12/02-12/08/06 | Weekly Bird Flu Thread: Third Suspect H5N1 Cluster in Sohag Egypt

Link to last week's thread:

http://www.timebomb2000.com/vb/showthread.php?t=219826

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

Third Suspect H5N1 Cluster in Sohag Egypt Raises Concerns​

http://www.recombinomics.com/News/12010601/H5N1_Sohag_Cluster_3.html

Recombinomics Commentary
December 1, 2006

A woman and her two children are suspected of contracting the deadly H5N1 strain of bird flu in Upper Egypt, a veterinary official reportedly said.

The 25-year-old mother, her 12-year-old son and daughter, 10, from a village in Sohag governorate, were hospitalized after showing the first symptoms of the sickness, the province's veterinary services chief Mohammed al-Masri told the official MENA news agency.

They are currently undergoing tests to determine whether they are suffering from H5N1 which has killed seven people in Egypt this year, he added.

The above suspect H5N1 cluster is the third in Sohag, and raises pandemic concerns. H5N1 re-emerged in Egypt in September. H5N1 was confirmed in Sohag and Cairo areas. The confirmed positives in poultry was followed by a cluster involving a mother and son. The symptoms were described as "haemorrhagic disease".

A second cluster involved three siblings and a neighbor who were hospitalized on the same day. Two of the four suspect cases were unconscious at the time of admission and had pneumonia. The two clusters were followed by reports of a 25 year old Sohag women admitted a week ago. It is unclear if the 25F admitted last week is the same person described above. If there is only one 25F patient, then infection of the children by their mother is likely.

The three suspect clusters in Sohag increase pandemic concerns. Although the human clusters have not been confirmed, the reports of false negatives worldwide are frequent. Media reports have not provided updates on these patients or described a subsequent diagnosis for these cluster members.

The only confirmed case in Egypt this season was of a fatal infection (39F) near Cairo. The sequence of HA H5N1 from that patient has been released, and it has a number of changes from H5N1 isolated in Egypt earlier this year, although the isolate clearly has many of the Egyptian associated markers.

One of the changes was M230I. This polymorphism is in all three human influenza's (H3N2, H1N1, influenza B). Moreover, the change creates a five amino acid exact match with the receptor binding domain of influenza B for positions 226-230 (QSGRI). Influenza B is efficiently transmitted human-to-human. Moreover, recent released sequences of otter Qinghai isolates in the region identify S227N in an Egyptian patient, as well as N186K and Q196R in patients in Azerbaijan and Iraq. The newly release human H5N1 sequences contained two Azerbaijan isolates with N186K and two Iraq isolates with Q196R. The Iraq isolates are confusing because there were more human HA H5N1 Iraq sequences than confirmed cases in Iraq

Since there have now been four changes at positions in or near the receptor binding domain (N186K, Q196R, S227N, M230I) in human Qinghai isolates in the region, further recombination can bring these changes together in the same sequence. The recent Nature paper provided synergy data for Q196R and S227N, which were found in one clone from a patient in Vietnam. The presence of such changes in birds infected with Qinghai H5N1 is unclear, since these isolates are from chicken eggs, which would select away from changes that increase affinity for 2,6 gal (human) receptors.

An increase in affinity for human receptors would lead to more efficient spread of H5N1 which would initially present as familial clusters. Such clusters were reported in Turkey, where two of the four public sequences have S227N, and Azerbaijan, where two of the public human H5N1 sequences have N186K. Moreover, all of the human Qinghai isolates have the mammalian polymorphism, PB2 E627K.

Thus, although the three suspect cluster in Egypt have not been confirmed, the clustering of suspect clusters in Sohag increase concern.

Details on the current status of these patients, regardless of H5N1 results, would be useful.

Bird flu causes losses of up to $2b​

http://www.thejakartapost.com/detailbusiness.asp?fileid=20061202.M04&irec=3

The Jakarta Post, Jakarta

From September 2005 to September 2006, the world's poultry industry suffered approximately US$2 billion in losses due to the bird flu epidemic.

"The global poultry industry has suffered direct losses of $2 billion due to lower prices. This is equal to 14 percent of the total value of world trade," National Avian Influenza Control Commission chairman Bayu Krisnamurthi said Friday in Jakarta as quoted by Antara.

Apart from the direct financial losses, Bayu said, indirect losses had also been severe, including lower incomes for poultry breeders, lower poultry consumption and lower nutritional intake as a result of people's unwillingness to consume poultry products.

"The indirect losses are about 1.7 times the value of the direct losses, or about $3.4 billion," he estimated.

He said that in Indonesia alone, the poultry industry had suffered Rp 1.1 trillion in losses due to bird flu.

Furthermore, he said, the bird flu outbreak had also affected tourism.

"Because the tourism industry is highly dependent on public perceptions, erroneous perceptions about bird flu have resulted in people being nervous about visiting places where they think there is bird flu," he said.

The Hotel and Restaurant Association's head of international affairs, Ron Muller, said that the impact of bird flu could be seen in the drop in tourism earnings that had occurred since last year.

"Bird flu has had a big impact on the tourism industry. Our earnings have dropped by 40 percent. In Bali, they have actually dropped by 50 percent," said Muller, who is also the owner of the Papapizza chain.

Muller said that in order to minimize the adverse effects on tourism, his association had been campaigning to counter mistaken perceptions.

"This bird flu issue has affected many people, including businesses. Hopefully, with business involved in the campaign, we can all overcome the problem together," he said.

In Indonesia, the first cases of bird flu in fowl were detected in 2003 and the first cases in humans in 2005. Since July 2005, the bird flu virus has infected 74 people and resulted in the deaths of 57. The most recent victim, a 6-year-old child, died at the Adam Malik Hospital in Medan, North Sumatra, last month.

The country has become one of the front lines in the battle against the disease. No other nation has suffered from more deaths than Indonesia, where millions of chickens roam backyards freely.

According to the World Health Organization, bird flu remains essentially an animal disease, but it has infected more than 250 people worldwide since late 2003, killing more than 150, Reuters reported.

China promises speedy bird flu sample sharing​

http://www.alertnet.org/thenews/newsdesk/HKG156939.htm

HONG KONG, Dec 2 (Reuters) - China has promised the new head of the World Health Organisation that it will share bird flu samples more quickly, after worries Chinese secrecy was hampering understanding of the virus, Hong Kong papers said on Saturday.

Chinese bird flu expert Margaret Chan, who was elected in November as head of the WHO, has just finished a four-day visit to China where she met President Hu Jintao as well as Premier Wen Jiabao and Health Minister Gao Qiang.

"I can frankly tell you President Hu, Premier Wen and the Ministry of Health all understand the importance of making speedy announcements," the Standard quoted Chan as saying.

"China has already put in a lot of resources in improving its notification system for communicable diseases," she added.

Chan has vowed to speak out if countries, including China, failed to strengthen surveillance against dangerous diseases, including bird flu, or proved reluctant to share the virus samples needed to help develop vaccines.

Experts fear the H5N1 bird flu virus could kill millions of people if it were to mutate into a version that could spread efficiently among humans.

Last month, China agreed to share long-sought bird flu virus samples from 2004 and 2005 to support global efforts to prevent a flu pandemic. The WHO has said its understanding had been hampered by China's refusal to share bird flu samples.

China recently rejected findings in a paper published by Hong Kong and U.S. scientists that they had detected a new strain of H5N1 virus in the southern Chinese province of Fujian last year.

SKorean soldiers guard bird flu zones amid cull​

http://news.yahoo.com/s/afp/20061201/hl_afp/healthfluskorea



by Park Chan-Kyong Fri Dec 1, 4:41 AM ET

SEOUL (AFP) - South Korean soldiers have guarded quarantine zones around two poultry farms hit by bird flu, as officials started slaughtering hundreds of thousands of birds in an expanded cull.

A total of 236 soldiers wearing protective suits and goggles were deployed at 17 checkpoints near the farms on the outskirts of the southern city of Iksan, the first time the military has been called in to help in the crisis.

Some 155,000 birds, mostly chickens, have already been culled and buried. On Friday, about 180 government workers started killing 600,000 more on 35 farms within a three-kilometer (two-mile) radius of the outbreaks.

"The soldiers are deployed on roads leading to the farm to help control the movements of vehicles and people as the cull is underway in the area," the defence ministry said in a statement Friday.

"All the solders have had vaccine injections and swallowed Tamiflu," it said, referring to an oral anti-viral drug used for treating influenza.

Quarantine officials had originally begun culling poultry within 500 meters (546 yards) of the two sites of infection. More than 400 pigs and eight dogs were also killed.

But the agriculture ministry decided at an emergency meeting Thursday to slaughter all poultry within three kilometers after the potentially deadly H5N1 virus was detected at a second farm.

The ministry came under fire from animal rights activists for killing dogs and pigs.

But Kim Chang-Seob, the chief veterinary official at the ministry, defended the cull of the dogs and pigs as necessary to prevent the spread of the highly contagious disease.

"A total of eight dogs that were either kept on the two farms or others that had frequented the contaminated areas were slaughtered. No more dogs will be culled," he told AFP.

Angry Internet users flooded the homepages of the agriculture ministry, Iksan City Hall and the National Veterinary Research Service with messages after a rumor spread that hundreds of dogs and cats were being slaughtered recklessly in Iksan.

But South Korean authorities earned praise from abroad for their quick response to the outbreak.

"We are impressed by the quick action on the part of government of Korea," ambassador John Lange, the special US representative on avian and pandemic influenza, was quoted as telling Yonhap news agency.

North Korea is a concern because of its lack of transparency, he said.

"We have serious concerns about North Korea in this regard, and it is critical for any country having an outbreak that they quickly report it through internationally recognized mechanisms," Lange said.

"We urge that they take all measures to be transparent and share samples quickly."

There were reports of an outbreak in the North late last year, but Pyongyang officials at the time denied it.

South Korea was the first country to report avian flu when the latest outbreaks, the largest and most severe on record, began in Asia in mid-2003.

From December 2003 to March 2004, 5.3 million ducks and chickens were destroyed at a cost of 150 billion won (now 160 million US dollars). In December last year the nation had declared itself free of the virus.

H5N1, which is spread through contact with sick animals, has killed more than 150 people worldwide since late 2003 and triggered mass culls of tens of millions of poultry.

VACCINE LABS TAKE WING ​

Drug companies retool to fight bird flu threat​

http://www.sfgate.com/cgi-bin/artic...hive/2006/12/01/BUG7QMM8QR1.DTL&type=business

Bernadette Tansey, Chronicle Staff Writer

Friday, December 1, 2006

The dog kidney cells clinging to the side of a flask in Jonathan Liu's lab have a stubborn preference to stick together. It's Liu's job to coax them apart so he can prepare them to save millions of lives.

Cultures of cells like the ones Liu creates at a MedImmune Inc. research lab in Santa Clara may someday be the incubators of an innovative vaccine against deadly bird flu.

If the research at MedImmune and other companies goes well, drug companies would have a faster, more flexible method of making vaccines based on lab-cultivated cells, instead of the current method that uses potentially contaminated chicken eggs. That could help defend against a catastrophic wave of infection that the U.S. government fears could kill 2 million Americans and perhaps hundreds of millions of people worldwide.

To prepare for a possible pandemic, the U.S. Department of Health and Human Services handed out more than $1 billion in grants to MedImmune and four other companies in May. The grant winners are vying with each other to develop reliable ways to use cultures of cells, taken from dogs or other mammals, as biological factories to make flu vaccines.

The new method requires a thorough understanding of the quirks of a mammalian cell population artificially maintained in a bottle, Liu said. His cells survive better if they are near each other, exchanging complex chemical signals.

Researchers use an enzyme to separate cells from the thin layer they form on culture flask walls. The cells, suspended in a bath of nutrients in a larger vessel, become hosts for the growth of a modified virus that can be processed into a vaccine. But if the lab tries to scale up the vessel size too much to meet manufacturing goals, the cells can die.

"They are social animals,'' said Liu, director of cell culture development at MedImmune, based in Gaithersburg, Md.

Factory work

Federal money is accelerating the construction of cell culture plants in the United States that could crank out vaccines if the deadly avian flu virus, H5N1, mutates into a form that easily infects people.

