HEALTH 8/16/08- 8/23/08 Weekly Bird Flu Thread:H9N2 bird flu threat understated in humans

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H9N2 bird flu threat understated in humans

http://news.yahoo.com/s/nm/20080815...g_h9n2_dc_1;_ylt=AkZghF8wAomqfiJDYH90ufW3SpZ4

HONG KONG (Reuters) - The H9N2 bird flu strain, identified as a possible pandemic threat, could be infecting more humans than commonly thought but its mild symptoms mean it often goes undetected, a leading Hong Kong bird flu expert said.
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"It's quite possible ... H9N2 is infecting humans quite a lot, much (more) than we appreciate merely because it is beyond the radar," Malik Peiris, a Hong Kong-based microbiologist, told Reuters.

"In humans, it is very mild, so most of the time it's probably not even recognized or biologically tested," said Peiris, who has co-authored several papers on the strain in recent years.

So far, only a handful of human H9N2 cases have been documented worldwide, including four children in Hong Kong in 2003 who suffered from mild fevers and coughs -- as well as a batch in China's Guangdong province, where people often live in close proximity to poultry, Peiris said.

The Hong Kong cases were only picked up by chance given the city's rigorous influenza testing regime, Peiris said.

"It's quite a silent virus, it's not highly pathogenic ... and sometimes it causes some morbidity in poultry but by and large it is just there and it's unnoticed," Peiris said of the H9N2 strain.

The strain occurs mostly in birds, although it has also affected pigs and other animals in Europe and Asia.

Most influenza experts agree that a pandemic -- a deadly global epidemic -- of some kind of flu is inevitable.

No one can predict what kind but the chief suspect is the H5N1 bird flu virus, which has infected 385 people and killed 243 of them since 2003.

However, flu experts at the University of Maryland, St. Jude's Children's Research hospital in Memphis and elsewhere recently wrote in the Public Library of Science journal PLoS ONE that the H9N2 strain posed a "significant threat for humans."

They found that just a few mutations could turn it into a virus that people catch and transmit easily.

Peiris said that while the H9N2 strain might be more transmissible, its effects would be far less devastating than a possible H5N1 pandemic.

"There are other viruses out there besides H5N1 that could be the next pandemic," Peiris said. "But I suspect (H9N2) will not be so severe in its outcome."

Peiris pointed out that the last three major pandemics vastly differed in their severity, with the 1918 Spanish flu pandemic killing an estimated 50 million people worldwide, whereas the "Hong Kong" flu in 1968 killed around one million.

There are hundreds of strains of avian influenza virus but only four -- H5N1, H7N3, H7N7, and H9N2 - are known to have caused human infections, according to the World Health Organization.
 

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Bird Flu In Indonesia: Prevalence, Mortality, And Action

http://www.medilexicon.com/medicalnews.php?newsid=118187

In order to help Indonesia improve its high human mortality due to bird flu (H5N1 influenza), more effective diagnostic methods must be used and improved case management must be implemented to achieve faster treatment with antivirals, according to the authors of an article released on August 14, 2008 in The Lancet.

Most of us are familiar with the flu, which seasonally affects many populations. Because it is an RNA virus, it will undergo genetic shifts relatively rapidly, providing challenges for scientists in creating vaccines. Avian influenza, also known as bird flu or H5N1 has achieved notoriety recently as it has transmitted from birds to humans with often fatal outcomes.

Internationally, the most human cases of bird flu have been found in Indonesia, which also has one of the highest case-fatality rates. While surveillance systems have been implemented to increase awareness to potential outbreaks, there are still significant risk factors that exist in this country.

To investigate the factors that contribute to the fatality of bird flu in Indonesia, Dr Toni Wandra, Directorate General of Disease Control and Environmental Health, Ministry of Health, Jakarta, and colleagues analyzed all 127 bird flu cases manifesting between June 2005 and February 2008. Each case was investigated by teams for epidemiological and clinical data from both case investigation reports and interviews with patients, family members and other individuals associated with the case.

In the first two days after onset, most patients had non-specific symptoms. That is, of the 122 patients with complete data, 25% had both fever and cough, and 7% had fever with breathing problems. The symptoms upon reaching the hospital were as follows: 99% had fever (121 cases), 88% had cough (107 cases), and 84% (103 cases) had breathing problems.

The median time from onset to treatment with oseltamivir was seven days. Survival frequency when compared to treatment time, the following was found, indicating a significant difference in treatment outcome between treatment in two days or less and five days or more:

* The one patient who received treatment within 2 days survived.
* Of patients receiving treatment within 2-4 days, 36% (4 of 11) survived.
* Of patients receiving treatment within 5-6 days, 38% (6 of 16) survived.
* Of patients receiving treatment in 7 or more days, 19% (10 of 44) survived.

Examining mortality in total, 81% of all infected patients (103 cases) died. The median hospitalization time for these patients was six days. Mortality was lower in cases that were clustered together rather than primary, stand-alone cases. For secondary cases, due to clusters, the median treatment time was five days instead of seven. Mortality was higher in cases that resided in urban areas or from indirect exposure to infected poultry through an intermediate.

The authors conclude that improving treatment times can help improve outcomes for bird flu cases. "Early case identification and treatment with oseltamivir is key to addressing the high case-fatality rate in Indonesian cases. There is a clear need to identify definite causes for high-case fatality...While additional research is done we propose the following strategies to provide early diagnosis and prompt treatment to improve quality of case management. Poultry surveillance is being stepped up, and active human case finding by local health centres and village officials is being instituted in areas of poultry deaths." Additionally, they point out, investigations in the surveillance system should include any history of contact with poultry, especially dead and sick poultry, for all illness similar to influenza. They add: ""This strategy will promote earlier and targeted detection of patients that have clear exposure to diseased birds, which should then prompt earlier treatment and reduced case fatality. Finally, all health-care workers should be trained in case management of early H5N1 influenza, and should be equipped with oseltamivir to enable timely administration."

Prof. Sheila Bird, Medical Research Council (MRC) Biostatistics Unit, Cambridge, UK, and Jeremy Farrar, Professor of Tropical Medicine, Oxford University, contributed an accompanying comment in which they emphasize the importance of early preventative action. "Consideration needs to be given now - not in the teeth of a pandemic, and not deflected by either proprietary defensiveness or opportunistic profiteering - to gauging the comprehensiveness of national surveillance for human H5N1 cases. And to ensuring the analysability of a minimum dataset on the exposures and clinical course of every confirmed case of human H5N1. The world also needs to find a more equitable way to ensure that all share in the benefits of such important research. Indonesia could give the lead here."

Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series
I Nyoman Kandun, Erna Tresnaningsih, Wilfried H Purba, Vernon Lee, Gina Samaan, Syahrial Harun, Eka Soni, Chita Septiawati, Tetty Setiawati, Elvieda Sariwati, Toni Wandra
highest case-fatality rates worldwide. We described the factors associated with H5N1 case-fatality in Indonesia.
Lancet Online August 14, 2008
DOI:10.1016/S0140-6736(08)61125-3
Click Here For Journal

Minimum dataset needed for confirmed human H5N1 cases
Sheila M Bird, Jeremy Farrar
Lancet Online, August 14, 2008
DOI:10.1016/S0140-6736(08)61126-5
Click Here For Journal
 

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Vietnam urged to change anti-bird flu vaccination program

http://www.thanhniennews.com/healthy/?catid=8&newsid=41183

Vietnam should progressively change from mass poultry anti-bird flu vaccinations twice a year to age-selective vaccinations throughout the year according to the Food and Agriculture Organization of the United Nations (FAO).

“Up until now, vaccination has been based on two campaigns each year, which is logistically the easiest way to implement a big vaccination, but technically it is not the most efficient way to immunize all the poultry because they’re not all being vaccinated at their best age,” FAO’s avian influenza response veterinarian Tony Forman told reporters on Thursday.

Many challenges regarding the shift are ahead, so it is necessary to start on a trial basis in some provinces before rolling out a national program, said Forman after a two-day international meeting to review Vietnam’s anti-bird flu strategy.

However, for at least the next 1-2 years, Vietnam needs to continue with one mass vaccination campaign in 0ctober and November to protect poultry over Lunar New Year Festival (Tet), which usually falls in January or February.

Most years see a spike in the occurrence of the disease during Tet.

In addition, there should be a requirement for the vaccination of all commercial poultry, he said.

“The vaccinations should be done on large commercial farms and then go down to smaller commercial farms. The requirement is that all birds going to live bird markets have to be vaccinated. They would require a certificate.”

Regarding vaccination expenditures, FAO experts strongly supported Vietnam in considering sharing the cost of avian flu vaccine with producers in order to progressively bring government support to a level that is sustainable, as funds from donors may be slashed in the future.

