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South Korea has culled 4.86 million chickens and ducks since the beginning of April, as the highly virulent H5N1 strain, first reported in the southwest, has been confirmed in five provinces.

The agriculture ministry said on Monday it would start probing all of the country's 260 duck farms as a preemptive measure and continue quarantine work. Some 360 soldiers have been sent to the hardest-hit North Jeolla province to help slaughtering and burying farmed birds.

South Korea had to kill 5.29 million birds in its first outbreak between late 2003 and early 2004. The second outbreak in 2006-2007 saw about half that number culled.

No human deaths from the disease have been reported so far from the country.

Some 240 human deaths have been reported globally from the H5N1 strain and 381 confirmed cases of infection since 2003, according to World Health Organisation data.

South Korea Bangladesh and India H5N1 Levels Raise Concerns​

http://www.recombinomics.com/News/04200802/H5N1_Records.html

Recombinomics Commentary 18:04
April 20, 2008

The latest H5N1 reports out of South Korea indicate H5 has been confirmed at 25 locations (which are almost certainly H5N1), and 21 additional sites are under investigation. Almost 5 million birds have been culled, suggesting that the H5N1 outbreak this month will be at record levels.

Recently, similar reports came out of Bangladesh and India. Although H5N1 in Bangladesh has been reported for over a year, the number of infected farms and level of culling increased dramatically in the spring. The same has been true for India (West Bengal and Tripura). All of these areas are close to major wetlands, including the Ganges Delta in Bangladesh and West Bengal. In South Korea the same regions in southwestern Korea (see satellite map) are affected year after year, which lie under a migratory bird flyway between South Korea and Mongolia.

These reports of record levels of H5N1 in these areas raises concerns that as wild birds fly to common nature reserves at the intersections of major flyways, the H5N1 from each region will recombine and generate more genetic diversity, which will the spread south in the fall.

Included in these new combinations are receptor binding domain changes, which have been widely reported in clade 2.2, especially in human cases in the Middle East. Moreover, vaccine resistant strains in Egypt have acquired a large number of non-synonymous changes, which will also be migrating north in the upcoming weeks.

The repeated and record outbreaks in South Korea may have led to the decision in Japan to implement a pre-pandemic vaccine strategy involving first responders, as well as 10-20 million citizens, which may also lead to an increase in vaccine doses.

Stockpiling vaccines makes little sense because H5N1 is constantly evolving away from the early vaccine targets, and this evolution is along multiple parallel pathways.

These changes highlight the need for more active surveillance. However, the detection of H5N1 in farms prior to the detection in wild birds points toward failed surveillance systems, which limits the predictability of the changes because of gaping holes in the sequence database.

The increasing pace of H5N1 evolution highlights the need for a more robust surveillance system. as well as the likelihood of a major pandemic sooner rather than later.

H1N1 Tamiflu Resistance Linked to Brisbane Strain​

http://www.recombinomics.com/News/04200804/H274Y_Brisbane.html

Recombinomics Commentary 22:17
April 20, 2008

A total of 200 (69%) of 290 influenza A (H1N1) viruses were characterized as A/Solomon Islands/3/2006-like, the influenza A (H1N1) component of the 2007--08 influenza vaccine for the Northern Hemisphere, and 70 (24%) were characterized as A/Brisbane/59/2007-like, the recommended H1N1 component of the 2008--09 Northern Hemisphere vaccine.

All the oseltamivir-resistant viruses have been influenza A (H1N1) viruses and have been determined to share the same genetic mutation that confers oseltamivir resistance. These 84 viruses represent 10.2% of the 824 influenza A (H1N1) viruses that have been tested, an increase from four (0.7%) of 588 influenza A (H1N1) viruses tested during the 2006--07 season.

The above comments are from the recent MMWR on the influenza season in the United States. Recently, sequences from the current flu season have been released at Genbank, and sixteen had H274Y. However, all were A/Brisbane/59/2007-like suggesting that the frequency of H274Y in the Brisbane strain may be significantly higher than the 10.2% found in H1N1 in the US. Since Brisbane only represents 24% of the H1N1 isolates in the US, if H274Y is concentrated in Brisbane, the frequency of H274Y in the Brisbane strain could be closer to 40%. Indeed, there have been 56 NA Brisbane sequences released, so the 16 with H274Y represent 29% of the Brisbane/59 isolates in the US.

The frequency of Brisbane/59 in European countries may also explain the differences in H274Y frequencies. In the recent WHO report on next year’s vaccine targets, two isolates with H274Y were mentioned, A/Paris/577/2007 and A/Norway/1735/2007, and both were the Brisbane strain. Norway and France have the highest levels of reported H274Y.

Similarly, two H274Y sequences were released at Genbank this week from Turkey and England, and both were identical to Brisbane-like sequences in the US.

Thus, all public H1N1 sequences from the current season with H274Y have been the Brisbane strain, suggesting that the differences in H274Y frequencies in Europe are largely linked to the frequency of of the Brisbane strain in those countries.

The WHO recommendation, as well as the CDC recommendation, includes Brisbane/59 as the H1N1 target for the fall trivalent vaccine, indicating that Brisbane is becoming dominant and the frequencies of H274Y in H1N1 will increase. Moreover, the current vaccine, which is directed against Solomon Island-like H1N1 may have contributed to the increase in the H274Y frequency by limiting Solomon Island infections.