MedImmune expects to complete the expansion of its factory in Frederick, Md., by 2009 or 2010. Novartis, the Swiss drug company that acquired Emeryville's Chiron this year, is building a cell culture plant in Holly Springs, N.C., that could be in full production by 2012. Some infectious disease specialists want to see the cell-based plants open much sooner.

Michael Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, said the government should put the cell culture program on overdrive. Given the latest news about avian flu, there isn't time for the normal pace of research, drug development, clinical trials and vaccine licensing, he said.

"We keep assuming we have this unlimited time,'' Osterholm said.

Osterholm points to research findings that the H5N1 virus is evolving into a wide array of strains as it spreads among migratory birds and poultry flocks. The bird virus has infected fewer than 300 people worldwide since 2003, but it has killed 59 percent of them. At some point, the genetic changes that produce new strains could allow the virus to spread quickly in the human population.

If a strain causes a pandemic within the next few years, nations would be relying on the limited capacity of existing vaccine factories that now make the annual flu shots given each year.

Both Novartis and MedImmune operate such plants near Liverpool, England. Their method, dating back about half a century, uses fertilized chicken eggs rather than cells to incubate the growth of viruses for vaccines. It takes months to line up supplies of eggs to begin making a new vaccine, and those supplies could be vulnerable if a pandemic strain were also killing the flocks of chickens that produce the eggs.

By contrast, cell cultures can be quickly expanded under carefully controlled conditions in smaller, less labor-intensive plants.

This method hasn't been approved by the Food and Drug Administration for production of flu vaccine. Among other things, the FDA wants to make sure that any vaccines produced this way don't include remnants of the cells themselves or their DNA. This is because the cell lines, which have been adapted for continuous growth, can cause tumors. The vaccine manufacturers use purification steps to eliminate such cell fragments.

Viral variants

Some of the egg-based plants have made stockpiles of experimental H5N1 vaccines for the U.S. government and other nations. But a panel of experts for the World Health Organization recently concluded that these vaccines don't seem to work well against the emerging new strains of bird flu.

The Department of Health and Human Services has just ordered additional vaccine stockpiles based on the newer strains of H5N1. But even those vaccines may not be fully effective against the viral strain that may eventually cause a pandemic. Factories might have to start from scratch to make a vaccine matched to the pandemic strain.

In a Nov. 13 pandemic planning report, HHS said its goal is to line up the manufacturing capacity to make enough vaccine for the entire U.S. population of 300 million within six months after the outbreak of a pandemic. The cell-based plants are needed to meet that goal, the agency said.

Osterholm said Americans should also be helping to ensure supplies of vaccine for the world population of 6.6 billion. For one thing, he said, plants in other countries supply a major portion of the other drugs used in the United States.

Dr. Thomas Monath, a former Army infectious disease specialist, said the government is wisely spreading out the grant money among a number of different manufacturers so that snags at one company won't hamper the whole cell culture program. Monath, a partner in the pandemic and biodefense fund at Kleiner Perkins Caufield & Byers, said the new plants could also be adapted to use future vaccine technology that might be even more effective.

MedImmune shares the field with big drug companies worth four to 18 times its market valuation of $7.9 billion. They include GlaxoSmithKline, Novartis, Solvay Pharmaceuticals and Baxter International. Sanofi Pasteur also received a U.S. vaccine development grant in 2005.

The competitors have made progress since May. MedImmune is ready to start clinical trials on a cell-based seasonal flu vaccine. It has also started to grow weakened versions of the H5N1 virus in cell culture at its research labs in Santa Clara and Mountain View.

In October, Baxter reported positive results from a small overseas trial of its cell-based H5N1 vaccine. It plans to begin U.S. testing by the end of the year.

Working to boost yield

Each of the companies is working on ways to improve manufacturing yields of vaccine and to make the drugs more potent. Novartis and other companies have developed additives that enhance the effectiveness of vaccines so that smaller doses might be used and vaccine supplies stretched to immunize a larger number of people.

Most companies making flu vaccines grow weakened versions of an influenza virus, either in eggs or in cell culture, and then inactivate them and break them apart. The vaccine shots are made from virus subunits, which arm the immune system against exposure to the same viruses in nature.

MedImmune's seasonal flu vaccine FluMist consists of a live form of the weakened virus that is inhaled into the nose. The dose causes a mild infection, confined to the nose, that spurs the immune system to create antibodies. Its H5N1 vaccine would be made the same way. The company says the method requires smaller doses than conventional vaccines and also seems to create better cross-protection against related strains.

Dr. George Kemble, MedImmune's vice president of vaccine research and development, said he doesn't worry when competitors announce favorable results on their cell culture programs or their experimental pandemic vaccines. The efforts of all the manufacturers, he said, will be needed to prepare for a bird flu pandemic and to respond if it occurs.

"All the companies realize that there's plenty of room for manufacturers to join in,'' Kemble said. "Good results propel all of us to be more optimistic and press ahead.''

BIRD FLU COOKS XMAS GOOSE​

http://www.dailyrecord.co.uk/news/t...objectid=18196079&siteid=66633-name_page.html

CHRISTMAS is coming and there could be fat chance of finding a Scottish goose this season.

Scotland's top geese farm have more than halved the number of birds they rear for the festive market because of fears over bird flu.

Highland Geese, based at the 400-acre Corranmor Farm in Ardfern in Argyll, have written to customers warning that there will be a shortage of geese this year.

Britain has seen just one case of the deadly H5N1 strain, in a dead swan found at Cellardyke in Fife in April.

But Scotland's goose producers have decided the risk of bird flu is too great, given that they face no compensation if they have to cull their birds, which are largely kept outdoors.

N186S and Q196R In Iraq H5N1 Patients​

http://www.recombinomics.com/News/12010602/H5N1_N186S_Q196R_Iraq.html

Recombinomics Commentary
December 1, 2006

Recently, human H5N1 sequences from patients in Iraq were released from the WHO private database of H5 sequences. The five sequences were generated by Weybridge and are listed below.

Recently, a paper in Nature described HA changes that enhanced binding to 2,6 gal receptors which are found in the upper respiratory tract of humans. Increases in affinity for these receptors are likely to lead to enhanced human-to-human transmission. The paper focused on changes in H5N1 human isolates from Vietnam and Thailand. Two of the changes, N186K and Q196R were said to be in human isolates from 1 case in Iraq and 2 cases in Azerbaijan. However, it was unclear if both changes were in isolates from the same individual(s), or separate individual(s).

The data could not be independently confirmed beyond WHO consulting scientists because the human sequences were not public. However, the recent release of human sequences from Iraq and Azerbaijan identifies these changes as being in separate cases.

However, N186S was present in the public human sequence from Iraq, but not in the goose or cat isolates. This change is also in all five additional human sequences from Iraq. In addition, two of the released sequences, A/Iraq/659/06 and A/Iraq/756/06, have Q196R. It is unclear if these two sequences, which are closely related to each other, are from the same individual.

Usually, multiple isolates from the same host isolated by the same lab have samples numbers in common. These two sequence numbers, 659 and 756, are distinct. The source of the five human sequences from Weybridge is also confusing because there are only three confirmed Iraq cases listed by WHO. None of the sequences from Weybridge have age or gender indications in the associated characterization sheet.

The characterization sheet associated with the human sequence isolated by US NAMRU3, A/human/Iraq/207-NAMRU3/2006, appears to be from the index case, because it is from a 15F. However, that sequence is distinct from the five sequences from Weybridge, including A/Iraq/1/2006. Two other human sequences from Weybridge, A/Iraq/754/06 and A/Iraq/755/206 are closely related to each other, but even if the two sets of closely related sequences are from the same individual, there would still be four distinct human sequences, while there are only three confirmed cases from Iraq.

Information on the relationship of the six human sequences from Iraq to the three confirmed cases in Iraq would be useful.

New Releases

ISDN140053 A/Iraq/1/2006 2006 H5N1
ISDN140059 A/Iraq/659/06 2006 H5N1
ISDN140060 A/Iraq/754/06 2006 H5N1
ISDN140052 A/Iraq/755/2006 2006 H5N1
ISDN140061 A/Iraq/756/06 2006 H5N1

Prior Releases

DQ435202 A/Iraq/207-NAMRU3/2006 2006 H5N1
DQ435200 A/domestic cat/Iraq/820/2006 2006 H5N1
DQ435201 A/domestic goose/Iraq/812/2006 2006 H5N1

N186K In Azerbaijan Patients​

http://www.recombinomics.com/News/12020601/H5N1_N186K_Azerbaijan.html

Recombinomics Commentary
December 2, 2006

Recently released human H5N1 sequences from Azerbaijan patients shed additional light on HA changes affecting the affinity of binding to 2,6 gal receptors, which are found in the human upper respiratory tract. Interest in such changes has been high, since an increased affinity is likely to lead to more efficient human-to-human transmission. The acquisition of one such change, S227N, was predicted because donor sequences were present in H9N2 in birds in the Middle East and Qinghai H5N1 migrated into the region in the fall of 2005.

S227N was present in the index case for the outbreak in Turkey as well as a second case in Turkey and a case in Egypt. A recent paper in Nature indicated S227N could synergize with another HA change, Q196R which was present patients from Iraq and or Azerbaijan. Moreover, another change that increased affinity for human receptor, N186K, was as present in these patients. However, these changes were not present in the public human sequences from these two countries and the description in the Nature paper was ambiguous. It was unclear if patients had one or both changes, and it was unclear which changes were in which patients. The only change in these positions in the public sequences was N186S in the index case for Iraq. Thus, only WHO consultants who could access the private database could confirm the statements in the Nature paper.

The release of five human H5N1 from Iraq clarified the distribution in Iraq. All six sequences had N186S and two had Q196R. The effect of N186S in receptor binding was not described in the Nature paper. However, this change is only in the human sequences from Iraq. It was not present in a goose or cat sequence from Iraq.

In addition to the five human sequences from Iraq, four additional human sequences from Azerbaijan were released. Those isolates are listed below. Two of the newly released sequences, A/Azerbaijan/001-161/2006 and A/Azerbaijan/011-162/2006 have N186K.

This newly released data are cause for concern. All of these isolates are in the Qinghai strain of H5N1, which has another mammalian polymorphism, PB2 E627K. Moreover, a recent isolate from a fatal case in Egypt has M230I. This is the first reported Qinghai H5N1 with this change. This change is found in all three circulating human HA's, H1N1, H3N2, and influenza B. Moreover, this change creates an identity between H5N1 and influenza B at positions 226-230 (QSGRI).

These changes in Qinghai isolates in a relatively small geographic region region are cause for concern. All of the isolates have PB2 E627K. S227N has been detected in Turkey and Egypt. N186K is in Azerbaijan, which is adjacent to Turkey and Iraq, while N186S and Q196R is in Iraq. Egypt has M230I, in addition to S227N.

Additional combinations are possible because all of these changes are in the Qinghai strain, which can lead to further recombination and acquisition of more than one change in the same host.

E627K has become fixed in in wild birds with Qinghai H5N1. Detection of the HA changes has been largely limited to human isolates, although N186S and M230I have been found in H5N1 in birds. Detection of these changes in birds may be low because of isolation procedures. Isolation of H5N1 from avian sources involves chicken eggs, which selects against these changes. Moreover, heterogeneity has been found in human isolates grown on mammalian MDCK cells. The patient from Vietnam who had both Q196R and S227N did not have either change in two of the three reported clones. Similarly N186K was in the first sequence deposited from the patient in Thailand, but was absent in the second sequence. In the examples from southeast Asia, the differential results were reported by the same lab, further highlighting the heterogeneity.

None of these changes have been reported in human H5N1 isolates from Indonesia, although clusters are common. However, the H5N1 from Indonesia is isolated in chicken eggs by Hong Kong and the CDC, which may limit detection of such changes.

H5N1 has already re-emerged in Egypt where M230I was detected. Moreover, there have now been reports of three suspected clusters in Sohag. Although these cluster have not been confirmed, the multiple, clusters in the same region where H5N1 has been detected in poultry remains a cause for concern. More information on the status of the patients, as well as additional sequence data from the region would be useful.