Funding from the main donor – US Agency for International Development (USAID) – remains high, but support from other donors has already started dropping off, he said.

But, there is a risk that by requiring poultry producers to share the cost of vaccination, they may be reluctant to vaccinate, Forman said.

“And that’s why we want to do this [vaccination cost sharing] on a trial basis to see at what level the government’s support will be appropriate.”

Currently, the two major sources of anti-bird flu vaccine for poultry to Vietnam are from Europe and China.

“The government would need to continue to make sure that only high quality vaccine is imported to Vietnam,” he urged.

Vietnam has given 800 million injections of anti-bird flu vaccine to poultry over the past three years, according to the country’s Department of Animal Health.

“Vietnam is doing a much better job [combating bird flu] than other countries and I believe that it is because of the strong government commitment,” Forman said.

However, the disease will continue to be present in Vietnam for the foreseeable future, according to FAO experts at the meeting.

In addition to vaccination strategy, long-term measures should be encouraged, including improvements to bio-security of poultry farms and improved regulations on live bird markets.

Bird flu has killed and led to the slaughter of nearly 60,100 poultry, including some 36,600 waterfowls in Vietnam since the beginning of this year.

The disease is currently hitting the three provinces of Quang Ngai in the central region, and Dong Thap and Kien Giang in the south.

Vietnam’s poultry population increased to 68.09 million in 2007, from 62.6 million in 2006 and 60.01 million in 2005, according to the Husbandry Department under the Ministry of Agriculture and Rural Development.
 

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Worried about bird flu? Wash your hands

http://news.ninemsn.com.au/article.aspx?id=67916

WASHINGTON — Little can be done to prevent an outbreak of bird flu if it comes in the next year or so before vaccine production can get started, health experts caution, but they say common sense measures can help individuals protect themselves.

Number one is hand-washing, they say — a surprisingly effective way to prevent all sorts of diseases, including ordinary influenza and the H5N1 virus that everyone now fears may jump into humans and cause a catastrophic pandemic.

Number two — do not try to buy your own personal supplies of Tamiflu, one of two drugs shown to work against avian influenza.

And number three, stay home if you do get sick.

Old-fashioned hygiene works very well, experts agreed.

"You wash your hands and you cut the transmission of a bunch of diseases," said Dr. Jeffrey Griffiths of Tufts University School of Medicine in Massachusetts.

This is because any type of influenza is mostly passed hand to mouth. People sneeze and wipe their noses, then touch a microwave button. Or particles from a cough land on a tabletop, only to be picked up on someone else's finger.

While viruses can be suspended in the air in droplets, doctors agree they are much more commonly spread on the hands. Alcohol-based gel or foam hand sanitizers also work well to destroy viruses and bacteria.

Once someone is infected, two drugs are effective — Roche and Gilead Sciences' Tamiflu, and GlaxoSmithKline's inhaled powder Relenza. Countries are stockpiling them now.

But Dr. D.A. Henderson, who helped lead the effort that wiped out smallpox and who founded the Center for Biosecurity at the University of Pittsburgh, said it would be a mistake for individuals to try to buy the drugs now.

NOT A PANACEA

"I think Tamiflu is being regarded now as the panacea of all panaceas," Henderson said in a telephone interview.

Henderson and other experts say while Tamiflu might help cope with an outbreak of H5N1, it is not going to offer outright protection.

For one thing, stocks are limited and it will take years for Roche to ramp up production — even if, as is being discussed now, it licenses generic versions to be made by other companies.

Plus, the more widely any drug is used, the more likely the virus or bacteria it targets is to develop what is known as resistance, meaning the drug becomes less effective.

Both Tamiflu and Relenza treat a flu infection, making it less serious and perhaps making the illness last fewer days. But they must be taken within 48 hours of the first symptoms to do any good.

They can also prevent infection with garden-variety flu if taken, for example, by a family member caring for a sick relative. No one knows if they will do the same with H5N1.

"If you were to take it as a preventative you'd have to take it for probably weeks, a pill a day, 75 milligrams a day is what they recommend," Henderson said.

And the average person is not going to know when, precisely, to begin taking the drug. Many infections look like flu, said pediatrician and immunologist Dr. Anne Moscona of Weill Cornell Medical College in New York.

"If you have Tamiflu at home and you take it for a cold or give it for a respiratory virus that is not influenza, we will be unable to use these drugs when we encounter a lethal strain of flu," Moscona said in a telephone interview.

If people do get sick, they must be careful to stay home from work and not spread viruses.

"Not exposing yourself to others is the best thing you can do for public health," said Dr. Chris Woods of Duke University Medical Center in North Carolina.

But if people are forced to go out while ill, wearing a face mask would be a responsible thing to do, although it is unlikely to protect against infection.

"People have asked, 'Should we wear masks?'," Henderson said. Studies show that people usually breathe in so forcefully when they wear a mask that they end up sucking in unfiltered air from around the sides, he said.
 

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Nigeria: Official Advises Poultry Farmers On Bird Flu Surveillance

http://allafrica.com/stories/200808150819.html

Dr Ezekiel Pam, Desk Officer, (Animal Health), Avian Influenza Preparedness Project, has advised poultry farmers in Plateau to make effective use of the 17 surveillance facilities provided for their operations.

He gave the advice yesterday in Jos in an interview with the News Agency of Nigeria (NAN) in Jos.

Pam said the facilities were to ensure the control of Avian Influenza in the event of an outbreak of the disease.

He also advised them to promptly report suspected cases of the disease to the local government desk officers in their areas.

Pam gave the assurance that the country was well equipped to contain the new strain of the disease reported to have been discovered in Nigeria.

According to him,"the level of preparedness in the country today is more than what it was in 2006 and 2007, when the disease first broke out in the country".

Pam said relevant authorities had beefed up surveillance on the disease, and urged poultry farmers to also increase their bio-security measures.

The measures, he added, include preventing the entry of unauthorised vehicles into poultry farms and disinfecting borrowed equipment before use.

Others are keeping all poultry farms clean, separating birds according to age, breed and species, as well as protecting their birds from coming in contact with wild birds.

The first outbreak of the disease in 2006 affected 97 local governments spread across 25 states.

The new outbreak was confirmed in Fagen-Kawo and Kagarko in Kano and Katsina states respectively.
 

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Coincident Tamiflu and Relenza Resistance Sequences in NJ

http://www.recombinomics.com/News/08150801/Q136R_H274Y_NJ.html

The recently released H1N1 sequences from South Africa confirm earlier reports indicating Tamiflu (oseltamivir) resistance had increased to 100% (23 of the first 23 isolates had H274Y). The released 8 NA sequences all had H274Y while the 8 HA sequences mapped with other HA sequences from isolates with H274Y.

Five of the HA sequences had a cluster of 5 polymorphisms, indicating they were rapidly evolving away from the oseltamivir resistant Brisbane/59 HA sequence via homologous recombination. Phylogenetic analysis of other HA sequences on the same branch indicated published NA sequences had H274Y. Most of these sequences were from New Jersey (see list below). However, one of the isolates, A/New Jesey/08/2008, did not have H274Y (Tamiflu resistance), but did have a mixed signal for Q136R, which likely caused zinamivir (Relenza) resistance. Isolates with Q136K have been reported to be Relenza resistance, so changing the acidic Q at position 136 to either basic amino acids (K or R) will likely cause Relenza resistance.

The Relenza and Tamiflu resistance coincident with similar HA sequences raises concern that these polymorphisms create a selective advantage for H1N1 in the absence of either neuraminidase inhibitor. If true, the increasing level of the HA sequence associated with Tamiflu resistance may lead to an increase in Relenza resistance, regardless of Tamiflu or Relenza usage.

The New Jersey sequences fro HA and NA are mixtures, so resequencing of plaque purified clones would be useful. Similarly, full sequencing of all eight gene segments may help taget changes that lead to selection of additional changes which confir resistance to the nuraminidase inhibitors, oseltamivir (Tamiflu) and zinamivir (Relenza).

HA Sequences Mapping With New Jersey/08/2008

Hawaii/02/2008
Johannesburg/10/2008
Johannesburg/25/2008
Johannesburg/34/2008
Johannesburg/35/2008
Johannesburg/46/2008
Maryland/04/2007
Memphis/03/2008
New Jersey/15/2007
New Jersey/16/2007
New Jersey/20/2007
New Jersey/05/2008
New Jersey/06/2008
New Jersey/10/2008
North Carolina/02/2008
Pennsylvania/02/2008
South Carolina/01/2008
Washington/01/2008
Wisconsin/01/2008
 

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Flu Shots Shipped Earlier, Get Makeover

http://www.knbc.com/health/17198367/detail.html

TRENTON, N.J. -- Flu shots are now being shipped, earlier than usual.

