Monday, April 30, 2007
Regular rest days help stop the spread of H5N1 because poultry vendors are required to stop selling and slaughtering and clean and disinfect their area of the market. Also, it gives the government a chance to clean larger areas of the market, ensure that there is proper drainage of waste, etc.
Market clean up days are recommend by WHO - you can find the guidelines at the Communications Initiative website
Sunday, April 29, 2007
During the next pandemic, morbidity and mortality will most likely be mediated through factors such as medical infrastructure, nutritional status, the presence of other diseases, and other poverty-related factors. While it is uncertain how the next pandemic influenza will play out, it is certain that its effects will disproportionately target poor and vulnerable groups. As Neil Ferguson suggests, more work needs to be done to explore the means by which poverty affected mortality in the 1918 pandemic so we can prevent and mitigate mortality in these populations during the next pandemic influenza.
Murray, CJL et al. (2006). Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-1920 pandemic: a quantitative analysis. The Lancet 368: 2211-2218.
Friday, April 27, 2007
Here's New Zealand's case definitions of avian influenza in humans. Are they similar to your country's definition? What's different?
A person who has been referred to the Public Health service for investigation of possible H5N1 infection.Suspect case of Influenza A (H5N1)
Person with acute lower respiratory tract illness of abrupt onset, characterised by:
- fever (temperature >38 C) and
- cough and/or
- dyspnoea (difficult or laboured breathing).
AND, in the seven days prior to the onset of symptoms, one or more of the following:
- having been in close contact (less then 1 metre) with a suspect, probable or confirmed case of influenza A (H5N1)
- exposure to avian species or their remains, or to environments contaminated by their faeces in an area where H5N1 infection in animals or humans have been suspect or confirmed in the last month
- consumption of raw or undercooked poultry products in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month
- close contact with a confirmed H5N1 infected animal of a species other than avian
- handling samples from persons or animals that are suspected of H5N1 infection
- working in a laboratory that is handling samples from persons or animals that are suspected of H5N1 infection.
Probable case of Influenza A (H5N1)
- a person meeting the definition of a suspected case and
- limited laboratory evidence for Influenza A (H5N1) (such as IFA+ using H5 monoclonal antibodies).
Confirmed case of Influenza A (H5N1)
- a person meeting the definition of a suspected case; and
- laboratory testing demonstrates one or more of the following:
- positive PCR for Influenza A (H5N1) or
- positive viral culture for Influenza A (H5N1) or
- immunofluorescence antibody (IFA) test positive using Influenza A/H5 monoclonal antibodies or
- a four-fold rise in H-5 specific Ab titer.
Thursday, April 26, 2007
I guess this begs the question: well, what's next? More countries are working on their own vaccines using strains found within their borders in hopes of creating a cheaper vaccine that's more effective to their own cases. Is this a vaccine race or a struggle between developing countries and developed nation pharmaceutical corporations?
Wednesday, April 25, 2007
With this article, and others like it, we remain hopeful that vulnerable populations will remain in the forefront of our minds as we prepare for a possible pandemic influenza.For further details, view the full article:
One of CARE's project beneficiaries brought in several dead chickens to a livestock center and CARE took down the case history. The high mortality rate and symptoms pointed to suspected H5N1, so CARE sent the samples to the nearest reference laboratory. It was confirmed H5N1 and within 2 days of the beneficiary bringing in the dead poultry, outbreak response was happening on the ground. CARE followed up with project beneficiaries in the area, reinforcing the AI prevention messages that they have been including in many of their projects.
Another great point about this, it will boost production capabilities of seasonal flu shots as well.
It's a great step forward, but it will take 3-5 years for production to start locally!
Monday, April 23, 2007
"The infection was detected at a farm in western Magura district 200 km (125 miles) west of the capital Dhaka and five farms at Savar in the Dhaka district"
"Since the detection of the H5N1 virus on March 22, some 98,000 chickens have been culled on 38 farms in nine districts."
Thursday, April 19, 2007
Why is this important then? If a pandemic occurred, this vaccine isn't going to save the world. However, it may be useful if we can vaccinate at the very start of a human to human pandemic.
The more cases you can prevent or delay at the onset has huge implications for how many people are affected and how long you have to prepare.
But all the press releases and articles I've seen have only said this won't be available commercially and that the U.S. Govt. is stockpiling the vaccine. There's no word on what other countries may be able to access it and it's very unlikely that a human pandemic will start in the United States...
Wednesday, April 18, 2007
Monday, April 16, 2007
Article - "Enhancing Control of Highly Pathogenic Avian Influenza in Developing Countries through Compensation: Issues and Good Practice"
It's another thing to figure out how to do it.
