Monday, December 29, 2008

Modelling NPIs

A new study out of Australia gives us some insite into why non-pharmaceutical interventions (NPIs) might be so important during a pandemic. The study doesn't have a summary for laymen so I've pulled out one paragraph and bolded some of the findings.

"For epidemics with an unmitigated R0 of 1.5, case isolation, school closure or community contact reduction made significant reductions in the final attack rate, reducing it from 33% to 6%, 13% and 16% respectively. School closure combined with any of the other interventions reduced the cumulative attack rate to below 10%, which may be deemed to be the threshold below which an epidemic does not occur. School closure combined with case isolation reduced the final attack rate to 8%. For epidemics with an R0 of 2.5, only the combination of all the modelled intervention measures appeared capable of controlling the epidemic, reducing the final attack rate from 65% to 3%. School closure combined with case isolation more than halved the final attack rate (to 30%). To achieve the large reductions in attack rates for R0 values of 2.0 and 2.5, combinations of interventions needed to operate for unfeasibly long periods of time (greater than 5 months)."

Basically, under various scenarios, there's a strong possibility that combining more than one NPI could drastically reduce the number of people that fall ill. One of the challenges would be how long we need to maintain the interventions. As the section above points out, 5 months or longer might be necessary but not feasible.

To read the full article, visit:

Bird flu turns 11 years old...

The fantastic public health blog, Effect Meausure called attention to the fact that December 28th, 1997 was the onset of our serious concern over H5N1 (though the virus was identified well before).

"As far as the world is concerned, if any day can be said to be bird flu's birthday, it's today. The disease of birds doctors call influenza A subtype H5N1 may have had a long gestation period, but we're not sure how long. A form of the virus deadly to poultry was isolated from a goose in southern China (Guangdong province) in 1996, marking the first time the highly pathogenic form of the H5 bird virus poked its head above water for us to see. How long it had "been around" before that we don't know. Then in May, 1997, a three year old tot in Hong Kong came down with a flu-like illness that got worse and worse. He died a hard and painful death 12 days after onset. Tests showed it was an influenza A virus, but not the kind that usually infected humans (H1, H2 or H3). It was an unidentified subtype for human infection. Specimens were sent to the Netherlands and the US and in August the Dutch team identified it as the H5N1 subtype. It was designated A/Hong Kong/156/97 (H5N1) and shown to be closely related to isolate A/Chicken/Hong Kong/258/97 (H5N1) (see here for more on the naming system for flu viruses). The latter virus had been isolated from a chicken in Hong Kong in March, just months before the child fell ill. A poultry flu virus had jumped to humans.

But it was only a single case. Everyone hoped it was an isolated one and over the summer there were no others. But with the onset of flu season in November, additional cases did start to appear and by the end of December there were 17 more, of which 6 died. Including the index case, there were 18 cases with a 33% case fatality ratio. By then an emergency team from the US CDC had been in Hong Kong for three weeks and there was grave worry this might be the start of a pandemic with an especially lethal flu virus. On Sunday, December 28, 1997 the world was alerted:

'Alarmed by the continuing spread of a deadly flu virus transmitted from birds to humans, Hong Kong health officials prepared today to slaughter the territory's entire population of farm-raised chickens and other poultry in markets and farms.
The extreme move, which follows a ban on chicken imports from China, was announced Sunday by Hong Kong Director of Health Margaret Chan after doctors confirmed at least 12 cases of the H5N1 virus, four of which were fatal. Nine other people, ranging widely in age, are suspected of having the virus, a particularly virulent type previously believed to infect only birds.
Health and agriculture officials said that more than 1,000 workers wearing masks and protective clothing will fan across the territory beginning this morning to gather an estimated 1.3 million chickens from 1,000 markets and 160 farms. The birds will be captured in sealed containers, asphyxiated, placed in plastic bags and buried in landfills.
"From tomorrow morning, we will start destroying all the chickens in Hong Kong Island, Kowloon and the New Territories," Secretary for Economic Services Stephen Ip told a news conference Sunday. Ip said the workers will also gather and kill ducks, geese, pigeons and quail housed near the chickens, in an operation that he said will be completed in 24 hours. (Rone Tempest, Los Angeles Times, print edition, page A1, Dec. 29, 1997)"

Read the full post here:

Sunday, December 28, 2008

We've been featured!