Newly Released
ISDN140057 A/Azerbaijan/001-161/2006(H5N1) H5N1 2006
ISDN140056 A/Azerbaijan/011-162/2006(H5N1) H5N1 2006
ISDN140058 A/Azerbaijan/002-115/2006(H5N1) H5N1 2006
ISDN140055 A/Azerbaijan/008-208/2006(H5N1) H5N1 2006

Previously Released
ISDN140054 A/Azerbaijan/006-207/2006(H5N1) H5N1 2006

On November 27, 2006, the Financial Services Sector Coordinating Council for Critical Infrastructure Protection and Homeland Security (FSSCC) announced[1] that reliance on “telecommunications due to the assumptions of high levels of ‘work-from-home’ during a pandemic is a major planning issue,” that needs to be addressed through cross-sector coordination.[1]

Formed in 2002, the FSSCC is a “group of more than 30 private-sector firms and financial trade associations that works to help reinforce the financial services sector's resilience against terrorist attacks and other threats to the nation's financial infrastructure.”[1]

The FSSCC “works with the Department of Treasury, which has direct responsibility for infrastructure protection and homeland security efforts for the financial services sector, while also serving under the overall guidance of the Department for Homeland Security.” The press release was issued from the FSSCC’s recently created Infectious Disease Forum. In the release the Forum reported working with the National Communications System (NCS) on a study which will refine models used to determine telecommunications needs during a pandemic. This study will yield a set of recommendations to resolve problems or gaps in telecommunications systems.[1]

In other financial news, on November 27 AFX News reported[2] that financial analysts believe a flu pandemic poses a greater risk to financial markets than does terrorism.[2] While analysts say that the risk of terrorism is “statistically significant,” the pandemic threat has “yet to be quantified,”[2] and its economic effects would be global and prolonged, possibly extending for months and having a more detrimental impact on the financial sector.

- Crystal Franco

References

Telecommunications' capacity to handle work-from-home traffic during pandemic questioned by financial sector planning group. FSSCC Press Release November 27. Available at: http://biz.yahoo.com/iw/061127/0188495.html. Accessed December 1, 2006.
Bird flu may pose greater risk to financial markets than terrorism – analysts. AFX News Limited November 27, 2006. Available at: http://www.forbes.com/markets/feeds/afx/2006/11/27/afx3205166.html. Accessed December 1, 2006.

Canadian Researchers Propose ICU Triage Protocol for Pandemic Flu​

In the November 21, 2006, issue of the Canadian Medical Association Journal (CMAJ), investigators propose a protocol for allocating scarce critical care medical treatment to patients during an influenza pandemic.[1] Development of the triage protocol was initiated in December 2004, “at the request of the steering committee of the Ontario Health Plan for an Influenza Pandemic (OHPIP)”. Following the OHPIP request, a “group of clinicians with expertise in critical care, infectious diseases, medical ethics, military medicine, and triage and disaster management” developed a prototype triage protocol which was incorporated in the Ontario Plan in 2005. In early 2006, the prototype protocol was revised in consultation with 55 “leading experts in a wide variety of relevant medical disciplines across Ontario.”

The protocol is based on the assumption that during times of scarce medical resources, the greatest number of patients can be served by implementing a strategy that equitably determines which patients should be admitted to an intensive care unit (ICU) by “triaging patients who will not benefit from treatment to non-critical care management, thereby conserving critical care resources for patients who are more likely to benefit.”[1] The researchers state that such a protocol will be essential since (1) a pandemic influenza outbreak alone would require more than double the current ICU bed and ventilator capacity than currently available for all ICU admissions, and (2) “international law requires a triage plan that will equitably provide every person the ‘opportunity’ to survive… [but] does not guarantee either treatment or survival.”[1]

The triage protocol is “intended to provide guidance for making decisions during the initial days to weeks of an influenza pandemic if the critical care system is overwhelmed.” The protocol uses four criteria to determine how patients would qualify for ICU admission:

Inclusion criteria: The first component identifies patients who may benefit from ICU care and who have a high probability of survival upon hospital discharge after treatment. This component includes influenza patients who require ventilator support, or patients who exhibit clinical evidence of shock and require treatment in an ICU setting.

Exclusion criteria: The second component includes a list of conditions that would rule out an ICU admission (e.g., 85 years of age, end-stage organ failure, metastatic cancer, severe trauma, or burns). The rationale for excluding these patients from the ICU is that they are likely to have a poor chance of survival with or without ICU care and would potentially tie up resources that could be used for patients who have a greater chance of recovery.

Minimal qualifications for survival: The third component is described as a monetary “ceiling” on ICU resources that could be expended on a patient; this ceiling would be reassessed for each patient at 48 hours and 120 hours after ICU admission.

Prioritization tool: The last and central component of the triage protocol establishes a 4-level triage code ranking system (blue, red, yellow, and green) that would prioritize a patient’s admission to the ICU. Patients’ medical conditions are assessed and ranked on admission to the hospital and then reassessed at 48 hours and 120 hours after hospital admission.

The four ranked levels of the prioritization tool are as follows:

Blue code: Patients in this category will not be admitted to the ICU, as they exceed the minimal requirements, do not meet the inclusion criteria, and/or meet the exclusion criteria. These patients are to be medically managed, provided palliative treatment, and/or discharged from the ICU.

Red code: Patients in this category have the highest priority for ICU resources. They are people who are “sick enough to require the resource and whose outcome will be poor if they do not receive it but are not so sick that they will not recover even if they do receive ICU care.”

Yellow code: Patients in this category will receive ICU care if available, but not at the expense of a “red” code patient, since they are deemed a less viable candidate for ICU care and recovery.

Green code: Patients in this category are deemed not ill enough to require ICU care.

A commentary on this triage protocol was presented within the same issue of CMAJ by Melnychuk and Kenny.[2] Although the commentary fundamentally supports the protocol, the authors noted two main issues that were not clearly addressed in the article. First, Melnychuk and Kenny believe the protocol will require public engagement and transparency to be effective because not everyone will receive equal care. Second, the protocol requires further detail about how the triage protocol values were determined, because these values will dictate the “formulation of policy and its implementation…why certain values are privileged and others are not.”[2]

- David Press and Jennifer Nuzzo

References

Christian MD, Hawryluck L, Wax RS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ 2006 Nov 21;175(11):1377-81. Available at http://www.cmaj.ca/cgi/content/full/175/11/1377. Accessed November 30, 2006.
Melnychuk RM and Kenny NP. Pandemic triage: the ethical challenge. CMAJ 2006 Nov 21;175(11):1393. Available at http://www.cmaj.ca/cgi/content/full/175/11/1393. Accessed November 30, 2006.

Experts Describe the Continuing Evolution of H5N1 Influenza​

In an article[1] published November 23, 2006, in the New England Journal of Medicine, authors Robert G. Webster and Elena A. Govorkova of St. Jude Children’s Research Hospital describe the continuing evolution of the highly pathogenic H5N1 avian influenza virus.[1] In an effort to emphasize the prudence of creating “robust plans” for managing a potential influenza pandemic in humans, the authors highlight critical characteristics of the highly pathogenic H5N1 strain that point to the need to prepare adequately.

Multiple H5N1 clades: The highly pathogenic strain of H5N1 occurs in multiple clades and subclades—differentiations which, according to the authors, may not only require preparation of multiple vaccines, but lead to varying sensitivities to anti-influenza drugs like adamantanes.[1] While all known clades appear to be sensitive to neuraminidase inhibitors, the inhibitors may be effective only for prophylaxis; studies tend to show that after the initial days of infection in humans, neuraminidase inhibitors are not effective in decreasing the viral load, and could instead promote the selection of resistant strains.[1]

Difficulty to diagnose with rapid tests: Citing an accompanying paper in the same issue of NEJM, the authors highlight the results of a study on a human outbreak in Turkey which indicated that H5N1 was difficult to detect using standard diagnostic techniques.[2] The more sensitive, but laboratory-intensive polymerase-chain-reaction assay had the best diagnostic value.[2]

Variability of success in controlling H5N1: Although quarantine and culling of domestic poultry have been effective in controlling avian H5N1 infections in wealthier countries like Japan, such methods have resulted “in only a temporary respite” in poorer regions.[1] Likewise, although poultry vaccines have worked successfully in some areas (such as Hong Kong), other areas (such as Vietnam) have seen H5N1 reemerge in waterfowl despite attempts to vaccinate all poultry.[1]

Waterfowl as H5N1 reservoir: Offering the example of China’s failed attempts to control H5N1 by vaccinating all poultry, the authors note that the lack of protection in waterfowl could be a major roadblock in eliminating the disease.[1] With ducks and other waterfowl as “stealth carriers” of the disease, more “draconian” surveillance and culling measures may be needed.[1]

Human genetic predisposition to H5N1 infection: To date, there have been relatively few human H5N1 infections in comparison with the millions of domestic birds that have been killed. The authors propose that H5N1 may not be well “fitted” to replicating in humans and that very few people have the H5N1 receptors in their respiratory tracts.[1] However, they also note that due to intermittent human infections and the virus’ constant evolution, increased compatibility with human transmission “may occur at any time.”[1]

Seasonal patterns similar to human influenza outbreaks: The H5N1 virus has been observed to follow the same seasonal patterns as other strains of human influenza: increased infectivity in the cooler months and decreased infectivity in the warmer months.[1] With winter approaching in the Northern Hemisphere, the authors question whether highly pathogenic H5N1 will spread to the Americas.[1]

- Allison Chamberlain


References

Webster RG, Govorkova EA. H5N1 influenza—continuing evolution and spread. New England Journal of Medicine. 355(21). p2174 – 2177. November 23, 2006. Available at: http://content.nejm.org/cgi/content/full/355/21/2174. Accessed November 30, 2006.
Oner AF, Bay A, et al. Avian influenza A (H5N1) infection in Eastern Turkey in 2006. New England Journal of Medicine. 355(21). p2179 – 2185. November 23, 2006. Available at: http://content.nejm.org/cgi/content/full/355/21/2179. Accessed November 30, 2006.

BRITAIN 'CLOSED OFF' IN KILLER FLU PLANS​

http://www.sundaymirror.co.uk/news/...objectid=18199455&siteid=62484-name_page.html

By Vincent Moss Political Editor

THOUSANDS of people will take part in a giant exercise next month to prepare Britain for a lethal bird flu outbreak - with parts of the country sealed off and patrolled by police.

Operation "Winter Willow" will involve all the emergency services, town hall officials and government ministers including Health Secretary Patricia Hewitt and Environment Secretary David Miliband.

Police will stop people entering the exclusion zones and emergency centres will be set up. Ministers are also considering allowing TV cameras to film the exercise to ease public fears.

The Government has drawn up the contingency plans amid concern that bird flu could mutate into a form which can be transmitted between humans. The exercise will take place in two stages, starting on January 30 and then February 19 and 20.

Government experts fear up to seven million Britons could die in a major outbreak. A senior minister said: "That is a worst case scenario. But we are overdue for a flu pandemic and when it arrives as many as one in four people could be affected."

Precautions could include closing public transport and masks being issued to millions of people. There have been 250 cases of bird flu in humans in Asia since 2003, plus suspected human cases in Somalia and South Korea.

More H5N1 Match Failures in Indonesia​

http://www.recombinomics.com/News/12020602/H5N1_Indonesia_Match_Not_2.html

Recombinomics Commentary
December 2, 2006

H5N1 sequences from the two most recent confirmed cases in Indonesia were released today. The most recent case (35F), from Tangerang, died November 28. The earlier case (2.5M) from Karawang died November 13. H5N1 was isolated from both patients on Nov 10 and 13 respectively. Although the WHO update indicated poultry had died in the Karawang neighborhood, the sequences from the two patient failed to match H5N1 from poultry.

The match failure is not a new development, but the two recent cases indicate that H5N1 continues to evolve in reservoirs that are not closely linked to most of the H5N1 from poultry. The first human H5N1 sequences was generated in July, 2005. It had the novel cleavage site RESRRKKR. All human H5N1 isolates from, the island of Java have had this cleavage site, except the second confirmed case, who was thought to have been infected by H5N1 in fertilizer in August, 2005. Thus, for well over a year, every human H5N1 isolate, including the sequences released today, have had the novel cleavage site.

In contrast, there has only been one bird isolate from Java that has had the cleavage site. It was from a duck in Indrmayu, but that isolate matched a small subset of human cases from the end of 2005. The duck isolate did not match human isolates from Indramayu, or any of the more recent human isolates.

