hello from bangkok

Hi readers,

Sorry I haven't posted in a while (it's not for the lack of avian influenza news!). Here's a good articles from CIDRAP:

So not only is avian influenza here to stay and fully entrenched in some countries, it just WILL spread. New cases in Bangladesh and the Czech Republic attest to this, and the only way humans are safe from the chance of a pandemic would be to eradicate the flu from birds.


Does this change how we should tackle the problem?

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun2707fao.html

International bird flu summit begins in Scotland

An international summit organized by the UN Avian Flu Task Force opens today in Aviemore, Scotland. The two day conference convenes approximately 30 experts from 15 countries across Europe, Africa, South America and Asia.

“They will review outbreaks of avian flu around the world, which have led to the deaths of 191 people since 2003, and examine issues including the surveillance of wild birds in relation to the disease. Delegates will also discuss contingency planning and response strategies for outbreaks and what information is needed to understand potential infection routes and further local spread”

Professor Colin Galbraith, director of policy and advice at Scottish Natural Heritage, who is a member of the task force, said: "Bird flu is one of the biggest international challenges that exists today. It knows no boundaries. Scientists across the world must work together to understand the nature of the disease and to contain any outbreaks.

To date, there have been three confirmed cases of bird flu in Britain. In February, 159,000 birds were slaughtered on a Suffolk farm belonging to Bernard Matthews after the H5N1 virus was discovered. In April 2006, a dead swan was found on the slipway of the harbour at Cellardyke in Fife.

The death of 15 chickens on a farm in Conwy, North Wales in May, was caused by a less virulent strain of avian flu -H7N2”

For more: http://thescotsman.scotsman.com/international.cfm?id=996022007

Bird markets and the social and cultural impact of avian flu.

The short article below highlights the cultural and historical threads that are intertwined with efforts to combat the spread of avian flu in Hong Kong. Bird flu silences once bustling Hong Kong songbird market: http://www.boston.com/news/world/asia/articles/2007/06/25/bird_flu_silences_once_bustling_hong_kong_songbird_market/

As organizations such as CARE work to encourage governments to prepare effectively for avian flu, it is important to make marginalized groups and small scale farmers a priority within government preparedness plans. FAO highlight some of the long term impacts and consequences of restructuring the poultry sector in Asia and South East Asia. These include:

• More concentrated markets dominated by few large poultry producers
• Poultry production zones with hygiene and bio-security criteria for participation
• Diminishing numbers of wet markets, with the trend to move these out of urban areas.
• Tougher inspections to gain production/trading licenses
• Improved fencing and housing of poultry.

Such restructuring, although necessary to prevent the outbreaks of H5N1 has the potential to jeopardize the livelihoods of small scale farmers and backyard poultry raisers as they are pushed out of the poultry sector. NGOs and similar organizations can play a role in supporting such communities to improve their overall poultry production and standards of bio security. They can also advocate for government prevention measures that are suitable to small scale farmers and ensure the protection of their livelihoods.

The table below, taken from the same FAO document, also provides some convincing data to support our focus upon decreasing the vulnerability of the backyard poultry raisers:

Poultry systems in five South East Asian countries affected by HPAI in 2003-5
Country	Industrial	Large commercial	Small commercial	Backyard
Cambodia		<>	<>	99.9% farms, 90% poultry
Indonesia	3.5 % poultry, export & national consumption	21.2% poultry	11.8% poultry	63.4% poultry
Lao PDR		Small	10% poultry	90% poultry
Thailand	70% production export important	20% production	10% production, 98+% producers
Vietnam	Small	20-25% production, few producers	10-15% production, few producers	65% production possibly 70% of poultry
Source: Rushton et al (forthcoming)

Source: FAO Anni McLeod: Economic and Social Impacts of Avian Influenza: http://www.hewsweb.org/downloads/avian_flu/docs/pdf/economicimpacts.pdf

First outbreak of H5N1 in Togo confirmed

From the Mail and Guardian online...