The U.S. PharmD website featured us in their blog, "100 Health Blogs that will Open Your Eyes."
This blog highlights other blogs on all different kinds of health topics, from Development and Policy to Global Health and Infectious Diseases. There are even country and continent-specific health blogs!

Stop by the U.S. PharmD website and check out this informative list- definitely worth a read!

-->Click here and follow the link to the website:

Tuesday, December 23, 2008

Social distancing on public transportation

A small experiment was recently run in Japan to test how social distancing might be applied to public transportation during a pandemic.

Currently, expert guidance recommends 1-2 meters distance between each person (though there is little in the way of research to confirm these distances would be effective). In Japan they had a group of study participants use the train and remain 1 meter away from all other riders. Based on the test, officials concluded trains would only be able to have 20% of their normal capacity to maintain 1 meter distance.

This could have an additional effect on asking workplaces to stagger their hours so as to reduce congestion and crowding not only at the job but also on the way to work

Can a mobile phone change the world?

There's been a very vibrant online discussion on various blogs about mobile phones being used to detect disease, based on a recent article from Wired Magazine article about mobile phones as laboratory.

Nathaniel Whittemore wrote on,

"Wired wrote yesterday about a cell-phone modification that could bring on-the-spot disease detection and monitoring to even the most remote corners of the world. The phone has its lens removed and modified with an LED light source that reveals particular properties of the blood when lit. The camera sensor can then image the blood, creating a diagnostic lab all in a cell phone...

So imagine this.

It's 2011, and a lot has changed in our approach to global health promotion. First, we've established a Department of Development that recognizes that prevention goes a lot further than treatment, and has begun to make strategic investments in technology and training around the world. Michael Kleinman is the director, with Paul Farmer as his Senior Adviser, of course. One of the early initiatives was the promotion of a global health corps which was focused on training community health workers, the backbone of most health systems. To enable even more effective home care, these community health workers have cell-phones outfitted with the LUCAS mobile test system above, and use Ushahidi and FrontlineSMS technology to immediately send results to a global epidemiological database from which regional and international teams can analyze trends in disease prevalence. Nonprofits and national agencies consult with the doctors monitoring the global database to design interventions that strategically head-off possible epidemics. Meanwhile, pharmaceutical companies who have negotiated lower rates with national governments, mediated by partners like the Clinton Foundation, employ a partnership with Coca-Cola to use their delivery trucks to get life saving drugs to even the most inaccessible regions. And of course, patients being treated can use their own cheap mobile phones to send messages to health workers about updates in their condition.

Sounds like fantasy? It's not. Everything above is happening or being discussed. The actors are corporate, nonprofit, and government. All it will take is the right collaboration, predicated on a common sense of moral outrage and an understanding of our immense opportunity to create a healthier world."

There are also some good posts that balance the optimism of what we can do with mobile phones with the realities of business models, scale and the need for human capacity and infrastructure as well. I'll post those view points as well.

Wednesday, December 17, 2008

Updates on outbreaks around the world

1. Cambodia begins poultry cull

Monday we blogged about the confirmed human case in Cambodia. Now culling has begun for poultry

"Cambodian officials began the culling of poultry near the capital of Phnom Penh on December 17, five days after a young man from the area was confirmed to have contracted H5N1 bird flu by the World Health Organization (WHO) and the Cambodian government. The country’s Agriculture Minister Chan Sarun was quoted by news reports as saying that he had ordered a three-month ban on poultry transportation from the province of Kandal, 50km south of Phnom Penh, after tests proved it had been hit by the deadly virus. Cambodian’s Health Ministry said in a statement last week that the 19-year-old man, the eighth person in Cambodia to have contracted bird flu since 2005, was in a stable condition in the capital's Calmette hospital. "