The paper called, "Enhancing Control of Highly Pathogenic Avian Influenza in Developing Countries through Compensation: Issues and Good Practice" from the World Bank, OIE, ARD, FAO, and IFPRI is a thorough document that gives baby steps in the general direction of compensation.
How should these actors work together? In your experience, how DO they work together?
On April 5th 2007, a 13 year old Cambodian girl, “died in the Kampong Cham province bordering
The girl died after cooking and eating a sick chicken from her backyard, officials said. More than 100 ducks and chickens from around her farm have since been killed after some birds tested positive for the H5N1 virus.”
Source and more information: http://www.physorg.com/news95839462.html
With recent outbreaks in Bangladeshi districts neighboring
Source: Indian Catholic: http://www.theindiancatholic.com/newsread.asp?nid=7065
Two more avian influenza (AI) outbreaks on farms in
A CARE Working Group and Core team have been established to develop an AI contingency plan, identify priority activities to be implemented within CARE programs, and maintain communication with the Government of Bangladesh (GoB). On April 9th CARE Bangladesh hosted a Coordination Meeting on AI, convening representatives from major international NGOs (Oxfam, Plan, MCC-Bangladesh, Concern Worldwide, International Development Enterprises and Helen Keller International) in order to share experiences and identify collective roles to support the Government against AI. The participants agreed:
- To asses their network capacity in terms of partner NGOs the communities they work with
- Build partnerships with other domestic NGOs
- Collect and print accurate information and training materials to be distributed to staff, partner NGOs, farmers, and other beneficiaries.
Source: CARE Bangladesh & Reuters: http://www.alertnet.org/thenews/newsdesk/DHA226251.htm
Thursday, April 12, 2007
Wednesday, April 11, 2007
This article is pretty radical as it points the finger at:
- The formal poultry sector profiting from AI prevention measures that squeeze out local, small-scale farmers
- The formal poultry sector having enough clout with governments to avoid inspections
- Even pharmaceutical companies for receiving AI samples to create vaccines for profit
What do you think?
- Is this far-fetched? Reasonable?
- What can we do to ensure all parties involved are accountable for their actions?
Against the Grain's "Bird Flu: A Bonanza for 'Big Chicken,'"
Monday, April 9, 2007
Sunday, April 8, 2007
Dr. Jahangir Hossain, CARE Bangladesh's Health Sector Coordinator (and AI point person). Is hosting a coordinating meeting for INGOs to discuss the current situation and how to coordinate efforts and possible joint advocacy.
Egypt has its 34th case, a 15 year old girl. Egypt has the highest number of cases outside of Asia.
And, Indonesia had its 74 death, a man from West Java.
Friday, April 6, 2007
Following the recent outbreak of H5N1 in Laos, the Government of the Lao PDR has declared the four districts of Sissatanack, Xaisetta, Sikkhotabong and Chanthabouli in Vientiane Capital, AI free.
Following a ban that has been in place since 7th March, residents in these areas of the Laos capital city are now able to eat poultry and eggs again, however the raising of live poultry in the 216 affected villages is still prohibited.
Strict measures will be put in place to ensure the safe import of 'AI free', killed and plucked poultry from other areas of Lao for sale in markets. At this stage, no live poultry is to be allowed in the villages that were affected.
Thursday, April 5, 2007
Here's a few of the truncated Q&A's below, if you'd like the whole document, email us at: AvianFluWG@CARE.org. There's also a good background paper on the latest evidence at:
Q. Is there a risk from drinking water?
A. Potentially Yes.
Avian influenza viruses can persist for extended periods of time in water depending on temperature, pH and salinity but information on environmental persistence of H5N1 in water is lacking. As influenza A (H5N1) infection is frequently accompanied by gastrointestinal symptoms this could mean that H5N1 might enter the host also through Gastrointestinal tract.
Based on no evidence but considering a potential risk. Knowing that water supplied for multiple use and for drinking water in health-care facilities, minimum standards are required based on national protocols.
Q. How does avian influenza virus get into drinking water sources?
A. Infected waterfowl carry avian influenza viruses in their gastrointestinal tract, where the virus replicates. Birds infected with avian influenza virus shed large quantities of virus in their faeces as well as in their saliva and nasal secretions. Recent studies of ducks inoculated with H5N1 isolates from 2003 and 2004 showed infective virus shedding up to 17 days post-infection. Thus, it is likely that infected droppings or other secretions from both symptomatic and asymptomatic waterfowl will enter water environments where these birds gather. Avian influenza virus has been isolated from unconcentrated lake water where ducks gathered and deposited large amounts of faeces, but virus concentrations were not determined in these studies. Still, avian influenza virus detection in unconcentrated water and in small sample volumes suggests that levels could be relatively high.