For the first time, every strain included in the shot is new.

There's a push this year to vaccinate an extra 30 million Americans, including children ages 5 to 18.

One strain is a new Australian variety that made a lot of people sick last winter, when the vaccine didn't match the active strains very well.

Federal health officials fear that mismatch will discourage some people from bothering to get vaccinated this year.

Five manufacturers said they expect to supply a record 143 million doses to the U.S. They've begun shipping the vaccine in the past two weeks.

Most said they hope to have all or at least the bulk of their supply in the hands of doctors, clinics and other providers by the end of October.

Figures from the Centers for Disease Control and Prevention showed that last year's vaccine turned out to be a good match for only about 40 percent of the flu making the rounds.

One of the strains that sickened many people was known as Brisbane/10. It was responsible for much of the misery Americans felt. Scientists spotted it in Australia ahead of time, but it was too late to get anything to fight it into the vaccine for North America.

The flu vaccine has to be formulated well in advance because it takes the manufacturers a long time to come up with millions of doses.
 

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1,500 Zambo residents have traces of Malaysian flu

http://www.abs-cbnnews.com/storyPage.aspx?storyId=128446

By JEWEL REYES
ABS-CBN Zamboanga

Local health workers in Zamboanga City said Saturday at least 1,500 residents have been found with traces of the "Malaysian flu."

Rodel Agbulos, Zamboanga City health officer, said the Malaysian flu or the Malaysian strain virus could have been brought to southern Mindanao by the Filipino illegal immigrants who were recently deported back to the country.

Agbulos said the Malaysian flu became prevalent in several Zamboanga City residents after the massive deportation of the illegal immigrants from Malaysia.

Agbulos added that the flu could have been reached the city because of its proximity to Malaysia.

The health officer said "vectoral viral strain" was detected in tests conducted on the 1,500 pneumonia patients in the city. He said the city health office has alerted the regional office about the presence of the Malaysian flu.

Agbulos, meanwhile, calmed residents who have become worried of the Malaysian flu. He said the strain virus is "only a common case of pneumonia."

Malaysia has been struck by the dreaded "avian flu" famously called the Bird flu. Its government ordered the killing thousands of birds and chicken were killed to prevent the deadly influenza virus from spreading.
 

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Two child deaths spark investigation in Hong Kong

http://www.monstersandcritics.com/n...child_deaths_spark_investigation_in_Hong_Kong

Hong Kong - The deaths of two children have sparked a health investigation in Hong Kong on fears the cause could be one virus, health officials said Saturday.

The girls, ages 3 and 9, both died after being admitted to hospital this week. The older girl had symptoms of myocarditis, or inflammation of the heart, while the younger had blood poisoning.

A third girl, 7, is in intensive care with encephalitis or brain inflammation.

Thomas Tsang Ho-fai, controller of the Centre for Health Protection, said the cluster of cases raised an alarm and an investigation was being conducted.

He said a virus was believed to be the cause but at this stage, it was not known whether one single virus or different viruses were responsible.

Results of the investigation were expected next week. In the meantime, Tsang urged parents to pay attention to their children's health, especially if they developed persistent high fever and vomiting.

In March, the government forced the closure of all Hong Kong primary schools and kindergartens after the deaths of two children, 3 and 7, caused panic among parents who remembered the grim days of the outbreak of SARS, or severe acute respiratory syndrome, which killed 299 in Hong Kong and 774 worldwide in 2002 and 2003.

At that time, millions of surgical-style face masks were sold in the territory and worn on the streets, in schools and in workplaces.

An investigation into this year's illnesses revealed the deaths were not the result of a new or more virulent virus but caused by strains of the H1N1 and H3N2 Brisbane virus, which had been circulating in different parts of the world earlier this year.

Hong Kong also saw the world's first modern-day outbreak of bird flu in 1997 when the virus infected 18 people, killing six of them.
 

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S Korea declares itself bird flu-free zone

http://news.xinhuanet.com/english/2008-08/17/content_9435584.htm

SEOUL, Aug. 17 (Xinhua) -- The South Korean government said Sunday that the country is a bird flu "clean zone" after three months without a confirmed case of the bird flu virus.

"Under OIE (the World Organization for Animal Health) rules, we can declare South Korea 'clean' three months after the last quarantine measures have been implemented," said Kim Chang-seob, the chief veterinary officer of South Korea's Agriculture Ministry.

South Korea technically became a bird flu free country as of Friday, Kim added.

The declaration is in accordance with guidelines set by the World Organization for Animal Health (OIE) and follows detailed tests conducted on 1,829 poultry farms throughout the country in May and June, the ministry said.

Following the declaration, South Korea will seek talks with Japan and other countries to resume poultry exports, Kim said.

This year's outbreak of bird flu was the most serious in the country's history. Since the first outbreak was reported on April 1, 8.46 million birds had been culled.
 

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Uganda: New Strain of Bird Flu Poses a Major Threat

http://allafrica.com/stories/200808170059.html

Scientists in Uganda and their colleagues elsewhere are worried that human beings could contract a new strain of bird flu.

The acting World Health Organisation (WHO) Representative in Uganda, Dr Jean Baptiste Tapko, said a global state of alert to the pandemic influenza has been declared.

"Transmission of the influenza virus infection to humans has been mainly from infected birds," Dr Tapko said. He was addressing a Kampala symposium that is drafting a code of ethics for pandemic influenza detection and response in Africa.

Dr Tapko said the emergence of H5NI strain of influenza virus would mark the beginning of an influenza pandemic.

In 1918, an influenza pandemic caused up to 50 million deaths worldwide while in 1957 influenza claimed between one to two million lives. In 1968 the pandemic caused about 700,000 deaths worldwide

Dr Tapko said that since 2003, a total of 385 human cases and 243 deaths from infection with avian influenza sub-type H5NI had been reported in 15 countries three of which are in Africa including Nigeria and Egypt.

"Unlike the previous pandemics, we have had the opportunity to see this one unfolding. We are all expected to be better prepared to rapidly contain and mitigate the possible impact of the pandemic," he said.

Dr Tapko said several countries including Uganda have developed and are implementing national multi-sectoral preparedness plans.

The potential public health impact of an influenza pandemic is enormous including social and economic disruptions , travel and trade restrictions, that would result into massive economic loses, overburdening health care services that are already weak in most developing countries.

Health Minister, Dr Stephen Mallinga said there are high chances for the virus to mutate (change ) and result into a serious influenza pandemic.

An influenza pandemic occurs when a new influenza virus emerges for which there is little or no immunity in the human population and as a result, infected human beings start to infect others.
 

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Elderly Survivors Of 1918 Flu Enable Resurrection Of Antibodies

http://www.medilexicon.com/medicalnews.php?newsid=118512

Ninety years after the sweeping destruction of the 1918 flu pandemic, researchers at Monroe Carell Jr. Children's Hospital at Vanderbilt have recovered antibodies to the virus - from elderly survivors of the original outbreak.

In addition to revealing the surprisingly long-lasting immunity to such viruses, these antibodies could be effective treatments to have on hand if another virus similar to the 1918 flu breaks out in the future.

The study, led by James Crowe Jr., M.D., professor of Pediatrics and director of the Vanderbilt Program in Vaccine Sciences, Christopher Basler, Ph.D., at the Mount Sinai School of Medicine, and Eric Altschuler, M.D., Ph.D., at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, is published online in the journal Nature.

The influenza pandemic of 1918 killed nearly 50 million people worldwide, many of whom were young, healthy adults. With fears of another looming flu pandemic stoked by the emergence of "bird flu" in Asia, researchers have wanted to study the 1918 virus and the immune response to it.

In 2005, researchers from Mount Sinai and the Armed Forces Institute of Pathology in Washington, D.C., resurrected the 1918 virus from the bodies of people killed in the outbreak. The bodies, and the virus, had been preserved in the permanently frozen soil of Alaska.

When the investigators approached Crowe, whose lab had developed methods of making antibodies, to try to make antibodies to the 1918 flu, he was skeptical, but agreed to try.

The researchers collected blood samples from 32 survivors age 91-101 years and found that all reacted to the 1918 virus, suggesting that they still possessed antibodies to the virus.

Crowe's team was then able to isolate exceedingly rare B cells - the immune cells that produce antibodies - from eight of those samples and grow them in culture. Seven of those samples produced antibodies to a 1918 virus protein, suggesting that their immune systems were waiting on standby for a long-awaited second outbreak.