More information on the association of H274Y with the Brisbane strain would be useful.

Bird flu resurfaces in northeast India​

http://tvnz.co.nz/view/page/536641/1734858

Apr 22, 2008 10:03 PM

Authorities in a remote northeastern state of India prepared to cull thousands of chickens after a fresh outbreak of bird flu in poultry was detected on Tuesday, officials said.

More than 25,000 chickens and ducks have already been slaughtered in Tripura state this month after eight villages were hit by the H5N1 strain.

On Tuesday, officials said bird flu had spread to a new area.

"Bird flu has been confirmed for the second time in Tripura," Kartick Debbarma, a senior animal resources official said in Agartala, Tripura's capital. "It is the H5N1 strain."

The remote northeastern state borders Bangladesh, where more than half the country's districts have been affected by the virus.

In India, the virus resurfaced in the eastern state of West Bengal in January this year, forcing authorities to cull more than four million birds.

Since then the virus has flared up intermittently, hitting poultry sales in the region.

Many states banned poultry products, pulling down prices sharply and prompting farmers to cut production.

The World Health Organization described the January outbreak in West Bengal as the worst ever in India.

Officials in Tripura said they were holding meetings and drawing up their strategy to contain the disease, which has hit Mohanpur, a town just 20 km (12 miles) west of Agartala.

Health department officials were also checking humans for any flu-like symptoms.

While no human cases have been reported in India, experts fear the H5N1 virus might mutate or combine with the highly contagious seasonal influenza virus and spark a pandemic that could kill millions of people.

Since the virus resurfaced in Asia in late 2003, at least 240 people have died from bird flu in a dozen countries, the WHO says.

2 New Suspected Cases of Bird Flu Reported​

http://www.koreatimes.co.kr/www/news/nation/2008/04/113_22912.html

Two more suspected cases of bird flu have been reported in the southwestern region of the country amid intensifying efforts to prevent further spread of the deadly disease, government officials said Tuesday.

The Ministry for Food, Agriculture, Forestry and Fisheries said it is checking cases reported at two chicken farms in Iksan, North Jeolla Province, to determine whether the recent deaths of poultry there were caused by avian influenza.

The two farms, which reported the deaths of 2,500 and 450 chickens, respectively, are located around 25 kilometers from an area where a bird flu outbreak was confirmed last Thursday, the ministry said. Samples tested positive in preliminary tests but the ministry said further investigation is required.

The latest cases in Iksan brought the number of suspected avian influenza outbreaks to 49 as of Tuesday morning. Of them, 26 have been confirmed to be related to a highly pathogenic bird flu virus, according to authorities.

WHO at odds with Indonesia over bird flu​

http://www.washingtontimes.com/article/20080422/FOREIGN/788682866/1003

A dispute over sharing samples of the bird-flu virus between Indonesia and the U.N. World Health Organization (WHO) is jeopardizing efforts to prevent a global influenza pandemic and putting lives at risk, international health officials warn.

The row centers on profits made by Western pharmaceutical companies from vaccines developed using the samples, and the potential benefits of vaccines to poor nations.

Indonesian officials say their country is being cheated out of benefits from vaccines that it cannot afford.

Indonesian Health Minister Siti Fadilah Supari raised the issue in a letter to U.S. Health and Human Services Secretary Michael O. Leavitt, saying Indonesia is not seeking royalties or direct payments.

Instead, she said, her nation wants "a method that leads to the allocation of values derived by commercial interests into one commonly defined system, which will provide benefits to those that have made contributions."

Last year, Indonesia stopped sending samples of the H5N1 bird-flu virus from new outbreaks to the WHO.

WHO labs analyze and gene-sequence the samples to find new variations that might herald the much-feared mutation of the virus into a form easily transmitted from human to human.

S. Korea checks soldier for bird flu infection​

http://www.straitstimes.com/Latest+News/Asia/STIStory_229867.html

SEOUL - SOUTH Korea is testing to see if one of the workers taking part in a mass cull of poultry infected with bird flu may have become infected with the deadly virus, the health ministry said on Tuesday.

The ministry said it would take about one to three weeks to confirm if the soldier, said to be 22-years old by local media, had been infected with the H5N1 strain of bird flu.

'The soldier's symptoms are consistent with that of suspected AI (avian influenza) patients, according to World Health Organisation standards, but the clinical symptoms also resemble bacterial pneumonia so we are on a close watch,' the ministry said in a statement.

The soldier, who is being treated in a quarantine ward, had a high fever and respiratory problems. He has shown signs of improvement after being treated with antibiotics, it said.

On Monday, South Korea's farm ministry said it planned to cull a record 5.3 million birds as it announced its 17th case of bird flu in three weeks, in what has become the country's fastest and biggest outbreak of avian influenza.

No human deaths from the disease have been reported so far from the country.

Some 240 human deaths have been reported globally from the H5N1 strain and 381 confirmed cases of infection since 2003, according to World Health Organisation data. -- REUTERS

Link to next weeks thread:

HEALTH - 4/23/08-4/29/08|Weekly Bird Flu Thread: Indian state suffers second bird flu outbreak

http://www.timebomb2000.com/vb/showthread.php?t=285610