The sequences from the most recent fatality is most closely related to H5N1 from a one year old girl from West Java who died in the spring of 2006 (A/Indonesia/CDC523/2006). The sequence of the 2 1/2 year old boy is closely related to more recent human H5N1 sequences, from the Jakarta are over the summer. Both sequences had some additional polymorphisms from Fujian isolates, as well as those in the Karo cluster indicating continued evolution via recombination.

However, these most recent sequences are most closely related to the other human sequences from Indonesia, which are readily distinguished from the poultry isolates.

Although the match failure is clear, WHO updates continue to mention dead poultry in the neighborhood of many cases even though the matching of a sequence from a bird with a nearby human case has never been demonstrated in Indonesia, even though the number of official deaths is at 57. Moreover, H5N1 testing is largely limited to patients who have some association with dead or dying poultry.

Thus far the only Java match with the H5N1 human sequences has been a cat isolate from Indramayu. Media reports have suggested additional H5N1 positive cats have been identified, but no sequences have been published other than the one cat sequence described above.

The continued match failures with poultry, couple with a lack of sequences from other H5N1 sources, remains a cause for concern.

Bird Flu Outbreak Plagues Korea​

http://theseoultimes.com/ST/?url=/ST/db/read.php?idx=4435

By Tom Pauken II
Associate Editor / Columnist

The bird flu has spread to the Korean Peninsula, infecting and killing about 10,000 fowl (chickens and ducks) in November, 2006. As of Sunday Nov. 26, 2006, South Korean officials culled 236,000 fowl in Iksan, North Jeolla Province, the southwestern region of Korea.

The Korean Central News Agency (KCNA) reported that authorities culled over 100,000 fowl in Hadang farm in Pyongyang, North Korea's capital city. Yet, neither countries reported cases of human infections.

The South and North Korean governments have taken dramatic steps to stem the spread of the bird flu, called the avian influenza by scientists. Nonetheless, the South Korean Agriculture Ministry announced on Saturday November, 25th that the chicken killed by the Avian Flu were infected by the H5N1 virus.

This illness is highly virulent and pathogenic with a mortality rate of 90-100% for fowl. H5N1 virus spreads mostly through chickens but humans can be infected with the possibility of being contagious.

Alarm bells have been ringing throughout the world. But some high-level South Korean government authorities expressed more concern for the financial welfare of poultry farmers than for the public at large.

On Sunday November 26th South Korean Prime Minister Han Myeong-sook and Agriculture Minister Park Hong-soo gathered in front of the local media to eat chicken soup. Even though if poultry is properly cooked nobody can be infected by it, they are sending the wrong message to their citizens.

What they are saying is that people should take the risk and continue eating chicken. They demanded all government cafeterias encourage people to eat chicken the day afterward. They launched a campaign to convince consumers that they must buy chicken to prevent sales from plummeting.

They've had some success. The large supermarket chains reported a slight drop in poultry purchases. Nevertheless, the same can't be said for their culling program.

They issued quarantine for five farms in the Iksan village with a 500m radius. Those chickens have all been slaughtered, as well as, six million eggs within a 3Km radius and restricted the movement of poultry in a 10Km radius.221 farms with 5 million head of fowl have been affected. This includes 300 pigs and 677 cats and dogs.

Yet a week after the government revealed the outbreak of the avian flu in Iksan it has spread northward to another village named Seoson. A pair of chicken and were infected by eggs from Iksan. They died and spread the virus more.

The process of culling chicken can be quick and effective but this doesn't guarantee a complete cure. 30 quarantine officials, national and local officials and staff from Halim, chicken meat processing firm adding up to 116 people herded chickens in a corner, covered them with a tarpaulin mat and suffocated them with carbon dioxide before burying them with lime in a 3m deep hole.

Seoul government plans to declare the region a special disaster zone and provide farmers millions of dollars in compensation. These actions are more adequate for dealing with the crisis.

The world fears a pandemic where avian influenza spreads from human to human, killing millions. They want to see governments establish preventative measures even if it adversely affects the economy. The world would dread seeing a government promote chicken consumption when the H5N1 virus spreads throughout their nation.

Certainly, people should not panic over the bird flu unless it's a crisis, but all should learn some basic information. A good website to click on is www.cdc.gov/flu/avian/. It is sponsored by the US Department of Health and Human Services Center for Disease Control and Prevention (CDC).

Not all types of bird flu are deadly but the H5N1 virus is. The symptoms are subtle in the beginning but progresses into an illness requiring hospitalization. The patient gets fever, cough, sore throat and muscle aches so few people report it. But the patient will then get an eye infection, pneumonia and face severe respiratory diseases. By that time many can't be cured.

Infected poultry spread the virus through their saliva and nasal secretions and feces. Farmers who care for them are at high risk so culling is necessary. Since 2003, 153 people were killed worldwide but most originate from the Asia-Pacific region with Vietnam suffering the most.

Fortunately, scientists proved that nobody could be infected by the bird flu if they eat poultry that's properly cooked. The US Department of Agriculture (USDA) and Food and Drug Administration give advice on how to avoid the H5N1 virus.

Wash your hands with soap and water for at least 20 seconds before and after handling raw poultry and eggs.

Clean cutting boards and other utensils with soap and hot water to keep poultry from contaminating other foods.

Use a food thermometer to make sure the cooking is at 75 degrees Celsius or 165 degrees Fahrenheit or more.

The scenes of men in white lab suits going to slaughter chickens are heart-rending for those farmers who dedicated their lives to raising them. They're forced to watch anonymous individuals hidden behind masks take away their means of financial support. It's as if one is watching a nightmare plot from a science-fiction film. But if the poultry were not culled then the results would be the same and worse.

H5N1 virus is highly virulent and would kill all of their chickens then spread throughout the land. So, culling is a difficult decision by the government but the right one.

Nonetheless, the South Korean government shouldn't promote chicken consumption until after the bird flu crisis ends. Not to do so is foolish and dangerous. It's quite possible that a pandemic might start just because the South Korean prime minister ate a bowl of chicken soup.

Bird flu fight needs extra $1.2-1.5 bln-World Bank​

http://today.reuters.com/News/CrisesArticle.aspx?storyId=L03934051&WTmodLoc=IntNewsHome_C4_Crises-9

By Alistair Thomson

DAKAR, Dec 4 (Reuters) - Global efforts to fight bird flu need $1.2-1.5 billion extra funding over the next two to three years, the World Bank said on Monday, advocating more effective compensation for poultry farmers caught in the front line. In a report prepared for distribution at a conference this week in the West African country of Mali, the Bank outlined funding needs over and above $1.9 billion pledged in January in Beijing, including an extra $466 million for Africa alone.

It said the extra costs were "a result of the rapid and sustained increase in animal and human outbreaks both within and across countries throughout Asia, Europe, the Middle East and Africa".

But it said the sums were a fraction of the potential $1.5-$2 trillion costs of a severe human influenza pandemic.

The Dec. 6-8 conference in Mali's capital Bamako will review existing programmes to contain bird flu and prepare for any human pandemic, and include a one-day donor conference to raise additional financing to fund them.

The report noted the highly pathogenic H5N1 bird flu strain had killed 76 people already this year, almost matching the death toll from the previous three years. The disease had spread to 55 countries, compared with just 16 at the end of 2005.

"The largest increases in needs are in Sub-Saharan Africa, the Middle East, and North Africa, which reflects both the spread of the disease to those regions and the relatively poor conditions of veterinary and public health services in most of the countries of those regions," it said.

Scientists fear the deadly virus could mutate into a version able to pass between people, triggering a global pandemic which could potentially kill tens of millions of people.



BETTER COMPENSATION, MONITORING NEEDED

Since 2003, avian influenza has killed or forced the culling of an estimated 250 million poultry birds, mainly in Asia, as veterinary officials have scrambled to control the disease.

A separate report, also compiled ahead of the Mali conference by the World Bank along with the U.N. Food and Agriculture Organisation and the International Food Policy Research Institute, urged more effective compensation programmes to ensure farmers whose birds get sick tell the authorities.

"Early identification of HPAI and the immediate culling of diseased or suspected animals are critical elements of reducing the risk of the disease spreading," said the report, whose lead author is Christopher Delgado of the World Bank's Agriculture and Rural Development Department.

"Payment of compensation to farmers whose animals are being culled enhances producer cooperation through better motivation to comply with the disease reporting and culling requirements of disease control packages," it said.

Compensation structure has been identified as a key item for discussion in Bamako.

The joint report recommended the international community be prepared to fund compensation in countries too poor to pay their own farmers, saying it was clearly in the interests of developed countries' own livestock industries to control disease.

It recommended poultry farmers affected by culls receive prompt payment of 75-90 percent of the value of the lost stock, to ensure farmers are prepared to notify authorities, together with strict oversight and controls on poultry movements to prevent farmers from outside a culling zone claiming cash.

"Experience suggests that compensation schemes are particularly susceptible to fraud, error and abuse," it said. (Additional reporting by Lesley Wroughton and Maggie Fox in Washington)

Bird-Flu Fight to Cost $750 Mln a Year, UN Envoy Says​

http://www.bloomberg.com/apps/news?pid=20601100&sid=a0FiaetQYBxY&refer=germany

(Update2)

By Vesna Poljak

Dec. 4 (Bloomberg) -- The global fight against bird flu needs as much as $750 million extra a year to stem its spread and prepare for any pandemic it spawns, the United Nations said.

Outbreaks of the lethal H5N1 avian flu virus, which is constantly changing and may mutate to be easily transmissible between humans, could spark the next flu pandemic, David Nabarro, the UN's pandemic-flu coordinator, said in an e-mail.

Between $500 million and $750 million a year is needed to fund efforts to monitor, manage and eradicate the virus and to bring animal and human health services to the standards sought by the World Organization for Animal Health and World Health Organization.

``Sustained financial provision will be necessary,'' Nabarro said. ``Humankind may have to live for years with the possibility that H5N1 will become the cause of the next influenza pandemic -- unless we develop the capacity to predict how this might happen and, better still, to neutralize it.''

Disease trackers, health officials and representatives from aid agencies will meet in Bamako, the capital of West African nation of Mali, this week to raise more funds and discuss ways to improve pandemic preparations.

The H5N1 virus is known to have infected 258 people in 10 countries, killing 154 of them, since 2003, according to the Geneva-based WHO. Millions could die if it becomes as contagious as seasonal flu.

More Pledges Sought

The international community will be asked to pledge between $1.31 billion and $1.58 billion in Bamako on Dec. 8 to fund activities for the next two to three years, Nabarro said. About a third of the extra financing is required in Africa, and UN agencies and partners need between $200 million and $300 million in 2007, he said.

In January, almost $1.9 billion was pledged by donors at a conference in Beijing. Since then, the H5N1 avian influenza virus has infected animals in 38 new countries, resulting in human cases in four nations.

``The virus has spread further, and now has appeared in 55 countries on every continent of the eastern hemisphere, killing an estimated 250 million poultry, and highlighting the increasing challenge in controlling the virus and the urgency to act immediately to prevent further spreading of the disease,'' the World Bank said in a draft report dated Nov. 30.

The largest increases in needs are in Sub-Saharan Africa, the Middle East and North Africa, the Washington-based organization said. The H5N1 virus was found in poultry in Nigeria in February, and was later found in Niger, Egypt, Cameroon, Burkina Faso, Ivory Coast and Djibouti.

Africa's Needs

``The African continent is much weaker economically and less structurally able to respond to the avian and human influenza threat, so effective implementation of integrated country programs will require significant grant funding,'' the World Bank said.

At least $200 million will be needed annually to address poultry outbreaks in Indonesia and to prevent a further spread to other countries in the region and beyond, and to reduce the risk of a human pandemic, it said.

More than half the 76 fatalities recorded this year have occurred in Indonesia, where the virus is reported to have killed about one person a month since January. H5N1 has been found in 30 of Indonesia's 33 provinces. The country needs assistance to speed poultry vaccination and to help fund compensation programs for farmers whose poultry were culled, the government's committee on avian and pandemic flu said in August.

``Compensation programs work best when you have them in place before disease breaks out, which can be difficult to do in poor countries where the extra finances and the expertise needed for fair and rapid payments to farmers and other poultry owners may be in short supply,'' Chris Delgado, a World Bank adviser on rural development, said in an e-mail.