"The B cells have been waiting for at least 60 years - if not 90 years - for that flu to come around again," Crowe said. "That's amazing…because it's the longest memory anyone's ever demonstrated."

Crowe's team then fused cells showing the highest levels of activity against the virus with "immortal" cells to create a cell line that secretes monoclonal (or identical) antibodies to the 1918 flu. The antibodies reacted strongly to the 1918 virus and cross-reacted with proteins from the related 1930 swine flu but not to more modern flu strains.

To test if these antibodies still work against 1918 flu in a living animal, Crowe's collaborators at the Centers for Disease Control and Prevention infected mice with the 1918 flu and then administered the antibodies at varying doses. Mice receiving the lowest dose of 1918 antibody - and those receiving a non-reactive "control" antibody - died. All mice given the highest doses of 1918 antibodies survived.

Although aging typically causes immunity to weaken, "these are some of the most potent antibodies ever isolated against a virus," Crowe said. "They're the best antibodies I've ever seen."

The findings suggest that B cells responding to a viral infection - and the antibody-based immunity that results - may last a lifetime, even nine or more decades after exposure.

These antibodies could be used as potential treatments for future outbreaks of flu strains similar to the 1918 virus. And the technology could be used to develop antibodies against other viruses, like HIV.

Most importantly, said Crowe, "the lessons we are learning about the 1918 flu tell us a lot about what may happen during a future pandemic."

###

Researchers at the Scripps Research Institute in La Jolla, Calif., also contributed to the study. The work was supported by grants from the National Institutes of Health.
 

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Flu not only killer in 1918 pandemic

http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2008/08/18/MNAD12CS5K.DTL

Most deaths in the 1918 influenza pandemic were caused not by the virus alone but by common bacterial infections that overwhelmed victims' weakened immune systems, according to two new studies that could change the strategy against the next pandemic.

"We have to realize that it isn't just antivirals that we need," said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and co-author of one of the studies.

"We need to make sure that we're prepared to treat people with antibiotics," said Fauci, whose study will be released online this month by the Journal of Infectious Diseases.

In both studies, scientists analyzed a trove of historical documents from around the world, examining firsthand accounts, medical records and autopsy reports.

Writing about the 1918 influenza outbreak in the August issue of the journal Emerging Infectious Diseases, researchers reported that few of the deaths were swift.

Instead, they found that most of the deaths occurred a week to two weeks later - indicating opportunistic bacterial infections.

Most of the samples collected from patients, dead or alive, were bacteria common to the noses and throats of healthy people, according to co-authors Dr. John Brundage, a medical epidemiologist at the U.S. Armed Forces Health Surveillance Center in Silver Spring, Md., and Dr. G. Dennis Shanks, director of the Australian Army Malaria Institute in Queensland, Australia.

Both groups of researchers were trying to understand why the 1918 virus - a novel strain of influenza for which few people had natural immunity - was so lethal.

The virus swept around the globe, killing an estimated 50 million people, striking down young, healthy adults even though influenza usually kills only infants, the elderly and the chronically ill.

It long has been recognized that most flu deaths are the result of pneumonia caused by secondary bacterial infections.

But to explain the 1918 pandemic's unusual virulence, many scientists had come to believe that the virus caused death by provoking an overzealous, destroy-the-village-to-save-it immune response, especially in young adults with robust immune systems.

In a previous experiment, scientists reconstructed the 1918 virus - using a genetic blueprint pieced together in 2005 from scraps of frozen DNA - and injected it first into mice and then into monkeys. The animals' immune systems responded violently, inflaming and flooding their lungs with blood and fluids, essentially drowning them.

A similar overkill response has been seen in deaths from the ongoing avian flu outbreak that began in Asia. Capable of jumping the species barrier, the H5N1 virus has infected 385 people, killing 243, and scientists fear that it could mutate to spread easily from human to human.

The two new studies suggest that the 1918 virus did induce severe immune reactions, particularly among young adults. But what made the reactions so deadly was the destruction of the respiratory system's lining, which made it easier for bacteria to infect the lungs.

In most infected populations, Brundage and Shanks found less than 5 percent of deaths occurred within three days of onset. The median time from onset of flu symptoms until death was seven to 10 days. A significant number died two weeks after their initial symptoms, which is typical of bacterial pneumonia.

Michael Katze, a University of Washington virologist who was a lead scientist in the mice and monkey experiments, said the animals' violent and rapid immune response made it almost unreasonable to expect victims of the 1918 virus to live long enough to develop secondary infections.

But he acknowledged that the pandemic could have been the result of a polymicrobial infection.

"Certainly, the idea that resident bacteria flora already present could play a role in developing pneumonia is relatively reasonable," he said. "If the 1918 flu had any impact that compromised (immune) function, it could render a normal resident bacteria pathological."

So far, public health officials around the world have focused on producing and stockpiling vast quantities of antiviral drugs to combat future pandemic flu strains.

Fauci said scientists also need to develop new antibiotics and vaccines against bacteria, especially against a virulent strain of Staphylococcus aureus that has been linked to seasonal flu deaths worldwide and is resistant to many antibiotics.
 

JPD

Inactive
Antibiotic Resistant Infections Will be Problem During Pandemic

http://hstoday.us/content/view/4766/149/

'Of course bacterial infection following influenza should be of concern'

Pandemic health preparedness authorities, virologists, and other scientists are expressing alarm over the findings of two new studies that indicate a potentially significant number of people died during the horrific 1918 influenza pandemic in part because highly opportunistic bacterial infections were able to flourish in these flu victims because the virus severely weakened their immune systems.

Scientists today also have found that the virulent H5N1 flu virus profoundly short circuits a person’s immune system, especially people with healthy systems.

But what's of particularly grave concern is that a terribly weakened immune system is vulnerable to aggressive bacterial infections like the virulent strain of Staphylococcus aureus that’s been linked to seasonal influenza deaths and has developed a resistance to many of the antibiotics used to treat it.

Last fall, the "Journal of the American Medical Association" (JAMA) reported that a strain of methicillin-resistant Staphylococcus aureus (MRSA) that has been spreading across the country is causing more life-threatening infections than public health authorities had thought, and killing more people in the US each year than AIDS.

The revelation that a pandemic strain of influenza could hasten the spread of antibiotic resistant bacterial infections like MRSA in flu patients is especially disturbing, and presents an entirely new set of challenges for pandemic preparedness planners.

HSToday.us earlier reported that hospital-acquired infections (HAIs) like MRSA that kill an estimated 90,000 to 100,000 Americans each year during routine hospital stays could be expected to run rampant during a health crisis in which tens of thousands – or more – persons require emergency medical care under what will likely be less than sterile and sanitary conditions. Conditions most authorities agree are primarily responsible for the transmission of HAIs like MRSA.

HAI infections can cause serious illnesses and, in severe cases, death. Indeed, infectious diseases are a major cause of illness, disability and death, statistics and authorities point out.

Consequently, "we have to realize that it isn't just antivirals that we need" during a pandemic, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and coauthor of one of the studies published in the "Journal of Infectious Diseases."

"We need to make sure that we're prepared to treat people with antibiotics," Fauci stressed.

“Yes, of course bacterial infection following influenza should be of concern, and antibiotic resistant bacteria of even greater concern,” Dr. Graeme Laver told HSToday.us.

A former professor of biochemistry and molecular biology at the John Curtin School of Medical Research at the Australian National University in Canberra, Laver played a key role in the development of the antivirals Tamiflu and Relenza.

Laver has been studying influenza viruses for nearly 40 years. Along with colleague Dr. Robert Webster, the two are credited with having first found the link between human flu and bird flu. In the 1960's, both received world acclaim when they developed a new and innovative generation of vaccines for flu viruses.

Both new studies – the other published in "Emerging Infectious Diseases" – indicate that opportunistic infections are able to take hold in the upper respiratory tract of flu victims because of the flu’s ability to provoke a severe immune system reaction called a “cytokine storm.”

This problem is prevalent in victims infected with the H5N1 flu virus which, unlike seasonal flu viruses, upsets the chemical messengers that regulate immune function in a healthy, vigorous immune system, thus activating an inordinate number of immune cells.

Studies show children and teens between birth and 19 years of age account for nearly 46 percent of all H5N1 flu deaths in the world.

Similarly, the 1918 pandemic flu virus struck down an inordinate number of young, healthy adults.

Prior to the new studies linking virulent influenza to the onset of opportunistic bacterial infections, a team led by Menno de Jong of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, urged that “the focus of clinical [pandemic] management should be on preventing this intense cytokine response by early diagnosis and effective antiviral treatment.”