"Laboratory tests in Ghana confirmed that the H5N1 bird-flu virus caused the sudden deaths of 2 000 chickens at a farm near Togo's capital, Lomé, the World Health Organisation representative in Togo said on Friday.

It is the first time the virus has been detected in Togo, the seventh West African nation to have reported an outbreak. In neighbouring Nigeria, more than one million birds have been destroyed since the first outbreak there in February last year; the virus has since been confirmed in 22 of Nigeria's 36 states. The farm in Togo, in the town of Sigbehoue, 45km east of Lomé, had received a shipment of chicks in February from neighbouring Ghana, according to a Reuters report. Avian flu was detected in Ghana last May. "

http://www.mg.co.za/articlepage.aspx?area=/breaking_news/breaking_news__africa/&articleid=312280

Indonesia reports 80th victim out of 100 human cases

"The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 26-year-old male from Riau Province developed symptoms on 3 June, was hospitalized on 6 June and died in hospital on 12 June. Investigations into the source of his infection indicate exposure to sick and dead poultry. Of the 100 cases confirmed to date in Indonesia, 80 have been fatal."

Source: http://www.who.int/csr/don/2007_06_15/en/index.html

Bangladesh: Avian influenza spreads to a new district.

Officials have reported the spread of avian influenza outbreaks in two farms in Jaipurhat district, approximately 188 miles from Dhaka. “With the latest cull, about 172,000 chickens have now been slaughtered and more than 1.6 million eggs destroyed on 68 farms in 14 districts since the virus was first detected near Dhaka in March”

For more: http://www.alertnet.org/thenews/newsdesk/DHA102207.htm

Vietnam reports 43rd victim

"Vietnam confirmed its first human death from bird flu since 2005, as the latest flare-up of the virus ravaged poultry stocks, official media said Saturday.Tests confirmed the 20-year-old from northern Ha Tay province died from the H5N1 virus on June 10, the Vietnam News Agency quoted Vice Minister of Health Trinh Quan Huan as saying at a bird flu meeting.

The man's family raised about two dozen fighting cocks along with ducks, the agency said. His house and surrounding areas have been disinfected. His death brought the country's toll to 43. Vietnam had not reported a human bird flu death since November 2005, though four other people were recently infected. Two have fully recovered."

At the meeting of the National Committee for Avian Influenza Prevention and Control and the National Committee for Controlling Avian Influenza in Humans, Prime Minister Nguyen Tan Dung emphasized the need for education to raise public awareness of preventive measures. The PM has also ordered the “closure of all hatching businesses that fail to meet new guidelines, the culling of affected poultry and the reduction of free-range poultry farms”.

With outbreaks in regions sharing the Chinese border, China has strengthened measures in its southern Guangxi region, “vaccinating birds, closing markets and banning cross-border poultry trade.”

Source: http://www.guardian.co.uk/worldlatest/story/0,,-6715338,00.html

http://english.vietnamnet.vn/social/2007/06/707255/

http://www.radioaustralia.net.au/news/stories/s1953092.htm

WHO: Vaccine stockpiling, increasing developing country vaccine production capacity and reviewing IHR

“SARS was a wake-up call for all of us. It spread faster than we had predicted and was only contained through intensive cooperation between countries which prevented this new disease from gaining a foothold," said Dr Margaret Chan, Director-General of the World Health Organization. "Today, the greatest threat to international public health security would be an influenza pandemic. The threat of a pandemic has not receded, but implementation of the IHR will help the world to be better prepared for the possibility of a pandemic."

“The experience of recent decades shows that no individual country can protect itself from diseases and other public health threats. All countries are vulnerable to the spread of pathogens and their economic, political and social impact”

Following on from the WHO’s World Health Assembly last month, several manufacturers (including GlaxoSmithKline (GSK), Sanofi-Pasteur, Baxter and Omnivest) have pledged millions of doses to contribute to the stockpiling scheme. GSK will donate 50 million doses of H5N1 pre-pandemic vaccine over a 3 year period with the goal of providing enough vaccine for 25 million people.