Pandemic Virus

A pandemic can start when a novel influenza A-type virus, to which almost no one has natural immunity, emerges and begins spreading. Experts believe that a pandemic in 1918, which may have killed as many as 50 million people, began when an avian flu virus jumped to people from birds.

A severe pandemic, similar to the one in 1918, may cause global economic losses of as much as $1.8 trillion, according to World Bank estimates.

US CDC contracts for new, faster bird flu tests​

http://today.reuters.com/News/CrisesArticle.aspx?storyId=N04197221

Mon 4 Dec 2006 3:47 PM ET

By Maggie Fox, Health and Science Editor

WASHINGTON, Dec 4 (Reuters) - The U.S. Centers for Disease Control and Prevention said on Monday it had awarded $11.4 million for developing new, quick tests for influenza to four U.S. companies.

The idea is to come up with reliable, on-the-spot tests for H5N1 avian influenza, the CDC said in a statement.

Current quick tests can tell if a person is infected with influenza A or B, but they do not identify the strain and reports suggest the tests miss influenza in patients infected with H5N1.

The companies are: Sunnyvale, California based Cepheid <CPHD.O>, which got $2.4 million; San Diego-based Nanogen <NGEN.O>, which won $4.5 million; Marlborough, Massachusetts-based Iquum, which got $3.8 million and Gaithersburg, Maryland-based MesoScale, which won $706,000, the CDC said in a statement.

"The tests could provide public health experts worldwide with critical information on the influenza viruses circulating and help monitor for viruses that could cause a global influenza pandemic," the CDC said.

"During the next year, the four companies will work to create tests that would detect seasonal human influenza viruses and differentiate influenza A H5N1 from seasonal human influenza viruses within 30 minutes."

"Because influenza viruses are constantly changing, the tests would also need to be quickly adapted if the virus mutates over time or if new viruses emerge that have the potential to cause a pandemic."

The CDC said it hoped to help the companies win Food and Drug Administration approval within two to three years.

"We have seen avian influenza infections since 1997 but we unfortunately still do not have a good way to quickly and easily distinguish at a patient's bedside whether they suffer from H5N1 or a more common type of influenza," said CDC Director Dr. Julie Gerberding.

"These contracts will support development of promising technology that could help doctors treat their patients faster and help public health authorities track influenza viruses that could spur a pandemic."

Currently, to test for H5N1, samples from the patient must be sent a specialized testing lab, which can sometimes take more than a week. This would be too slow to stop the spread of a pandemic, experts say.

While the H5N1 avian flu virus mostly affects birds, it has infected 258 people and killed 154. Experts say it could evolve into a pandemic strain that infects people easily if it acquires the ability to pass easily from one person to another.

Zanzibar destroys imported chickens to prevent bird flu​

http://english.people.com.cn/200612/05/eng20061205_328625.html

The Indian Ocean archipelago of Zanzibar has incinerated 40 imported chickens in its continued bid to prevent the spread of bird flu.

Local English newspaper The Guardian on Tuesday quoted Kassim Gharib from the Zanzibar Bird Flu Task Force as confirming that the chickens had been imported from mainland Tanzania.

But the government official said that the business people who imported the chickens had escaped arrest.

To prevent bird flu from invading the isles, Zanzibar has imposed last year an indefinite ban on importing poultry and poultry products.

The isles have confiscated and destroyed hundreds of chickens and eggs smuggled into Zanzibar.

"Since bird flu has not been controlled in many countries, the ban of poultry products from outside Zanzibar remains," said Gharib.

Bird flu, that originated in Asia, has been found in several countries in Africa.

Source: Xinhua

Bird flu search called off course​

http://www.adn.com/life/health/birdflu/story/8468132p-8362083c.html

RESEARCH: A study said infected birds most likely will enter the U.S. by Latin America.

By LIBBY QUAID
The Associated Press

Published: December 5, 2006
Last Modified: December 5, 2006 at 01:49 AM

WASHINGTON -- Birds from Latin America -- not from the north -- are most likely to bring deadly bird flu to the main United States, researchers said Monday, suggesting the government might miss the H5N1 virus because biologists have been looking in the wrong direction.

The United States' $29 million bird flu surveillance program has focused heavily on migratory birds flying from Asia to Alaska, where researchers this year collected tens of thousands of samples from wild birds nesting on frozen tundra before making their way south.

Those birds present a much lower risk than migratory birds that make their way north from South America through Central America and Mexico, where controls on imported poultry are not as tough as in the United States and Canada, according to findings in the latest Proceedings of the National Academy of Sciences.

Nations south of the United States import hundreds of thousands of chickens a year from countries where bird flu has turned up in migratory birds or poultry, said A. Marm Kilpatrick, lead author of the study.

"The risk is actually higher from the poultry trade to the Americas than from migratory birds," said Kilpatrick, of the Consortium for Conservation Medicine in New York. Other researchers on the study came from the Smithsonian Institution.

If bird flu arrives in Mexico or somewhere farther south, it could be only a short time before a migratory bird carries the virus to the United States, Kilpatrick said.

"It's not just a matter of worrying about who you trade with, but it's a matter of thinking about who do your neighbors trade with, and who do your trading partners trade with," Kilpatrick said. "We need to be looking both south and north."

The study concluded that "current American surveillance plans that focus primarily on the Alaska migratory bird pathway may fail to detect the introduction of H5N1 into the United States in time to prevent its spread into domestic poultry."

The report is the first to match the DNA fingerprint of the H5N1 virus in different countries with data on the movement of migratory birds and commercial poultry in those countries.

The analysis helped to determine, for example, that the outbreak of bird flu in Turkey likely didn't come from poultry imports from Thailand, as previously thought. Instead, the probable source was migratory birds in Russia, where the virus had similar DNA to the virus in Turkey.

The study found that:

• Bird flu was spread through Asia by the poultry trade.

• Most of the spread throughout Europe was from migratory birds.

• Bird flu spread into Africa from migratory birds as well as poultry trade.

U.S. officials cautioned that the study is not the final authority on the spread and prevention of bird flu.

"When you look at scientific literature, it's a big puzzle. This puts in a few more pieces," said David Swayne, director of the Agriculture Department's Southeast Poultry Research Laboratory in Athens, Ga.

Swayne cautioned that researchers looked only at countries' import restrictions through 2005.

Agriculture Department officials said they are not focusing exclusively on Alaska.

More resources have been spent in Alaska than in other states so far, but testing is happening throughout the lower 48, and the United States is even helping Mexico do surveillance, said Tom DeLiberto, the department's National Wildlife Disease Coordinator.

"We have more information now than we did when we designed the surveillance effort last fall," DeLiberto said. "We know as we get more information, we'll adapt our system."

Since the deadly H5N1 virus emerged in Hong Kong in 1996, at least 154 people have died and hundreds of millions of chickens, ducks, geese and turkeys have died or been killed to keep it from spreading.

So far, the virus has killed mostly people who had close contact with sick birds or their droppings, but scientists fear the virus could someday mutate into a form that spreads easily among people.

INDONESIA will start clearing residential areas
of chickens and ducks​

http://www.poultryindonesia.com/modules.php?name=News&file=article&sid=1149

INDONESIA will start clearing residential areas of chickens and ducks as part of its fight against bird flu, government officials said, acknowledging it would be a monumental and difficult task.

“It’s a measure we have to take to be free from bird flu,” Health Minister Siti Fadilah Supari said following a government meeting on the H5N1 virus that has killed 55 people across Indonesia, the most in the world.

No timeframe was given for the plan, which will almost certainly face resistance in a nation that has hundreds of millions of backyard birds, many of them in towns and cities.

Agriculture Minister Anton Apriyantono said the measure would be implemented systematically.

“We will start by demanding that poultry be kept in cages in urban areas,” he said.

The National Bird Flu Commission said that the number of provinces where the virus is endemic had been reduced from 30 to 16 over the past six months, but that the number of deaths is still expected to rise.

Aburizal Bakrie, welfare minister and commission chairman, said the government would spend an additional 100 billion rupiah (US$11 million) to more than double the number of hospitals offering bird flu treatment facilities to 100 nationwide.

Nigeria's bird flu status still uncertain despite 4-month gap since last known case​

http://www.iht.com/articles/ap/2006/12/05/africa/AF_GEN_Nigeria_Bird_Flu.php

The Associated Press
Published: December 5, 2006

JAJI, Nigeria: The farm in northern Nigeria where Africa's first case of a deadly bird flu strain was discovered has replaced its slaughtered fowl, and chicken has started to return to local menus after four months without a report of the virus.

But as experts from around the world gather in the West African country of Mali for a conference on the ongoing battle against the avian infection, the status of bird flu remains uncertain in Nigeria and throughout the continent.

Health experts say insufficient surveillance means they don't really know the true level of bird flu. The two-day conference that opens Wednesday in Mali, and follows similar international meetings in China and Austria, will focus on preparedness as the next bird flu season approaches, including marshaling financial and other resources to fight a disease experts fear could transform into a human pandemic.

At the last official count, the H5N1 strain had been confirmed in 14 of Nigeria's 36 states.
Today in Africa & Middle East

The 46,000 chickens slaughtered at Sambawa Farms, where H5N1 was first detected in Africa in January, have been replaced by 50,000 new birds, said farm manager Muhammadu Sambawa.

Cases of bird flu were later reported in neighboring Niger and Cameroon and farther afield in Ivory Coast, Burkina Faso, Egypt and Sudan.

An international effort is behind a surveillance project due to start by January, said Timothy Obi, head of the UN Food and Agriculture Organization's bird flu team in Nigeria.

FAO has trained 600 animal health technicians and they have been provided with laboratory equipment and protective clothing. They will be sent to Nigeria's 36 states to test for H5N1 in commercial farms and at homes where poultry is raised and help set up a reporting system for bird deaths, according to Junaid Maina, Nigeria's head of livestock and pest control.

The EU has provided more than US$200,000 (more than €150,000), and some additional funding will be provided by the Nigerian government.

Across West Africa, FAO is providing funding and working with the African Union to set up a network of bird flu laboratories and surveillance, encouraging countries to exchange information and personnel. Officials say the new scheme for Nigeria is only an intensification of this effort in the worst hit country.

By September when the last known case of the virus was found in poultry in a farm near Nigeria's biggest city of Lagos, 915,650 birds had been slaughtered nationwide by government veterinary teams under a scheme in which the owners were promised compensation.

The scheme was suspended in July after it ran out of funds. Many backyard poultry farmers, estimated by FAO to keep 60 percent of Nigeria's 140 million poultry, complain they were shut out of the compensation process in favor of the large, commercial farms.

Often keeping their birds at home, close to people and other domestic animals, they and their families appear to be at greater risk of catching the virus from birds and bringing the world closer to the dreaded jump that could create a strain of the virus communicable between humans.

So far they appear to be the ones with the least access to any form of support to deal with the impact of bird flu.

Official rules require that poultry deaths be formally reported and slaughter carried out by government veterinary teams before a farmer can qualify for compensation. But most of the poor and illiterate farmers lack the ability to file the type of official reports required.

Many veterinary officials fear widespread dissatisfaction with the compensation system is keeping farmers from reporting bird deaths, making tracking of the virus more difficult.

The government sees the new surveillance project as an opportunity to assess what is needed and better address the shortcomings of current efforts, according to Maina, head of Nigeria's livestock department.

At Birnin Yero Gari, a small rural village that lies next to Sambawa Farms on gently sloping brush, villagers recount what they consider the government's failings.

Every family in the village of about 2,000 people lost an average of 10 birds each to bird flu, which they believe came from the nearby big, commercial farm, but got no compensation, said 55-year-old village shopkeeper, Mohammed Shuaibu.

"Government officials came here, took blood samples from our birds and from people, but we never saw them again," Shuaibu said. "They don't care for us."

The village is shrouded in a mist of dust and a cold, dry wind blew southwards from the Sahara. Some of the villagers recalled it was the time of the year when chicken plagues strike.

One of them, 26-year-old Lawal Shittu, said he bought a cock from a market a few weeks ago and days later it sickened and died. His other fowls also started sickening and dying one after another, making him fear the disease had returned.