“If virus replication can be stopped in the early stages, then the likelihood of bacterial infection will be greatly reduced,” Laver said.

Laver earlier explained to HSToday.us that “If people with flu symptoms take Tamiflu immediately, say within six or so hours after symptom onset, the infection should be rapidly terminated, the person should recover, and then, and this is important, should then be immune to reinfection for the rest of the pandemic.”

Laver said “this has been called ‘Aborted-infection Immunization,’ and to use Tamiflu in this way would allow many health care workers and so on to go about their business without fear of reinfection.”
 

JPD

Inactive
ProMED Resumes Reports Of Suspect H5N1 Cases in Indonesia

http://www.recombinomics.com/News/08180801/H5N1_ProMED_Resumes.html

ProMED-mail has now decided to report all suspected human cases of H5N1 from Indonesia because the usual flow of information -- first suspect and then confirmation -- is disrupted there because of their public health policy.

Recombinomics applauds ProMED’s decision to reverse policy and report all suspect human H5N1 cases in Indonesia. As noted above, the flow of information from Indonesia has been disrupted by their announced change in public health policy. The length of the reporting delays is unclear, as is the reason for the failure of WHO to report lab confirmed H5N1 cases. Two July cases were widely reported in the media. The first case died on July 10 and was lab confirmed on July 13. The Ministry of Health refused to confirm or deny the lab confirmation. The second case died in early August. Although the Ministry of Health did confirm this case, the WHO had yet to report either case.

It remains unclear if this lag in WHO confirmations is due to IHR violations by Indonesia, or a change in WHO policy on reporting lab confirmed H5N1 cases, which are usually included in situation updates published a day or tow after confirmation.

Similarly, neither Indonesia nor WHO has commented on the three fatal cases in North Sumatra. Associated poultry has tested positive for H5N1, but recent deaths in the area have been attributed to dengue hemorrhagic fever, which has symptoms that approximate bird flu.

Clearly it is time for more transparency in Indonesia, official Indonesian reports notwithstanding.

WHO has the authority to investigate suspect H5N1 cases and they have an obligation to report the results of such investigations. It is time for WHO to follow the ProMED lead and increase transparency in Indonesia, by releases human H5N1 sequences generated since the Indonesian blackout from the beginning of 2007, and provide timely situation updates on lab confirmed cases, including those from July of this year and the three fatal suspect cases this month.
 

JPD

Inactive
Young scouts add voices to curb bird flu in West Java

http://www.unicef.org/infobycountry/indonesia_45253.html

WEST JAVA, Indonesia, 19 August 2008 – More than 5,000 Indonesian boy and girl scouts have pledged to fight the battle against avian influenza in their home province of West Java. The scouts recently gathered at a seaside town in Sukabumi district to learn about bird flu and how they can help protect their communities from the deadly virus.

The event was a small part of a massive nationwide campaign that was launched in 2006, when experts warned that if the virus mutated, it could lead to a global pandemic.

“Since we started the campaign, we have worked with teachers and students, community members and religious leaders to get these life-saving messages out to the public,” said UNICEF West Java Field Office Chief Steve Aswin. “The scouts of Indonesia are a great way to build on that foundation. They understand the problem and are committed to helping.”

Dangers of raising poultry

Indonesia is the most bird flu-affected country in the world with 135 cases and 110 fatalities. Some 40 per cent of all victims are children.
UNICEF Image
© UNICEF video
Actors take part in a play to spread awareness of the dangers of avian influenza in Indonesia.

Many Indonesians raise poultry in their backyards, so children often find themselves in close contact with these birds.

Scout Adista Mawarni, 9, said her family doesn’t have any chickens – but her neighbours do. “Sometimes the chickens walk near our house. I didn’t know until now how dangerous bird flu was,” she said.

Scouts as ‘agents of change’

UNICEF, with funding from Canada and Japan, has so far reached some 5 million children and 100,000 communities with educational materials on avian influenza. In addition, a mass media campaign has reached every province in the country through television, radio and print.

UNICEF has long been working with schools and community groups. The collaboration with scout groups is the latest venture.

"Children are agents of change and can bring information to their families, especially information on how to protect themselves and their families from deadly diseases such as bird flu,” said Mr. Aswin.

Communicating through the arts

Nina Rusmalina, 18, said she and her fellow scouts are going door to door to raise awareness about bird flu. “I think if everyone understood the problem really well, then they would do something. We have to make sure they don’t forget,” she said.

Nina was part of a group of scouts who performed a short play for their fellow scouts to show what to do if bird flu hits their village. Communicating through the arts and education have been key to the UNICEF programme.

“We all have to do something,” said Nina. “It is my responsibility to also fight this disease. I am thrilled to be part of the campaign that tries to save lives.”
 

JPD

Inactive
More diseases surface as bush meat eating rises

http://www.monitor.co.ug/artman/pub...surface_as_bush_meat_eating_rises_70101.shtml

As high beef and fish prices push populations to rely on home reared chicken and bush meat, the likelihood of them contracting zoonotic diseases increases in a continent not adequately prepared for bird flu, ebola and other animal-spread diseases outbreaks, writes Curtis Abraham

Last year’s outbreaks of the deadly Marburg and Ebola Hemorrhagic Fever viruses in southwestern Uganda and in the neighbouring Democratic Republic of Congo’s province of Kasai Occidental and the sporadic outbreaks of Avian Influenza (Bird Flu) across the continent once again bring to light the threat zoonotic diseases pose to sub-Saharan Africa in particular and the world generally.
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According to recent analysis, more than 60 percent of the estimated 1,415 infectious diseases known to modern medicine are capable of infecting both animals and humans. Most of these diseases such as anthrax, Rift Valley fever and monkey pox are zoonotic, meaning they originated in animals but have crossed the species barrier to infect people.

It is estimated that about 75 per cent of the new diseases that have affected humans over the past 10 years have been caused by pathogens (infective agents) originating from animals or animal products. This was the case of the HIV-- the virus that causes Aids, which experts believe jumped the Darwinian divide from apes to humans.

Such diseases are of course not confined to the developing world. In 2003, there was an outbreak of human monkey-pox in the American states of Illinois, Indiana and Wisconsin. Human monkey-pox is a rare zoonotic viral disease that occurs primarily in equatorial West and central Africa.

The outbreak in America occurred when a Wisconsin prairie-dog dealer allowed several of his animals to mix with rodents recently imported from Ghana that happened to be carrying the Monkey-pox virus. Luckily, no one died despite there being 71 reported cases of the disease in six mid-western states.

And it isn’t only humans who are at risk of disease. Domestic animals, as the bird flu (H5N10) or Avian Influenza outbreaks in Asia, Europe and Africa have proven, are equally vulnerable to infectious ailments.

Livestock agriculture is the most important industry across sub-Saharan Africa, and disease is its biggest enemy. Overall, the industry represents 25 per cent of the gross domestic product (GDP) of the region, and, in certain countries, provides enough stock for export.

However, compared with other parts of the world, Sub-Saharan Africa has the heaviest burden of animal diseases. For example, 12 out of the 15 diseases that were considered by the Office Internationale des Epizooties as the most contagious are found in Africa.

According to experts, Africa is not threatened by a single malaise such as HIV and Aids or Avian Influenza but by a combination of various human, plant and animal diseases, which can have potentially devastating social, environmental and economic effects.

But why has there been a rise of new zoonotic diseases such as West Nile Fever, Rift Valley Fever, Marburg and the emergence of new virulent organisms when health care throughout the world is arguably the best it has ever been in the history of humanity?

The misuse of antibiotics by Sub-Saharan Africans is one key consideration. Patients in poor areas of the continent have poor prescriptions habits by not taking the full dosage of their prescribed medications.

Furthermore, even if the patient in question is taking the proper dosages, many Africans are unable to afford the necessary full course antibiotic prescriptions. There is also the lack of government regulation of pharmacies many of which sell drugs without a physician’s prescription.

Rapid population growth in sub-Saharan Africa is also another important factor. Along with population increase comes the need for more arable and grazing land and the exploration of new forest, swamp and cave habitats. This raises the likelihood of exposure to ‘new’ infectious agents in those environments, and could result in the emergence of new disease pathogens.

Increased demand for food
As population grows, there is also an increase in the demand for food. In sub-Saharan Africa and elsewhere, people are more and more turning to wild animals for food. This high demand for bush meat in the countries of the Congo Basin is helping to fuel the increase in outbreaks of such illnesses as Ebola Hemorrhagic Fever.

Ebola, like the HIV virus that causes Aids, passed into the human population through contact with blood from infected primates such as gorillas and chimpanzees as well as other primates like monkeys who regularly from part of the bush meat trade.