While there have been no quantitative studies on the transport of avian influenza virus to groundwater underlying poultry operations, the disposal and composting of infected waste on poultry farms could create a potential pathway for the virus to enter groundwater. Similarly, interconnected surface water and groundwater systems might provide a potential route to groundwater if surface waters are carrying high concentrations of the virus.
Q. Do we know how long avian influenza viruses persist in drinking water sources?
A. Avian influenza viruses are known to persist for extended periods of time in water depending on environmental conditions, including temperature, pH and salinity, but information on the persistence of highly pathogenic avian influenza (HPAI) viruses, including H5N1, in water is lacking. Persistence of avian influenza in water is most sensitive to temperature.
Wednesday, April 4, 2007
Four workers test positive for Avian Flu in
72nd Victim of Bird Flu in
The Health Ministry announces the death of a maid who cared for a pet eagle:
For more: http://www.sciam.com/article.cfm?alias=indonesian-woman-dies-of&chanID=sa003&modsrc=reuters
Tuesday, April 3, 2007
The workshop, attended by representatives from all 17 provinces together with international partners focused on independent research conducted by CARE, UNICEF and AED. This research, together with reports from government lead communication campaigns guided discussions about the direction that behavior change communication activities in Lao should take in the future.
Lao PDR has had 3 AI outbreaks, in 2004, 2006 and the early 2007 outbreak which saw 2 human fatalities from H5N1. However, there are still many obstacles to be overcome in raising awareness of the disease. ‘Of critical importance to communications campaigns is that people still do not understand the risk of the disease. To many of the backyard farmers, who make up 80% of people raising poultry in Lao, HPAI is just another seasonal disease poultry disease that affects their flock. When people do not understand the danger, it is difficult to make campaigns strong. This is something all campaigns need to focus on’, says Khounkham, Project Manager for the CARE Avian Influenza Local Risk Reduction Project.
The difficulty in reaching all areas of the country was also discussed. Findings from national campaigns indicate that only 5% of the 12,000 villages in Lao have received information on AI. The geographic disparity of Lao, combined with the large number of ethnic minority languages makes communications campaigns difficult. CARE AI programs are attempting to fill the niche of involvement at the village level; working with village volunteers and committees to deliver awareness raising activities and pilot behaviour change models.
Following the recent outbreak, discussions also focused on communications needed in an AI response. ‘Messages need to be targeted for before, during and after an AI outbreak. There needs to be a dedicated team that is responsible for informing the community of important decisions in an outbreak’, says Siphone, Training and Capacity building officer for the CARE AI Program. ‘From our experience, we need to create clearer messages to inform the community why culling of their poultry is occurring and why it is important that they report sick or dead poultry. Having trained staff available to do this if and when another outbreak occurs is critical.’
A clinical trial is about to be launched that will test whether doubling the dose of
oseltamivir (Tamiflu) will improve H5N1 patients chances of recovery and/or reduce illness in seasonal flu patients. The trial will last for two years
According to Thailand's MoH, animal studies with higher doses have yielded better survival rates.
In 2005, we started focusing more of our program strategy on trade and travel after plotting outbreaks and noticing how they often follow major roads or railways! Since then, many researchers have put forth evidence for these points 1) once H5N1 enters a country or region, most of the spread of H5N1 is related to trade 2) wild birds may introduce the virus to a country, but trade has been equally important in establishing the virus in new areas.
Now, an article from Bird Life Interational goes even further and suggests that in many cases migratory birds were actually the victims of a virus that was already present.
It's an interesting theory and well written article, check it out and let us know what you think!
In the meantime, a national panel is recommending to the MoH that autopsies be done on H5N1 victims to better understand the virus. Indonesia has the highest number of human H5N1 deaths in world
H5N1 resurfaced in 2 duck farms in Southern Vietnam (Cau Mau Province). Vietnam continues to be plagued with outbreaks for the last few months after over a year with none.
H5N1 Continued to spread among poultry in Bangladesh. 1,500 birds were culled in Jessore and Dhaka. The infected districts now include Dhaka, Gazipur, Tangail, Jessore, Jamalpur and Narayanganj.
Poultry and eggs culled in Kuwait outbreak. The outbreak is seriously affecting egg producers around the outbreak.
5th outbreak of H5N1 on the outskirts of Yangoon, Myanmar
This is a very reliable resource for information on more technical questions (evolution of the virus, vaccine and drug issues) and also a good resource for timelines for past pandemics and the current H5N1 threat