"It also affected some neighbors' chickens, but it hasn't spread like the last time," Shittu said.

Those deaths, the villagers said, were not reported to the authorities.

Cepheid Gets Bird Flu Test CDC Contract ​

http://www.chron.com/disp/story.mpl/ap/fn/4380156.html

SUNNYVALE, Calif. — Genetic analysis systems maker Cepheid said Tuesday it received a $14.9 million contract from the Centers for Disease Control and Prevention to develop a quick test for bird flu and other types of influenza.

Cepheid said it already received a $2.4 million payment Friday to start the first two parts of a five phase program.

The test, which is part of a government plan for pandemic preparedness, will be developed over 30 months and seeks to be a fully automated, self-contained diagnostic that does not require special training to use.

Global Conference to Focus on Avian and Pandemic Influenza December 6-8​

http://www.state.gov/r/pa/prs/ps/2006/77362.htm

Countries from around the globe as well as senior representatives of the United Nations and other international and regional organizations will come together in Africa December 6-8 to assess programs to counter the threat of avian and pandemic influenza and to boost financial support for preparedness and response efforts worldwide.

The conference, held in Bamako, Mali, will increase help for countries faced by the potential severe social and economic consequences of this human and animal health threat. It will be hosted by the African Union and the Government of Mali in conjunction with the European Union.

This conference will provide an update on outbreaks of the virus across the world and the risks of transmission it poses. It will also review preparedness and response efforts and achievements since the last pledging conference in Beijing in January 2006 and the June 2006 Vienna Senior Officials Meeting of the International Partnership on Avian and Pandemic Influenza, an initiative launched by President George W. Bush in September 2005. The first meeting of the International Partnership was held in Washington, D.C. in October 2005.

Health ministers, agriculture ministers, other officials, and technical experts will discuss vaccination and communication strategies, as well as means of compensating losses of poultry raisers who destroyed their flocks to contain the spread of the virus. The status of assistance pledges will be assessed, new pledges outlined, and strategies and priorities for the future presented.

The U.S. delegation will be headed by Ambassador John E. Lange, Special Representative on Avian and Pandemic Influenza, U.S. Department of State. The U.S. delegation will include Dr. Kent Hill, Assistant Administrator for Global Health, U.S. Agency for International Development; Dr. Ron DeHaven, Administrator of the Animal and Plant Health Inspection Service, Department of Agriculture; and Dr. David Bell, Coordinator of the International Influenza Unit, Department of Health and Human Services. All of these departments and agencies have significant roles in the U.S. international engagement against the disease.

For further information on the U.S. international engagement on avian influenza, see www.state.gov/g/oes/avianflu and www.pandemicflu.gov.

U.N.: bird flu virus still a powerful threat, vulnerable
regions include Africa and eastern Europe​

http://www.iht.com/articles/ap/2006/12/06/europe/EU_GEN_UN_Bird_Flu.php

The Associated Press
Published: December 6, 2006

ROME: The H5N1 bird flu virus remains a powerful threat to animals and humans, and the most vulnerable regions include southeast Asia, Africa, eastern Europe and the Caucasus, the U.N. food agency said Wednesday.

"The possibility of a human pandemic hangs over us," the U.N. Food and Agriculture Organization warned in a statement to be read at Thursday's donor conference in Bamako, Mali.

"Failure by any one country to contain the disease could lead to rapid re-infection in many more countries," said Alexander Muller, assistant director-general at FAO. "One weak link can lead to a domino effect, undoing all the good that we have achieved so far. Now is no time for complacency."

Several regions remain particularly vulnerable because of a shortfall in donor funding, the Rome-based agency said. However, the agency said its investment in national and regional plans to prepare for a possible outbreak is paying off in unaffected parts of the world like Latin America and the Caribbean.

The agency also stressed the need for greater transparency and the sharing of information, especially regarding virus strains.

Since the virus first began ravaging Asia's poultry in late 2003, the H5N1 strain has spread to Europe, the Middle East and Africa and killed at least 154 people around the world, according to the World Health Organization. Fears remain high the virus could mutate into a form that would spark a human flu pandemic.

INTERVIEW-Bird flu steps to boost Africa
animal, human health​

http://today.reuters.co.uk/news/CrisesArticle.aspx?storyId=L06477724&WTmodLoc=World-R5-Alertnet-5

Wed 6 Dec 2006 8:47:00 GMT

By Alistair Thomson

BAMAKO, Dec 6 (Reuters) - International aid to help Africa fight off bird flu should give a shot in the arm to public health and veterinary services and help the continent tackle its many other health scourges, the U.N. bird flu coordinator said.

"This continent is affected by quite a number of development and humanitarian challenges, some of which are very well known, including malaria and HIV," David Nabarro said ahead of a global summit on bird flu in Mali, West Africa, starting on Wednesday.

"I think African heads of state would be forgiven for saying 'Well, thanks for coming and telling us about this challenge -- we will add it to our list'," Nabarro said.

The summit, which will include a donor conference on Friday to raise more than $1 billion in new funds to fight the disease over the next two to three years, will review progress around the world, including Asia, hardest-hit by the deadly H5N1 virus.

Much of the new money is destined for Africa, which has seen eight countries infected since the last donor conference in Beijing in January.

Experts will discuss how best to monitor and control the disease given weak human and animal health systems on the world's poorest continent.

"Human public health will be improved, which is the health of populations. Yes, I'd like to see hospitals improved, but in the long term what matters is that the health of the wider public gets systematic attention," Nabarro said.

"That may include hospital beds, but it may also include other services provided by surveillance teams and response teams, so yes, there is a capacity for human public health to improve greatly," he said.

Nabarro acknowledged there were few resources available for healthcare in Africa, but said progress was possible with the resources that were available.

"There has been really big investment in this continent on polio surveillance. Why can't we piggy-back influenza surveillance on the back of that?" he said.



CLEANING UP

Since the outbreak began in Asia in 2003, the H5N1 virus has infected at least 258 people who came into contact with sick birds, killing 154 of them, according to World Health Organisation records.

Scientists' greatest fear is that the virus will mutate into a form able to pass from human to human, triggering off a global flu pandemic killing tens of millions of people.

They say that risk can be cut by reducing contact with sick birds by selling and slaughtering poultry more carefully.

"Go to a poultry farm in Thailand these days and it's like going into an operating theatre in a hospital," Nabarro said. "Go to a market ... and the slaughter is carried out under controlled conditions, subject to inspections."

But Thailand and its hygiene rules are a long way from Bamako, the venue for this week's meeting.

Here in the city's open air Dibida market, chickens are slaughtered, plucked and dismembered by workers using no protective clothing within a couple of feet of cages packed with live hens, guinea fowl and other birds waiting to be sold.

"Any effort to prepare globally for a possible pandemic cannot afford to neglect the needs of the animal health sector, and crisis preparedness, in Africa," Nabarro said.

When to use bird flu vaccine a "tricky issue"​

http://www.alertnet.org/thenews/newsdesk/BKK289105.htm

By Darren Schuettler BANGKOK, Dec 6 (Reuters) - A vaccine against the killer H5N1 bird flu virus could be licensed for human use in a year, but when to use it is becoming a "tricky issue", a senior World Health Organisation official said on Wednesday.

Drug companies are racing to find a cure for the avian influenza virus which has killed 154 people since 2003 and fanned fears of a global human pandemic. At least a dozen manufacturers have clinical trials underway or planned. "We can expect that a year from now there would be vaccines against H5N1 influenza strains that would be licensed for human use," Marie-Paule Kieny, head of the WHO's Initiative for Vaccine Research, told reporters on the final day of a WHO vaccine conference in Bangkok.

Health experts say vaccines work well when they match the circulating strain of flu.

The H5N1 strain has not evolved yet into a form that passes easily between humans, but studies suggest some vaccines might help protect people from death if a pandemic strain does emerge.

Several countries have ordered or are negotiating to stockpile pre-pandemic H5N1 vaccines, which some experts recommend to immunise health care workers, firefighters and other essential staff before a pandemic breaks out.

David Salisbury, director of immunisation at Britain's Department of Health, told the conference it would take 4-6 months for the first vaccine doses to emerge from factories, and up to a year to produce enough for the recommended two doses.

"During this time, at least the first pandemic wave will be over, and the second and third waves, should they occur, may also be over before significant numbers of individuals can be vaccinated," he said.

Salisbury said some data on vaccines had shown that "even if poorly matched against the pandemic strain, they may play a valuable role in minimising disease, reducing transmission and even aborting a pandemic".

PRODUCTION PROBLEMS

Kieny said the WHO did not yet have an official position on pre-pandemic vaccination, which she called a "tricky issue".

"We need to take into consideration that immunising part of your population, especially groups on the front line to combat the pandemic, might be a good benefit," she said.

"But you have to weigh that against the risk of immunising against a pandemic that is not there," she said, referring to the 1976 swine flu scare in the United States.

That year, millions of Americans were vaccinated against swine flu after an outbreak at a U.S army base triggered fears of a wider pandemic. It never occurred and the vaccine was blamed for a rise in cases of a rare neurological illness. WHO officials said several projects were now underway to boost production capacity for vaccines to protect against bird flu and other viruses with pandemic potential.

The U.N. health agency launched a plan in October to increase global flu vaccine capacity, which is expected to rise to 780 million doses by 2009 under current expansion plans, still far short of what would be needed to fight a global pandemic.

The strategy calls on governments to increase normal flu vaccination campaigns to encourage companies to raise capacity.

Drug makers could also be paid to keep capacity idle for pandemic vaccines. It also urges study of more potent vaccines to reduce the number of recommended doses to one from two.

The plan could cost $3-$10 billion over the next decade.

"None of these strategies will be able to fill the gap in the immediate short term but, starting now, first results may be seen in three to five years," the WHO's Alejandro Costa said.

Bird flu virus 'still smoldering,' U.S. expert says​

http://www.cnn.com/2006/HEALTH/12/06/bird.flu/index.html

By Caleb Hellerman
CNN
Adjust font size:
Decrease fontDecrease font
Enlarge fontEnlarge font

A year ago, headlines were screaming about a looming disaster: the rapid spread of bird flu across two-thirds of the globe. The H5N1 strain of the virus was killing more than half its human victims. Experts were urging the government to stockpile medicine and experimental vaccines.

Dr. Robert Webster, whose vaccine the U.S. government plans to use in case of an outbreak, told CNN at the time, "If this virus learns to transmit human to human and maintains that level of killing, we've got a global catastrophe."

That worldwide pandemic hasn't yet materialized, and bird flu has been out of the headlines for a while. But we may be in for another round of news.

Last week South Korea announced two new outbreaks in poultry. And Dr. Timothy Uyeki of the U.S. Centers for Disease Control and Prevention said he's bracing for another surge in human infections. "When the temperature drops and the humidity drops, that's when you start seeing more poultry outbreaks. And when you see poultry outbreaks, that's when you see human cases."

"It's still smoldering," said Dr. Anthony Fauci, who heads U.S. scientific efforts to combat bird flu. "What it hasn't done, much to our relief, is to become more virulent or better able to transmit from person to person."
New research

Three recent papers in the New England Journal of Medicine illustrate serious roadblocks to understanding and controlling the virus. The first describes three clusters of cases within families in Indonesia, eight patients in all. In two of the clusters, the authors said it's quite possible one person caught the disease, then passed it to family members.

One of those families was profiled in "Killer Flu," a CNN program last December. Rini Dina, a 37-year-old woman in a Jakarta suburb, died of an H5N1 infection, and her 8-year-old nephew, Firdaus, was hospitalized with fever for 10 days. Indonesian health officials said Rini was probably infected by tainted fertilizer in her garden. Firdaus had no direct contact with birds or the garden, but cuddled with his aunt on a couch while she lay shivering with fever. According to medical detectives, that's probably how he got sick.

"We can't prove it, but it probably happened," said Dr. Uyeki, who helped an Indonesian team with the investigations. Worldwide, about a third of all cases involve family clusters and there are a handful of cases where the virus likely passed from person to person, he said.

As a clinician, Uyeki has also helped to examine bird flu patients in Indonesia and Vietnam, the only U.S. doctor to do so. As the virus evolves, he said, its symptoms are evolving as well. "The clinical features in 1997 were different than what they are now. We're seeing less diarrhea, and in Indonesia, it's been much more fatal." Other, more common symptoms are hard to distinguish from other infections -- fever, aches and coughing, and shortness of breath and pneumonia as the illness progresses.