This latest action by the WHO is coupled by a push to increase and strengthen the vaccine production capacity of developing countries through six grant schemes. In May, the first of these grants provided. In addition to the vaccine stockpiling and the grants, the WHO is announcing the latest revision of the International Health Regulations (IHR). Significant to the flight against avian flu, the IHR revision emphasizes that “health emergencies be contained at the source, not just national borders”. They also stipulate:

• “Notification. Greater openness demanded by a world in which serious disease events are increasingly visible.
• Designation of National IHR Focal Points: world on 24-hour alert.
• Establishment of core public health capacities to maximize surveillance and response.
  Cross-sectoral international collaboration key to implementing IHR..
  Threat-specific international programs to improve international health security.”
  

For more see the WHO press release and article
http://www.who.int/mediacentre/news/releases/2007/pr31/en/index.html
http://www.who.int/mediacentre/news/statements/2007/s14/en/index.html
http://www.in-pharmatechnologist.com/news/ng.asp?n=77381-world-health-organization-stockpile-avian-flu-vaccine

Indonesia’s 80th victim of bird flu

“A Indonesian man who slaughtered sick chickens and then ate them has died of bird flu, health officials said on Thursday, taking the country's human death toll to 80. The man lived on a palm oil plantation in a remote area and had been in contact with sick fowl. "He kept some chickens in his house. At least three died all of a sudden and he slaughtered the rest," said Husnedi, adding that the family then ate them and the man fell sick the next day. Azizman Saad, head of the hospital's bird flu control section said the remaining family members were being monitored”although none have developed symptoms.

Source: http://www.alertnet.org/thenews/newsdesk/JAK37037.htm

Vietnam: more human cases

“Two Vietnamese women (from the northern provinces of Thanh Hoa and Ha Nam) have tested positive for the H5N1 bird flu virus, but one has recovered while the other is in intensive care. Bird flu has killed 42 people out of 95 cases of infection in Vietnam since it emerged in late 2003.Meanwhile, the Animal Health Department said three bird flu cases in poultry were found on June 7 and June 8 in the northern province of Thai Binh, which had reported outbreaks in other districts in the province”

A local newspaper has quoted the Central Veterinary Diagnosis Center that approximately 13 percent of waterfowls in Vietnam have bird flu virus strain H5N1.

“Tests show that nearly 21.7 percent of waterfowls in capital Hanoi, 21.2 percent in northern Bac Ninh and over 7.6 percent in Bac Giang carry the virus. Vietnam has planned to import additional 500 million doses of bird flu vaccines for fowls, expected to be used in the 2007-2008 period. The country has so far this year vaccinated 136.8 million fowls, including nearly 79.7 million chickens, 53.7 million ducks and roughly 3.5 million white-winged ducks, according to the department of Animal Health under the Vietnamese ministry of agriculture and rural development. Bird flu hit Vietnam in December 2003 and has spread to 16 Vietnamese cities and provinces nationwide"

Source: http://www.indianmuslims.info/news/2007/jun/13/nearly_13_percent_vietnams_waterfowls_carry_h5n1.html

http://www.reuters.com/article/healthNews/idUSHAN6319220070612

another form of bird flu transmission?

Medical experts found the H5N1 virus in the throat, gastric juices, and even in the stool of a bird flu patient in Vietnam.

While not a pleasant image, this has significant implications on bird flu programmatic efforts. If bird flu can be transmitted from fecal material, people who handle poultry and reside in rural areas with poor sanitation may be at increased risk of avian influenza. Water and sanitation projects need to be emphasized.

Has anyone noticed this trend? Has any country combined bird flu prevention activities with water and sanitation projects?

http://english.vietnamnet.vn/tech/2007/06/704134/

Outbreak in Malaysia

Malaysia’s Department of Veterinary Services announced the death of 60 birds in Paya Jaras Hilir village, in Selangor state, which surrounds the capital, Kula Lumpur. This is the first case of avian influenza in Malaysia since March 21^st 2006. Authorities plan to cull poultry within a 1km radius of the outbreak and impose a 10km quarantine zone.