However, the multi-billion dollar bush meat industry is a key contributor to local economies throughout the developing world. It is also among the most immediate threats to tropical wildlife.

The consumption of bush meat is particularly acute across west and central Africa where there are still large equatorial forests. In fact, the Congo River Basin is home to one of the biggest expanse of tropical rainforest in the world.

Cameroon, Central African Republic, Democratic Republic of Congo, Equatorial Guinea, Gabon and the Republic of Congo have a combined forest area of 1,856,207 kilometres squared — one of the largest in the world. Add to this the estimated combined forest and urban population of the Congo Basin of 5432,945,932 who consume an astonishing 1,196,395,911 kilogrammes (one million to five million tones) of bush meat annually. You now appreciate why wildlife conservationist call it the Bush meat crisis.

These vast forest areas harbour various monkey and antelope species. But it’s Africa’s highly endangered Great Apes: gorillas, chimpanzees and bonobos whose very existence is being severely affected by the bush meat trade.

Recent scientific surveys of great ape populations in Gabon, which has one of the largest populations, indicates that the numbers of gorillas and chimpanzees declined by more than half between 1983 and 2000. But it is not only the bush meat trade that has decimated the ape population of West and Central Africa. Ebola has killed tens of thousands of gorillas and chimpanzees.

Decline in fish stocks
But the bush meat trade in sub-Saharan Africa has also been linked to the decline of fish stocks in West Africa. According to experts, people substitute wildlife for fish in ears of fish scarcity. In 2005, researchers found that declining fish stocks were fuelling a multibillion- dollar meat trade in West Africa.
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A man poses with his hunt. Diseases such as HIV, anthrax, Rift Valley fever and monkey pox are zoonotic, meaning they originated in animals such as chimpanzees and monkeys but have crossed the species barrier to infect people. NET PHOTO

In Ghana, more than half of the country’s 20 million people reside within 100 kilometres of the coast, where fish is the primary source of protein and income.

However, using 30-year data collected monthly by rangers in six nature reserves in Ghana, researchers have found a direct link between fish supply and the demand for bush meat in Ghanaian villages. Looking at data for the years 1970 to 1998, researchers found that in 14 local food markets, residents substituted bush meat as an alternative to fish and the number of poachers observed by rangers in parks increased when fish supply was limited or its price increased.

During the same period trawler surveys conducted in the Gulf of Guinea, off Ghana’s coast, since 1970 along with other regional stock assessments, estimate that fish biomass in near-shore and off-shore waters has declined by at least 50 percent.

In the same period, there has been a threefold increase in human population in the region. The researchers suspect the decline in the availability of fish at local Ghanaian markets is linked to heavy over-fishing in the Gulf of Guinea.

The Gulf of Guinea is one of the most over fished areas of the world. Declines in fish stocks in waters off West Africa have coincided with more than ten-fold increases in regional fish harvests by foreign and domestic fleets since 1950.

Shipping fleets subsided by the European Union (EU) have consistently had the largest foreign presence off West Africa, with EU fish harvests there increasing 20 times from 1950 to 2001.
As the outbreaks of zoonotic diseases increase, indigenous Africans (and others communities in developing countries) might hold the key to disease prevention and containment.

Some pioneers in the field of modern medical anthropology agree that the global fight against emerging zoonotic diseases as well as re-emerging contagious and infectious ailments in Sub-Saharan Africa and elsewhere has failed to incorporate traditional African medicine for disease control and prevention.

This negative attitude towards indigenous notions of contagious diseases stems largely from the assumption that African health beliefs are primarily based on witchcraft, sorcery or black magic.

Experts have indeed found this to be true in the realm of mental illness in sub-Saharan Africa (perhaps due to a superficial likeness between possession by spirits and symptoms of some mental illnesses) but curiously not so when it comes to infectious diseases.

“Western medical science has long dismissed African indigenous (and by extension, other indigenous) medical theories as superstitious gibberish, unworthy of serious consideration,” writes anthropologist Edward C. Green, now a Senior Research Scientist at the Harvard Centre for Population and Development Studies.

The attitudes of the Western medical fraternity as well as Western-trained African health care workers will only hamper current efforts to control and prevention of the spread of the latest zoonotic threat to the African continent, Avian Influenza. So far only 40 Africans are known to have been infected with the potentially fatal disease.

However, a recent report by Folorunso O. Fasina and colleagues in The Lancet Infectious Diseases says that Africa is incapable of fighting an Avian Influenza epidemic. According to the report the African strain of H5N1 has acquired “troubling” properties such as respiratory rather than faecal transmission in poultry and a mutation associated with increased spread of disease in mammals, including humans.

Furthermore, the possibility of human infection on the continent is increased by inefficient diagnosis, denial of outbreaks, inter-ethnic crisis, politicisation of the issue, poor reporting surveillance and communication risks.

Devastating epidemic
A large-scale epidemic of Avian Influenza could happen in Africa if the virus changes so that human to human transmission occurs, say experts. If it does millions of people could die as a result. In fact, some observers predict that such an epidemic could be just as devastating to the continent as the rinderpest epidemic was back in the 1890s and the HIV and Aids epidemic of today.

For starters, surveillance systems in Africa are notoriously weak and are unable to detect early H5N1 outbreaks in poultry or wild birds.

Control remains difficult because of the continent’s ineffective border controls, overtaxed health-care systems and inadequate bio-security. Furthermore, the crowding of poultry farms and the blossoming of live poultry markets promote the rapid spread of the disease, as do high-risk conditions and practices like the slaughter of sick birds in homes.

The result of such an epidemic would have devastating socio-economic consequences. For example, African women might be particularly at risk. Epidemiological studies have shown that there is a higher likelihood of the transmission of Avian Influenza from poultry to humans through contact with infected poultry. As poultry in Africa is predominately managed by women, they may have a higher incidence of contracting H5N1 with the possibility of them passing it on to their children were the virus ever to make the big leap form bird to human transmission to human-to-human transmission.

An epidemic outbreak of H5N1 could also lead to widespread micronutrient deficiencies, say experts. Even small reductions in meat and egg consumption can lead to large reductions of micronutrient intake. Therefore, there may be negative impacts on nutrition of people at risk such as children, women and people living with HIV and Aids.

Against such a background, the International Food and Policy Research Institute in cooperation with the International Livestock Research Institute is assisting developing regions to protect their economic livelihood in case of an H5N1 epidemic outbreak.

In May a $7.8m project was launched to assist poor farmers in developing countries to protect their livelihoods in the event of an avian flu outbreak. Research is being conducted in Ethiopia, Indonesia, Kenya, Mali, and Nigeria, where experts will identify strategies, such as farmer compensation schemes, that can both control the disease and protect poor households from losing critical sources of income.

The consequences for failed infectious disease control and eradication programmes in Africa and elsewhere are alarming. Mark E.J. Woolhouse and Sonya Gowtage-Sequeria of the Centre for Infectious Diseases, University of Edinburgh cite the failure of public health programs as one of the 10 drivers associated with the emergence and re-emergence of human pathogens.
 

JPD

Inactive
ND birds show no dangerous flu

http://www.kxmb.com/News/267021.asp

DICKINSON, N.D. (AP) State officials say tests of birds in the state continue to show no signs of a dangerous strain of avian flu.

Game and Fish Department bird management supervisor Mike Johnson says the testing is a continent-wide effort.

Johnson says a bird flu strain called H5N1 is the one that affected people in Southeast Asia and caused fears of a pandemic.

The Game and Fish Department does testing along with its duck banding operations in August and September.

Johnson says the state will continue to run the tests on both wild and domestic birds, but officials have found no reason for worry.
 

JPD

Inactive
Fourth child succumbs to mystery virus in Hong Kong

http://www.monstersandcritics.com/n..._child_succumbs_to_mystery_virus_in_Hong_Kong

Hong Kong - A fourth child has fallen ill with a mystery virus that is suspected to have killed two children and left one in serious condition, health officials said Thursday.

The latest patient, a 3-year-old boy, was admitted to hospital Tuesday with fever and vomiting. His conditioned worsened after convulsions and he fell into a coma, the Centre for Health Protection said.

His condition was said to be critical Thursday with signs of blood poisoning and brain abnormalities.

Health officials are already conducting an investigation into the illnesses after the deaths last week of two girls, 9 and 3, who suffered from inflammation of the heart and blood poisoning.

A third girl, 7, is in critical condition, suffering from brain inflammation.

Thomas Tsang Ho-fai, controller of the Centre for Health Protection, said it was not known whether one single virus or different viruses were responsible and an investigation was ongoing.

In the meantime, he reminded parents to pay close attention to their children's health and seek medical help if they developed persistent high fever, vomiting or convulsions.