Simply making a diagnosis can be difficult. A second NEJM paper describes eight human patients in Turkey, all of whom initially tested negative for H5N1. The first samples were taken by swabbing the patients' nasal passages. That's standard for most influenza tests, but Uyeki says the H5N1 virus embeds itself deeper in the throat and lungs.

In Turkey, all the patients had been in contact with sick birds, so doctors were looking for H5N1. But in less-suspicious cases, a delay could be fatal. The only known treatment is the drug oseltamivir, sold as Tamiflu. While data are scarce because of the small number of human cases, most experts believe Tamiflu can lessen the symptoms of bird flu -- as it does with typical influenza - but only if taken in the first two days after symptoms appear.

In a commentary published with the two articles, Webster and another prominent flu expert said efforts to eradicate the virus, through killing infected chicken flocks or by vaccinating poultry, have largely failed. Worse, they said, many vaccines used in Asia are of poor quality and are pushing the virus to mutate faster, in potentially more dangerous directions.

So far, H5N1 hasn't gained the ability to easily infect humans, but eyebrows went up during an outbreak in May, on the Indonesian island of Sumatra. Bird flu infected eight people in a single family, killing seven of them. The World Health Organization concluded the illness had spread among the victims, but said genetic testing did not show major changes in the virus. Fauci said the H5N1 virus is indeed "a moving target," but that the existing vaccine provides at least some protection against the different strains. Work on more advanced vaccines is ongoing, he said. "Our capability is getting better and better, but it's not going to happen overnight."

"It's been a really rare human disease to date," Uyeki cautions, but "who can predict what's going to happen? We better continue to monitor and plan. To ignore this would be insane."

In a single year, bird flu caused $5.4 billion in economic losses to global economy

(NewsTarget) The bird flu has already caused $5.4 billion in damage to the global economy, according to new estimates that cite $2 billion in direct costs, and $3.4 billion in indirect costs.

But further global efforts to fight the bird flu will required over the next two to three years according to the World Bank, who was advocating more effective compensation for poultry farmers caught in the front line of the bird flu dilemma.

In November, President Bush announced that he would ask Congress for $7.1 billion in emergency funding to prepare the country for a possible flu pandemic. Bush said that said that there had not been an outbreak in the United States or the rest of the world, but stressed that health officials must be ready.

Bush stated that "A pandemic is a lot like a forest fire … if caught early, it might be extinguished with limited damage; if allowed to smolder undetected, it can grow to an inferno that spreads quickly beyond our ability to control it."

The current bird flu strain -- known as the H5N1 virus -- has spread to birds in 16 countries, infected 121 people and killed 62 -- according to the World Health Organization. The H5N1 strain does not spread easily from person to person, but health experts fear that it could mutate.

The Bush administration's plan provides funding for early detection, containment and treatment of an outbreak, but with billions more in funding. The plan also calls for improving the process of creating flu vaccines and stockpiling antiviral drugs.

In addition to a day-by-day assessment of the bird flu on a global scale, the U.S. -- in order to strengthen domestic surveillance -- is launching the National Biosurveillance Initiative "to detect, quantify and respond to outbreaks of disease in humans and animals."

Of the $1.2 billion asked for, Bush said that this amount would buy enough bird flu vaccine for 20 million people. He said the vaccine probably would not be a perfect match for a pandemic flu, but it could help. Bush added, "A vaccine against the current avian flu virus would likely offer some protection against a pandemic strain and possibly save many lives in the first critical months of an outbreak."

Protein's tail may be flu virus' Achilles' heel​

http://washington.bizjournals.com/houston/stories/2006/12/04/daily29.html

New research from Rice University and the University of Texas at Austin has revealed a potential new target that drug makers can use to attack several strains of influenza, including those that cause bird flu as well as the common variety that infects millions each flu season.

The target is the long and flexible tail of nucleocapsid protein. Biochemists at Rice and UT found that even minor changes to the tail prevented NP from fulfilling one of its roles - linking together into structural columns that the virus uses to transmit copies of itself.

"There is a small binding pocket for the tail loop of the protein that appears to be a promising target for a new class of antiviral drugs," said lead researcher Jane Tao, assistant professor in biochemistry and cell biology. "We know from previous genetic studies that this tail loop is almost identical across strains of influenza A, so drugs that target the tail have a high potential of being effective against multiple strains, including the H5N1 strains."

Tao also noted that new antivirals such as these are now needed because some H5N1 viruses are resistant to the flu drug Tamiflu.

The research findings are based on a series for experiments that revealed the atomic structure of NP. The protein's structure was discerned via X-ray crystallography, a method that allows scientists to discern the three-dimensional placement of atoms in a crystal based upon the diffraction patterns of X-rays that pass through it.

NP is one of only 11 proteins that are encoded by the influenza A genome. One of its main functions is structural. Once the virus has hijacked a host cell, and converted it into a virus-replicating factory, the NPs come together in small rings as building blocks. Many NP rings stack one atop the other in a slightly off-registered fashion, forming long helical-shaped columns. The virus's RNA genome is twisted around this column and shipped out to infect other cells.

"NP has about 500 amino acids and the tail loop contains about 30 of those," Tao said. "We found that a mutation in only one residue out of 30 was enough to prevent the NPs from coming together to form the building blocks for the columns, and without these columns the virus cannot make copies and infect other cells."

Bird flu experts meet to fight virus, complacency​

http://www.alertnet.org/thenews/newsdesk/L06730047.htm

By Alistair Thomson

BAMAKO, Dec 6 (Reuters) - Experts fighting bird flu around the world met on Wednesday to replenish their war chest and plot the next stage of their campaign to control the disease and avert a devastating human flu pandemic.

The three-day meeting in Mali, the fourth global bird flu summit since late last year, includes a donor conference on Friday seeking an extra $1.2 billion to $1.5 billion over 2-3 years to add to $1.9 billion pledged in Beijing last January.

But the meeting began with a warning that complacency threatened to undermine international efforts against bird flu.

"Technical experts are sometimes accused of having overestimated the risks from this disease, or of exaggerating its potential threat," said Modibo Traore, head of the African Union's InterAfrican Bureau for Animal Resources.

"The rampant demotivation that has resulted seems to have affected the main players in the struggle on all continents, and notably the donor community," Traore told the opening session.

The outbreak of highly pathogenic H5N1 avian influenza began in Asia in 2003 and spread rapidly in early 2006.

It has been detected in more than 50 countries around the world, including eight in Africa, where experts fear veterinary and human health systems are inadequate to contain outbreaks.

"It's not a lot of money: $500 million per year, divided by the population of Africa is less than a dollar each a year," United Nations influenza coordinator David Nabarro told Reuters in the Malian capital Bamako.

So far the virus has killed 154 people who came into contact with sick birds and there are 258 reported cases worldwide.

But worse than the devastating effects on vital poultry industries in poor and densely populated countries, scientists fear the virus could mutate to jump between humans, triggering a human flu pandemic that could kill millions of people.

"The potential costs of an influenza pandemic would be of the order of $1-2 trillion ... and the actual cost of avian influenza thus far has been in the multiple billions of dollars," Nabarro said.

TICKING CLOCK

Ordinary flu kills around 250,000 people around the world each year, but every 20 years or so the virus changes enough to cause a much more deadly pandemic -- the worst in living memory being "Spanish influenza" which killed anywhere from 20 million to 100 million people in 1918 at the end of World War One.

The last pandemic was in 1968 and experts say another pandemic could happen any time.

"There is still a danger and the best solution is to finish with the virus in animals," said Bernard Vallat, director general of the World Organisation for Animal Health (OIE).

Scientists say that is most likely to happen in Asia, which has the most infections, but Africa remains a weak link due to poor veterinary and public health services which are likely to give infections more time to spread before being detected.

"The resources need to be mobilised and they need to be targeted at the countries at risk," said Ok Pannenborg, senior health advisor at the World Bank.

The U.N.'s Nabarro was upbeat, saying with the right advice and support African countries could step up their controls to combat bird flu -- and that rich nations would be prepared to foot the $500 million-a-year bill.

"Yes, I think the money will be pledged, because I think the world cares," he said.

Better bird flu detection planned​

http://news.xinhuanet.com/english/2006-12/07/content_5449502.htm

BEIJING, Dec. 7 -- New equipment to help detect potential bird flu cases is to be installed at all of the city's border points.

All checkpoints will have infrared thermograph systems from January, the Shenzhen Entry-Exit Inspection and Quarantine Bureau announced during the visit of two World Health Organization (WHO) experts Tuesday.

The infrared thermograph system, developed by the inspection and quarantine bureau, has been trailed at Luohu Checkpoint since last December.

Winter is the high season for bird flu and wintering migratory birds arriving in Shenzhen also put the local center for disease control and prevention (CDC) on high alert for the deadly virus.

According to the quarantine bureau, the new thermographs will be first installed at Huanggang Checkpoint, the soon-to-open Futian and Shenzhen Bay checkpoints and Shenzhen airport.

The whole system includes 12 infrared thermograph devices and 40 surveillance cameras, linked to a network terminal.

Rather than taking passengers' temperatures one by one, the infrared thermograph devices enable quarantine workers to check a mass of body temperatures at a time. Any visitor at a surveillance site with a temperature higher than a preset one will be automatically located and tailed by the system.

"It helps the customs clearance as tourists no longer have to have their temperature tested by a thermograph at individual checkpoint counters," said Ye Qing, a spokeswoman for the quarantine bureau. "People don't even notice the infrared thermographs are there."

The new system will also reduce the number of quarantine workers from 51 to nine.

Using the Internet, monitoring staff can communicate with customs and health watchdogs immediately a suspected case is found. The municipal and Central authorities are allowed to inspect and take command during an emergency.

"More than 2,244 suspected bird flu cases were detected during the past 11 months, and seven confirmed as pneumonia while eight were meningitis," Ye said.

Dr. Pierre Carnevale and Dr. Daniel Lins-Menucci from the WHO inspected the system at Luohu Checkpoint with the General Administration of Quality Supervision, Inspection and Quarantine and the local quarantine bureau officials.

Luohu Checkpoint is the biggest land checkpoint on the Chinese mainland, with an average of 250,000 people crossing the border daily.

WHO tells bird flu scientists to stop squabbling​

http://today.reuters.co.uk/news/CrisesArticle.aspx?storyId=HKG327384

Wed 8 Nov 2006 8:53:45 GMT

HONG KONG, Nov 8 (Reuters) - The World Health Organisation has urged Chinese and foreign scientists to stop squabbling and share information to figure out how to combat a new H5N1 bird flu virus strain that is spreading unchecked in poultry flocks.

"Instead of having a battle in the media ... we encourage the scientists from the Chinese government and from Hong Kong and elsewhere to sit round a table and go over all these details," said Henk Bekedam, WHO's China representative.

"This is an ideal opportunity to get a better idea what is happening in China and assess strategies that have been effective and develop even more targeted strategies if there is a need."

Chinese officials and scientists rejected a paper published last week by Hong Kong and U.S. scientists who said a new vaccine-resistant "Fujian-like" H5N1 strain had emerged in poultry in China and may spread across Asia and Europe.

In an interview with Chinese media published on Tuesday, two Chinese scientists fired strongly worded rebuttals, saying there was "no scientific basis" for the views and conclusions in the paper. They accused the foreign researchers of "unscientific methods" and said China's vaccination programme was effective.

But they gave no details or data, something that Bekedam says is badly wanting.

"Right or wrong, this goes to a level of details that you have to talk to scientists, people who look at gene sequencing and give us clues as to what is happening," he told Reuters.

"If viruses are substantially different, then it is very important for us to make some re-adjustment in the diagnostics, to consider if we might need to come up with a new vaccine."

H5N1 remains a disease in birds although it has killed over 150 people since late 2003. However, experts fear it could start a pandemic and kill millions if it ever learns to transmit efficiently among people. Research so far into the Fujian strain shows it poses no heightened danger to people.