“Neighboring Singapore suspended poultry and egg imports from Selangor state "as a precautionary measure with immediate effect," the city-state's Agri-Food and Veterinary Authority said in a statement.

Poultry imports from the disease-free zones of Johor, Malacca, Negri Sembilan and Perak states will not be affected by this suspension, it said.

Malaysia supplies 3.6 million poultry and 83.7 million eggs per month to Singapore. Imports from Selangor constitute only about 6 percent of the poultry and 1 percent of the egg imports from Malaysia, the statement said”

Source: http://in.today.reuters.com/news/newsArticle.aspx?type=worldNews&storyID=2007-06-06T144839Z_01_NOOTR_RTRJONC_0_India-301725-2.xml&archived=False

Two possible human H5N1 cases in Vietnam.

From CIDRAP:

"Vietnam's health ministry announced over the weekend that a poultry slaughterhouse worker was being treated for H5N1 avian influenza, and the World Health Organization (WHO) confirmed today that China's most recent H5N1 patient has died. Vietnam's health ministry said the man, from the northern province of Thai Nguyen, worked in a Hanoi slaughterhouse on May 14, got sick 5 days later, and was admitted to Hanoi's Tropical Disease Hospital...

After a nearly 18-month lull in Vietnamese H5N1 cases, the man's case is the country's second in a little more than a week. In the previous case, a 30-year-old farmer fell ill after he helped slaughter chickens for a wedding. He was recovering at Hanoi's Bach Mai Hospital"


http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun0407vietnam.html

UK study reveals "complacent" doctors

"The threat of an influenza pandemic is very real and inevitable at some point in the future. There is evidence of pandemics occurring throughout history, including three in the 20th century, but we do not know when the next pandemic will occur. Pandemic influenza will be a global health emergency and everybody should prepare for it." Health Protection Agency spokesman

Despite the recent outbreaks of highly pathogenic H5NI and low pathogenic H7N2 in the UK, a study conducted by Oxford University reveals complacency about the threat of avian flu by doctors. “Most of the 161 doctors questioned at a recent conference in the U.K. thought a pandemic this decade was ``possible'' and 9.9 percent said it was ``unlikely'' or ``very unlikely,'' according to a study published today in the British journal Archives of Disease in Childhood”.

The spread of the H5N1 avian influenza strain to 59 countries the past four years has brought the world closer to another pandemic than at any time since 1968, when the last of the previous century's three major outbreaks occurred, world health experts say. While H5N1 has killed millions of poultry, fewer than 200 people are known to have died from the virus, which isn't easily transmitted between people.

``Just like the public, doctors have heard about it for so long and yet it doesn't seem to eventuate,'' Curtis said in a telephone interview from Melbourne yesterday. ``The incorrect conclusion people draw from that is that maybe it's never going to happen, whereas history tells us that there is an inevitability of a pandemic at some point, it's just a question of when, where and how large.''”

Source:http://www.bloomberg.com/apps/news?pid=20601102&sid=aIFyUwcIJ8og&refer=uk

http://www.onmedica.net/content.asp?c=40314&t=1

China’s 16th victim of avian influenza: 19 -year-old solider

“A 19-year-old Chinese soldier, (Chang), has died of the virulent strain of bird flu, the country's 16th reported death from the virus,,, The man, who was stationed in the southern province of Fujian, died Sunday after being hospitalized May 14 with a fever and a cough.

Last year, it was disclosed that new tests on the body of a 24-year-old soldier who died in 2003 in Beijing confirmed that he succumbed to bird flu - one of the earliest deaths in a resurgent wave of the disease that swept through the region.

While H5N1 is most commonly passed from sick poultry to humans who have close contact with the infected birds, the WHO has said that Cheng's case was China's 24th of 25 human infections that occurred without a reported outbreak among poultry - indicating a weak surveillance system and a still-circulating virus.”

Source: http://www.guardian.co.uk/worldlatest/story/0,,-6684172,00.html

Technical, financial, and political barriers challenge implementation of new IHR

According to an editorial in last week’s edition of The Lancet, “Poorer countries could struggle to implement the new International Health Regulations (IHR) about to be brought into force.”