In March, the government closed all Hong Kong primary schools and kindergartens after the deaths of two children caused panic among parents who remembered the grim days of the 2003 outbreak of SARS, or severe acute respiratory syndrome, which killed 299 and infected 1,755 in Hong Kong.

It brought the return of surgical-style face masks, which were sold by the million and worn on the streets, in schools and in workplaces during the SARS outbreak.

An investigation into the March illnesses revealed the deaths were not the result of a virulent virus but strains of the H1N1 and H3N2 Brisbane virus, which had been circulating in different parts of the world earlier this year.

As well as SARS, Hong Kong saw the world's first modern-day outbreak of bird flu in 1997 when the virus infected 18 people, killing six of them.
 

JPD

Inactive
Global Spread of H1N1 Tamiflu Resistance

http://www.recombinomics.com/News/08220801/H274Y_Global.html

``The patients are from across the country, so the resistant strain is widespread,'' Terry Besselaar, director of South Africa's National Influenza Centre in Johannesburg, said in an e- mail today.

The above comments on Tamiflu (oseltamivir) resistance in H1N1 in South Africa represent a small subset of Tamiflu resistance spreading globally. Earlier reports on H1N1 in South Africa indicated that 23 of 23 H1N1 isolates had H274Y. Sequence data from these early isolates indicated all isolates were clade 2B (Brisbane/59), but the isolates fell into two sub-clades. The larger sub-clade had the same background as the dominant sequences in northern Europe and the United States reported in the 2007 / 2008 season. However, the South African isolates had a cluster of 5 polymorphisms on both sides of the receptor binding domain position 190 (using H3 numbers). One of the polymorphisms (G617A) was present on a subset of isolates from the United States and Europe. It had been in circulation in the on H1N1 isolates from the 1940’s. The polymorphism adjacent to this change (C610T) was also present on H1N1 isolates from the 1940’s, demonstrating sequential acquisition of adjacent polymorphisms via homologous recombination. These clustered changes will likely reduce the effectiveness of the northern hemisphere vaccine which will be introduced in the upcoming months and targets Brisbane/59.

However, H274Y is much more widespread the isolates in South Africa. All 10 of the H1N1 isolates from Australia this season also have H274Y. Similarly, recent data from a number of countries are reporting high frequencies of H274Y. Although the number of samples is low, H274Y is also being reported at 100% in Cameroon in west Africa and Montserrat in the Caribbean. High levels (5 of 8) are also being reported for the Seychelles off the coast of east Africa. Early reports on increased pneumonia rates have also been reported in nearby countries, including Zimbabwe in Africa as well as Honduras and Nicaragua in central America, raise concerns that these additional cases are also due to oseltamivir resistant H1N1.

The dramatic spread of H274Y is largely linked to its increased fixation on the Brisbane/59 strain which accounts for virtually all recent cases outside of Asia. H274Y was initially reported on New Caledonia (clade 1) in the United States and Hong Kong (clade 2C) in China, but the global spread has been fueled by clade 2B and involved multiple introductions. The initial sequence data from South Africa which has 3 non-synonymous changes flanking the receptor binding domain position 190 (N187S, G189A, A193T), raises concerns that the new northern hemisphere H1N1 vaccine will have limited utility and Tamiflu resistance will continue on a global expansion.
 

JPD

Inactive
1918 Pandemic Survivors Tell Their Stories

http://www.redorbit.com/news/health...tell_their_stories/index.html?source=r_health

In an effort to put a face on pandemic planning, the stories of 50 people who survived the 1918 Spanish Flu are available online, U.S. health officials said.

The Centers for Disease Control and Prevention released the online storybook Thursday containing narratives from survivors, families and friends about the most devastating epidemic in recorded history, which killed more than 50 million.

"Complacency is enemy No. 1 when it comes to preparing for another influenza pandemic," Dr. Julie Gerberding, director of the CDC, said in a statement. "These stories, told so eloquently by survivors, family members and friends from past pandemics, serve as a sobering reminder of the devastating impact that influenza can have and reading them is a must for anyone involved in public health preparedness."

The storybook provides valuable insight for public health officials and the public in preparing for the possibility of another pandemic sometime in the future, Gerberding added.

The storybook is available at http://www.pandemicflu.gov/storybook/index.html.
 

JPD

Inactive
Sequential Acquisition of Adjacent Vintage H1N1 Polymorphisms

http://www.recombinomics.com/News/08210803/H1N1_Sequential_1940.html

Recently released H1N1 sequences from South Africa confirmed earlier reports indicating that Tamiflu (oseltamivir) resistance was running at 100% in the first 23 isolates sequenced. Recently, the South African data has been updated with results on the first 107 isolates sequenced, and all were Tamiflu resistant. Similarly, 100% of the first 10 isolates in Australia are also Tamiflu resistance.

The HA and NA sequences from South Africa fell into two major sub-clades. Five of the 8 HA sequences had a cluster of five polymorphisms (A599G, G604A, G605A, C610T, G617A), which created three non-synonymous changes (N187S, G189, A193T). The A193T change had been seen earlier in H1N1 isolates from the 1940’s. The G617T change created a 16 BP region of identity between recent isolates and those from the 1940’s (see list below). All but one of the recent isolates had H274Y in the public NA sequence with the exception of A/New Jersey/08/2008, which had Q136R, which is likely associated with Relenza (zanamivir) resistance (Q136K has been shown to confer Relenza resistance).

The clustering of the five sequences suggested that the changes were acquired via homologous recombination. This mechanism was further supported by the subsequent acquisition of the adjacent polymorphism, C610T, which is also present in H1N1 isolates from the 1940’s. The sequential acquisition by these adjacent polymorphisms demonstrates how one acquisition can create larger islands of identity, which then lead to additional acquisitions from related parental strains.

Release of additional sequence data on the more recent resistant isolates would be useful. These changes surrounding the receptor binding domain sequence at position 190 further suggests that the new H1N1 vaccine targeting Brisbane/59 will once again be chasing H1N1 evolution, and will have limited utility.

Isolates with 16 BP of identity

A/Johannesburg/46/2008
A/Johannesburg/35/2008
A/Johannesburg/34/2008
A/Johannesburg/25/2008
A/Johannesburg/10/2008
A/South Carolina/01/2008
A/Wisconsin/01/2008
A/Hawaii/02/2008
A/North Carolina/02/2008
A/New Jersey/10/2008
A/Memphis/03/2008
A/Washington/01/2008
A/New Jersey/08/2008
A/New Jersey/AF1291/2008
A/England/557/2007
A/New Jersey/05/2008
A/New Jersey/20/2007
A/New Jersey/06/2008
A/Pennsylvania/02/2008
A/Maryland/04/2007
A/New Jersey/16/2007
A/New Jersey/15/2007
A/Albany/4836/1950
A/Roma/1949
A/Albany/4835/1948
A/Lepine/1948
A/Fort Monmouth/1/1947
A/Rhodes/47
A/Cam/46
A/Hickox/1940
 

JPD

Inactive
H7N3 in Rhode Island

http://www.recombinomics.com/News/08210801/H7N3_RI.html

A strain of avian influenza (bird flu) has been detected in a small number of mute swans collected from the Seekonk River during routine surveillance performed by the Department of Environmental Management's Division of Fish & Wildlife.

The swans were caught near the Swan Point Cemetery in Providence, and subsequently tested by the USDA.

Four of the eleven birds were found to be infected with the H7N3 strain of the avian influenza virus.

The above comments describe the confirmation of H7N3 in Rhode Island. Although H7 outbreaks are reportable, an OIE report has not yet appeared, and the media reports do not indicate if the H7N1 is high or low path.

Reports of H7 outbreaks in the US have become more common. The most recent was in wild birds in Arkansas. Initially only antibodies were detected, but low path H7N3 was subsequently isolated.

In addition, H7N3 sequences from Delaware and Maryland have been deposited at Genbank, but have not yet been released (see list of 2006 and 2007 isolates here). H7N3 has also been reported in Canada last year.

H7 outbreaks are frequently linked to human infections, although such cases are usually mild. A more aggressive case was identified in New York in 2002, but that infection involved H7N2. Most of the H7N3 cases have been linked to eye infections.

More information on the pathogenicity of these isolates would be useful.
 

JPD

Inactive
Recombination Drives Global Spread of H1N1 Tamiflu Resistance

http://www.recombinomics.com/News/08230801/H274Y_Global_Recombination.html

``What we're seeing is the evolution of the resistance gene and the distribution of it throughout the world,'' said Lance Jennings, a clinical virologist with the Canterbury District Health Board in Christchurch, New Zealand, who is chairman of the Asia-Pacific Advisory Committee on Influenza.