Go here http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=414702&in_page_id=1770

Côte d'Ivoire: Suspicion And Denial Over Bird Flu​

http://allafrica.com/stories/200612070512.html

December 7, 2006
Posted to the web December 7, 2006

Abatta

Poultry breeders in Cote d'Ivoire have accused the government of inventing two recent cases of bird flu in an attempt to slow down local production and cash in on pricier imported birds ahead of the Christian and Muslim holiday season.

"Here nobody really believes in bird flu," said Ibrahim Bakayoko, manager of one of the dozen poultry farms around Abatta, 30 km northeast of the main city, Abidjan. "It is only in the press that we were informed of the discovery of the illness in our area. Health authorities arrived here and all of the poultry farmers expressed our unhappiness. It strongly resembles a plot to slow down our production."

The central veterinary laboratory in Bingerville identified two cases of the deadly H5N1 strain of bird flu last month in two turkeys in Abatta. They were the first reported cases of bird flu in Cote d'Ivoire since April.

International health authorities have warned that Africa is unprepared to handle bird flu, especially if it were to mutate into a virus that could easily pass from one human to another. Bird flu is lethal in fowl and worldwide has infected at least 258 people and killed more than 154 of them since 2003.

An international conference on avian flu is being held in Bamako, Mali, which includes a donor conference on Friday to seek funds to help fight the illness. Much of the money raised is expected to go to Africa. Cote d'Ivoire, Nigeria, Cameroon, Burkina Faso and Sudan are among the African countries that have detected the presence of H5N1 in poultry and birds.

Livelihoods threatened

The cases of bird flu in Cote d'Ivoire in April resulted in the culling of some 2,000 domestic fowl. Authorities also ordered millions of doses of animal vaccine to halt the spread of the H5N1 strain of the illness.

In addition to poor laboratory capacity and inadequate health infrastructure, Africa's ability to cope with bird flu is further compromised by its poverty. Preventive measures such as culling birds have profound effects on already impoverished communities that live off selling poultry and other farm produce.

Citing the recent threat of avian flu among domestic fowl, the Ivorian government reduced the import tax on poultry by 50 percent to help meet demand for upcoming Christian, Muslim and New Year holidays.

"We are against this decision. The government doesn't want to boost our income. They want to kill the poultry network," said Jean-Marie Aka, president of an Ivorian network of poultry producers known as Ipravi. "People should know that the chickens that are imported from neighbouring countries and the West are going to be poured out on the local market like toxic waste and no one will be able to prove that they're clean."

Measures taken

Dr. Bian Tano, programme officer with the United Nations World Health Organisation (WHO), told IRIN that 76 unspecified poultry had been culled on the farm where the recent cases of bird flu were reported and general surveillance measures were undertaken to prevent the disease from spreading to neighbouring farms.

"Due to the health measures taken, with the systematic culling of the two turkeys carrying the virus and with the vaccination of poultry where the turkeys were being traditionally raised, the illness was contained," said veterinarian Kanga Kouame, the national coordinator for the fight against avian flu.

The government in May imposed a ban on poultry imports after cases of bird flu were discovered near Abidjan. All poultry breeders were called on to adopt rigorous health, sanitation and security measures and to intensify vaccinations to prevent additional cases of bird flu.

The government lifted the ban in September.

Suspicions linger

Poultry producers have threatened to disrupt the poultry market if their grievances are not taken into account. For many of them, poultry production is their only source of revenue. International bird flu specialists have said more effective programmes are needed to compensate farmers when culling is carried out.

Of the 5,000 chickens on Bakayoko's farm near Abatta, he said more than half have already been ordered for the holidays. Nationally, poultry producers say they are prepared to put 2.5 million fowl on the market for the end-of-year festivities.

Abatta residents say further measures should be taken to find the origins of the most recently infected poultry. They believe the turkeys were contaminated elsewhere.

"Nobody here raises turkeys," Bakayoko said. "We ask ourselves how they could come from here."

Africa: Bird Flu Specialists Focus On Continent, Asia​

http://allafrica.com/stories/200612070776.html

December 7, 2006
Posted to the web December 7, 2006

Bamako

The people most likely to contract the deadly strain of flu that infects poultry and wild birds are those living in close proximity to the animals, which is why experts are focusing attention on developing countries.

"Currently the greatest risk of an outbreak is in Asia followed by Africa," said Joseph Domenech, chief veterinary officer for the Food and Agriculture Organisation (FAO) and a specialist on avian flu.

Speaking to IRIN on Thursday at an international bird flu conference in Mali, Domenech said that the worst-case scenario is that the explosion of outbreaks that occurred between October 2005 and May 2006 in 50 mostly developing countries were to restart and that the systems set up to control the outbreaks were to fail.

At least 240 million birds have been culled since the first reported outbreak of the disease in late 2003. So far only 258 people are known to have contracted the illness but half of them have died.

If the virus were to start infecting humans easily scientists fear it could spread quickly to populations throughout the world and millions of people could die.

Asked to predict where the next outbreaks are likely to occur, Domenech said Indonesia is high on the list because a comprehensive system to monitor and cull infected birds has not yet been established. An effective system has been created in China, but with more than five billion ducks and chickens living in close proximity to humans, the risk there also remains real.

Domenech said that ducks in China are particularly worrying because scientists have found that some are "permanent reservoirs" for avian flu, meaning that they survive the disease and spread it to other birds as well as humans.

Also the risk of contamination between domestic and wild birds is high in China, he said. "In the rice paddies you see ducks, wild birds and humans all in close proximity," Domenech said.

In Turkey, where there was an outbreak in 2005, people live with ducks inside their homes in winter to keep the animals warm.

Evaluating the risks of bird flu outbreaks is particularly difficult in Africa, Domenech said. Outbreaks like those that occurred earlier this year in seven African countries could reappear, although he said this is less likely in Nigeria where authorities were effective in killing off infected birds.

Domenech noted that human contact with poultry varies greatly in different parts of the developing world. In Thailand, 80 percent of poultry are produced in industrial-scale poultry farms, which are largely bio-secure, while in Cambodia 80 percent of poultry production is small scale.

Africa doesn't have the huge poultry populations that Asia has, Domenech said. Also risks of contamination between wild birds and poultry might be lower in Africa because there is less contact than in Asia.

However, the illegal trade in poultry and exotic birds could be a cause of outbreaks in Africa, he said. Also many Africans live with chickens in their backyards, making contamination between animals and humans more likely, Domenech said.

Furthermore, most African countries do not have the capacity to respond to outbreaks and thus when one occurs it may become difficult to contain.

Domenech also said that surveillance of wild birds in Africa is more difficult because they have natural predators such as vultures. "Many wild birds might have died from the disease without anyone knowing," he said.

"We are actually surprised not to have seen outbreaks already in areas with many migratory birds such as in deltas of the Senegal and Niger rivers and in East Africa's Rift Valley," Domenech said.

Bird flu has deadly friends - health experts​

http://today.reuters.com/news/artic...RTRIDST_0_BIRDFLU-SUMMIT-DISEASES-PICTURE.XML

By Alistair Thomson

BAMAKO, Dec 8 (Reuters) - Bird flu may be the tip of the iceberg.

Experts meeting in Mali say the deadly H5N1 virus is just one of a plethora of diseases threatening animals and people around the world as global warming, intensive farming, increased travel and trade help dangerous microbes breed and spread.

"Avian flu is just one of many diseases that are impacting the continent (of Africa). The experts are telling us that other diseases are going to emerge or re-emerge," said Francois Le Gall, the World Bank's lead livestock specialist for Africa.

"Almost every year there is a new disease appearing, and 75 percent of these emerging or re-emerging diseases are coming from animals; 80 percent of those have zoonotic potential," he said in an interview.

Le Gall said such zoonoses -- animal diseases that humans can also catch -- included Rift Valley fever, rabies and anthrax.

"These could come together to create what the experts are calling 'the perfect microbial storm'," he said.

But Le Gall said progress being made to tackle the current bird flu outbreak by strengthening veterinary and human health monitoring systems around the world would temper the risk of an apocalyptic conflagration of diseases.

"All the measures we are using now are going to be useful to control all these emerging or re-emerging diseases -- like veterinary services, public health services," he said.

What singles out bird flu is the potential of the virus to mutate into a human form of influenza capable of passing from person to person, not just from infected animals. International health experts were winding up a three-day meeting in Mali, the fourth global bird flu summit since late last year, aimed at plotting strategies to halt the spread of the disease and seeking donor funds for this campaign.

GLOBALISATION, CLIMATE CHANGE

"Remember that with globalisation, and unprecedented movements of merchandise, of people, there is a continuous transfer of pathogens," Bernard Vallat, director general of the World Organisation for Animal Health, told Reuters.

"This is made worse by climate change. Many disease vectors have colonised new territories," Vallat said.

Some diseases were being spread by mosquitoes or other insects whose larvae were previously killed off by cold winters, but who now survive in temperate zones, he said.

"Unfortunately, there are plenty of examples. There is a disease called blue tongue, which infects sheep, which for the first time in history has attacked northern Europe, the Netherlands, Belgium, Germany, and by a vector that is capable of spreading the virus in this region, which is unprecedented."

Blue tongue spreads via biting insects, but does not affect humans.

But West Nile Disease, which affects birds and was first found in Egypt and is spread by mosquitoes, has killed hundreds of people in the United States since it first spread there in 1999 -- probably via an imported pet bird, Vallat said.

"Now the United States is completely infected, as well as southern Canada and Mexico. In a few years this disease which was completely unknown (there) has colonised all the eastern United States via a mosquito vector," he said.

"Microbes can cross the world in a few hours," he said.

"The globalisation of exchanges of people, merchandise and commodities is a phenomenon that affects the whole planet more and more each year. It's a good thing, but it brings with it new risks. We have to be prepared."

China bird flu strain dispute all in the name​

http://www.alertnet.org/thenews/newsdesk/PEK297126.htm

By Lindsay Beck

BEIJING, Dec 8 (Reuters) - A dispute between China and the authors of a paper on bird flu centres on the name of the strain identified, not its existence, scientists said on Friday, adding China's vaccination programmes were not to blame for the strain's emergence.

China had rejected findings in a paper published in the U.S. Proceedings of the National Academy of Sciences that a vaccine-resistant strain of H5N1 bird flu the paper's authors called the "Fujian-like virus" was circulating in the country.

But officials from the World Health Organisation indicated that China does accept its existence, but takes issue with its being named after its southern province as well as other details in the paper on the circumstances of its evolution.

"It's very important that naming of viruses is done in a way that doesn't stigmatise countries, that doesn't stigmatise regions and doesn't stigmatise individual people," David Heymann, the WHO's assistant director-general for communicable diseases, told a news conference on Friday.

He made the comments following four days of meetings in Beijing that included scientists from China's health and agriculture ministries, the WHO and the Food and Agriculture Organisation.

"The first thing this group identified was the need for standardised international naming for influenza viruses," he said.

With the world's largest poultry population and millions of chickens and ducks roaming free in backyards, China is seen as a key to the fight against the H5N1 bird flu virus, which scientists fear could mutate into a form that can be passed easily between humans.

China has been criticised for hampering scientists' ability to understand how bird flu is changing by not sharing virus samples, but in a breakthrough last month, the government agreed to provide samples to the World Health Organisation.

"There was also widespread agreement that sharing information and sharing viruses is critical for the defence of everybody," Keiji Fukuda, coordinator of the WHO's global influenza programme, said of the meeting.

The WHO and FAO scientists also indicated they disagreed with some of the bird flu paper's findings that the strain in question was vaccine-resistant and had started a wave of outbreaks across Southeast Asia.

The strain had been identified in southern China, Malaysia and Laos, but it was unclear how widespread it was outside of those areas, Fukuda said.

China's Ministry of Agriculture was also stepping up its bird flu surveillance, with monthly, rather than annual, reporting, said Henk Bekedam, the WHO's China representative.

But the strength of its vaccination and surveillance programmes will be put to the test during the winter months, which traditionally have seen a surge in outbreaks.

China has not reported a human case of bird flu for the last five months and last reported poultry outbreaks in October, but Bekedam said there were still gaps in vaccination levels among smaller farms in the country's vast hinterland.

Link To Next Weeks Thread:

HEALTH - 12/09-12/15/06 | Weekly Bird Flu Thread: AFRICA: Multi-tier approach to bird flu

http://www.timebomb2000.com/vb/showthread.php?t=221356