“Countries are obliged to nominate a national focal point to communicate detailed public-health information to WHO, including case definitions, laboratory results, number of cases and deaths, and conditions affecting the spread of disease. WHO would then be responsible for validating whether the threat was of international concern—declaring emergencies, recommending containment measures, and coordinating an international response. Chernobyl, Ebola virus, variant Creutzfeldt-Jakob disease, severe acute respiratory syndrome, and more recently avian influenza, have all highlighted the inadequacy of the old regulations (IHR 1969), which only required countries to raise the alarm in emergencies involving three diseases—yellow fever, plague, and cholera.”

The new IHR may pose additional challenges for resource poor nations that do not have the level of capacity or infrastructure necessary for meeting IHR surveillance, diagnostic, and containment demands. While the revised IHR requires WHO and Member States to mobilize financial resources, there is no mention of any concrete funding mechanisms. CARE's role in developing capacity and strengthening community-based surveillance may, therefore, become increasingly important as Member States work to adhere to these new regulations.

Political resistance will also pose a challenge for IHR implementation. “For the IHR to work, no territory—whether Taiwan or the Occupied Palestinian Territory—can be excluded from the global surveillance system, especially in light of the threat posed by avian influenza.”

Additionally, health inequities sure to arise in the event of a pandemic influenza might prevent compliance with the new regulations, as 96% of the projected 62 million deaths are expected to occur in the developing world.

http://www.thelancet.com/journals/lancet/article/PIIS0140673607607880/fulltext

http://www.medicalnewstoday.com/medicalnews.php?newsid=72097

16th Province with H5N1 in Vietnam

New H5N1 outbreaks have occurred in Vietnam, the latest in the central province of Quang Nam and the southern province of Can Tho. These outbreaks bring the number of Vietnamese provinces affected by avian influenza since last month to 16 .

Most outbreaks in Vietnam occur in the densely populated Red River and Mekong River deltas in the north and south, respectively. Until now, only two provinces in the central region had outbreaks.

Because H5N1 outbreaks, particularly those involving waterfowl, are more likely to occur in areas near fresh water, it is no surprise that these outbreaks are concentrated around the Red River and Mekong River delta regions. However, the reasons why the virus in the last month has appeared in areas like the central region or the mountains of the northwest, which are neiter densely populated nor rich in bodies of fresh water, remain unclear.

Bird flu hits 16 provinces in Vietnam
Map of Vietnam's Provinces

Why are we seeing a rash of new outbreaks in poultry in Vietnam?

It may be because virus mutations have made the current vaccines for poultry less effective.


"A change in bird flu virus strain H5N1 has diminished the effectiveness of vaccines against the disease among poultry, local newspaper Pioneer Thursday quoted a local official as saying.
Bird flu vaccines are produced according to the gene type Z found in bird flu virus strain H5N1 in 2003 when Vietnam was first hit by the disease, but another gene type called G was detected in 2005, said Nguyen Tien Dung, head of the Ultra-Virus Department of the Veterinary Institute under the Ministry of Agriculture and Rural Development.

The gene type Z and type G are not very similar, so the vaccines are more effective to the type Z, and less effective to the type G, he said, noting that first infected poultry with the type G in Vietnam were mainly smuggled.

Vietnam is strengthening bird flu vaccinations among fowls nationwide, using the vaccines imported mainly from China and the Netherlands, according to the ministry's Department of Animal Health."

http://news.xinhuanet.com/english/2007-05/31/content_6179028.htm

Indonesia reporting 79th death from H5N1

"An Indonesian girl from Central Java has died of bird flu, a health ministry official said on Friday.The girl, 15, from the Kendal area near the city of Semarang, died on Tuesday, Muhammad Nadirin of the ministry's bird flu centre said by telephone."

Apparently, she may have contracted the virus while preparing poultry for cooking.

http://www.reuters.com/article/healthNews/idUSJAK27283420070601?rpc=401&