``We have a lot to learn about the molecular epidemiology of influenza viruses.''

The above comments on the dramatic emergence of oseltamivir (Tamiflu) resistance in H1N1 reflect the current state of confusion among those trying to understand the spread, based on the out-dated paradigm of selection of random mutations as a mechanism of antigenic drift. The application of this paradigm to antiviral resistance is conceptually straightforward, since the drug creates a strong selection pressure for the emergence of resistance.

Early reports on one such change, NA H274Y, indicated that this resistance would be limited to patients receiving oseltamivir. Although H274Y was said to generate significant resistance to the drug, influenza with H274Y would not be evolutionarily fit and would not compete favorably with wild type influenza in patients not receiving oseltamivir.

Initial data on H274Y seemed to support this paradigm, as initial reports of the emergence of H274Y was limited to patients in Vietnam who were being treated with Tamiflu, including one patient receiving a sub-optimal prophylactic dose in 2005, as well as a patient in Indonesia who stopped taking a treatment dose in 2006.

However, reports of H274Y in H5N1 in isolates from wild birds in late 2005 demonstrated that H274Y could compete with wild type H5N1 in hosts not taking oseltamivir.

The report of H274Y in H5N1 was then followed by H274Y in H1N1 in seasonal flu cases in the United States at the beginning of the 2006 season. These cases involved the dominant strain in the United States at the time, New Caledonia, which was clade 1. Similarly, in 2006 H274Y was also present in the Hong Kong strain (clade 2C) in China. In both cases, the resistance was found in patients who had not been receiving oseltamivir, demonstrating that H274Y was evolutionarily fit on two distinct H1N1 genetic backgrounds, although these isolates shared a region of identity adjacent to the polymorphisms, supporting distribution of the polymorphism via homologous recombination.

At the beginning of the 2007 season in the northern hemisphere, H274Y jumped to another H1N1 genetic background, Brisbane/59 (clade 2B) in Hawaii in the United States. These isolates were closely related to other isolates from Hawaii, but acquired H274Y and also matched the clade 1 and clade 2C sequences on the 3’ side of the acquisition. This acquisition was followed by a jump to another version of clade 2B, which became the dominant oseltamivir strain in the United States, and became the dominant H1N1 strain in Norway, where the high frequency caught the attention of surveillance groups. The presence o f H274Y on the “northern European” H1N1 background led to widespread reports of high frequencies of H274Y in early 2008.

Thus, the H274Y polymorphism was evolutionarily fit on a number of genetic backgrounds, including H5N1 in wild birds in 2005, followed by H1N1 on clade 1 and clade 2C in 2006, and the dramatic spread onto multiple versions of clade 2B in the 2007/2008 season.

Moreover, at the time of clade 2B expansion, the H1N1 vaccine target switched from clade 1 to clade 2A (Solomon Islands/3). However, in the 2007/2008 season Solomon Island had virtually disappeared, and there were no reports of H274Y on a Solomon Island genetic background. Therefore the mismatched H1N1 would have reduced effectiveness in blunting the spread of H274Y, and may have accelerated the H1N1 evolution away from the vaccine..

Recent reports of H274Y in the 2008 season in the southern hemisphere include multiple countries where H274Y is being reported on 100% of H1N1 isolates. The first sequences from a country with 100% resistance are from South Africa, where the first 107 H1N1 isolates have H274Y. The dominant sequence from South Africa has a cluster of five polymorphisms near position 190 (H3 numbering) in the receptor binding domain. One of these changes was seen earlier in the “northern European” lineage, and is also present in H1N1 from the 1940’s. The adjacent polymorphism, which is only in the South African isolates, is also in H1N1 isolates from the 1940’s further supporting acquisitions via homologous recombination.

The polymorphisms jumping from one genetic background to another, followed by expansion of the dominant strain, was reported earlier for a polymorphism on NA of H5N1, G743A. The spread of this polymorphism is also dramatic, in the absence of obvious selection, because it is synonymous and therefore does not change the NA sequence.

Like H274Y, G743A was initially reported on multiple genetic backgrounds (all major H5N1 sub-clades). The spread of clade 2.2 out of China in 2005 allowed for further analysis of G743A. In 2006 the polymorphisms was almost exclusively limited to one clade 2.2 sub-clade found in a limited geographical area (southern Germany, northern Switzerland and eastern France).

In early 2007, it appeared in bird isolates in the Nile Delta. The H5N1 in Egypt was well defined by 2006 isolates, which began to diversify in the 2006/2007 season. G743A appeared in multiple isolates in February in the Nile Delta. Plaque purified clones of isolates from one of the birds demonstrated that there were two readily distinguishable sub-clades and both had acquired G743A, which would have been difficult to explain by random mutations, because the parental sequences were present in 2006, and the number of new acquisitions on each background was limited, but included G743A in both instances. Shortly thereafter G743A appeared on additional genetic backgrounds in Egypt, including human isolates in southern Egypt, virtually eliminating the chances of coincidental copy errors on multiple isolates at the same time.

However, the G743A acquisitions were not limited to multiple H5N1 genetic backgrounds in Egypt. At the same time there was a H5N1 outbreak in Moscow and those sequences were closely related to clade 2.2.3 sequences which had been found in Azerbaijan in 2006, without G743A. However, the isoaltes from early 2007 had G743A.

The polymorphism also appeared on another clade 2.2.3 background in Kuwait. This clade 2.2.3 was the Uvs Lake strain which emerged in the summer of 2006 at Uvs lake in Mongolia. This H5N1, which evolved from a massive wild bird outbreak in Mongolai and Russia migrated to South Korea and Japan in late 2006 and none of the isolates had G743A. However, this genetic background acquired G743A in early 2007 in Kuwait.

The same scenario played out in western Africa. G743A was found in isolates in Ghana on an H5N1 genetic background that had been reported in 2006 in the Ivory Coast. G743 was also on another genetic background related to the H5N1 found in the first human H5N1 case in Nigeria. The presence of G743A is a subset of these related sequences in Nigeria also signaled acquisitions in early 2007.

These outbreaks in early 2007 were followed by outbreaks in Europe, beginning in the summer of 2007. These isolates were the Uvs Lake strain, which became dominant in Europe, and all reported sequences had G743A. Recently the Uvs Lake strain was reported in Nigeria for the first time, and it is likely that G743A will be reported in those sequences also.

Thus, the concurrent acquisition of G743A on multiple genetic backgrounds, and emergence on the dominant strain in Europe, parallels to emergence and spread of H274Y on H1N1 season flu. Neither polymorphism generated clear selection advantages in the avina or human hosts, but became fixed in the dominant clade in circulation, leading to dramatic spread.

These examples of genetic background jumping via homologous recombination are common, and the two examples above illustrate such acquisitions of single nucleotide polymorphism. This mechanism is the primary driver of influenza evolution and represents a paradigm shift.

These examples will be included in a keynote address to the drug discovery meeting in Beijing in the fall.
 

JPD

Inactive
New Flu Vaccine Fights Multiple Strains

http://www.newsmax.com/health/new_flu_vaccine/2008/08/22/124068.html?utm_medium=RSS

A universal vaccine effective against several strains of influenza has passed its first phase of testing, according to Dr. Christine Turley of the University of Texas at Galveston.

Turley, who is director of clinical trials and clinical research at the Sealy Center for Vaccine Development at UTMB and the study's principal investigator, said that VaxInnate's M2e universal vaccine could possibly protect against seasonal and pandemic influenza strains.

"We'd characterize this influenza vaccine candidate as very promising, based upon the immune responses and tolerability we saw in the clinical trial participants," Turley said. "UTMB is committed to further studies of the vaccine candidate, which has the potential to be a safe, highly effective and much-needed option to prevent seasonal and pandemic influenza A."

The results of the study will be presented at the Oct.25-28 joint meeting of the Interscience Conference on Agents and Chemotherapy and the Infectious Disease Society of America (ICAAC/IDSA).

The study was supported by a $9.5 million grant awarded to UTMB by the Bill & Melinda Gates Foundation.

The trial involved 60 young adults in a double-blind, dose-escalating, first time in human, Phase I study to assess the safety and immunogenicity, or the ability to produce a response in the immune system, of the vaccine.

The trial was also designed to evaluate the methods used by VaxInnate to develop and produce flu vaccines. The company uses a proprietary combination of toll-like receptor-mediated immune enhancement and recombinant bacterial production of vaccine antigen. This proprietary technology could significantly reduce the time required to produce vaccine supplies sufficient to meet national demand, and provide a solution to international influenza vaccine needs which are unmet in all but the developed world.
 
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