2. Egyptian teen dies of H5N1 infection

"The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A(H5N1) virus infection. The case is a 16-year-old female from Assuit Governorate, Upper Egypt whose symptoms began on 8 December 2008. She was initially hospitalized at the district hospital on 11 December and then transferred to the Assuit University Hospital on 13 December where she died on 15 December. Infection with the H5N1 avian influenza virus was diagnosed by PCR at the Egyptian Central Public Health Laboratory and subsequently confirmed by the US Naval Medical Research Unit No. 3 (NAMRU-3) laboratories on 15 December 2008. Investigations into the source of her infection indicate a recent history of contact with sick and dead poultry."

3. Unorganized culling efforts meet resistance in West Bengal

Households refused to give up their poultry to cullers when compensation failed to arrive at the same time. Culling teams waited around and had to return home with very little accomplished. The local government promises that tomorrow will be more organized.

" Efforts by state authorities in east India to cull poultry to contain the latest outbreak of the H5N1 bird flu virus are being thwarted by poor villagers hiding their birds, officials said on Wednesday. Hundreds of veterinary workers in protective suits were only able to kill about 250 birds after they began culling operations in the Malda district of West Bengal on Tuesday.
They have set a target of 16,500 chickens and ducks to be killed by Thursday, with owners to be compensated by the state.

"The villagers tried to hide their poultry that survived the virus," said Bishon Chowdhury, a senior local government official. "Also, many resisted because the workers arrived without spot payments for the culled birds," he said"

4. China has confirmed H5N1 outbreak in poultry

"NEARLY 380,000 birds were slaughtered after the deadly strain of H5N1 avian flu was found in east China's Jiangsu Province, the Ministry of Agriculture said yesterday. The virus was discovered in Dongtai City and neighboring Hai'an County, the ministry said in a statement posted on its Website. There were no reports of human cases.

The ministry said it received information about H5N1 infection among hens in Dongtai and Hai'an on Monday. It was discovered during routine checks; no birds were reported sick."

A Picture is Worth a Thousand Words...

...or in this case, a map!

The Avian Influenza Daily Digest has posted two maps of avian influenza on Google Earth that are worth looking up:

1. An HPAI H5N1 Outbreak Map that allows you to see the global count and spread of all suspected and confirmed cases of HPAI H5N1 in the last 60 days.

---> Click here to go directly to the map:,112.664795&spn=5.372291,7.514648&t=h&z=7

2. An H5N1 in Humans Map that lets you see all cases of human infection with H5N1 confirmed by the World Health Organization for 2008.

--->Click here to go directly to the map:

These two maps are great tools to help visualize the recent spread of avian influenza in the world. We hope you will find it helpful!

Monday, December 15, 2008

An avian flu success story!

I saw this story on Crofsblog and had to make sure all of you saw it! It's a report about the farmer who had the unlucky distinction of being the first outbreak of H5N1 on the China mainland in 2004. Because of the experience he transitioned from being a backyard farmer that made very little off of poultry to establishing a large poultry farm which follows biosecurity measures and makes a great profit!

Excerpt below:

"Nearly five years ago he was hiding from reporters and even fearing for his life. Today he is a very successful local chicken farmer with a lot to crow about.

His Dingdang chicken brand is now sold in the markets of Nanning, capital of the Guangxi Zhuang autonomous region in Southwest China. It is also sold in Hong Kong and Macao too.
I remember talking to Huang on his duck farm in Dingdang Town during the 2004 crisis. We both wore white coats and masks for fear of contracting bird flu, which killed 200 of Huang's ducks.

It was confirmed to be the first case of H5N1 subtype of avian influenza on the mainland.
A gravel path zigzags through patches of sugar cane and orange trees to Huang's home. Back in 2004, it was coated with white lime for decontamination purposes. Today, grass and bushes grow lavishly near the ponds, which were once swarming with ducks.

Now the grounds are a playground for his chickens, which are fenced inside the 0.4-hec farm.
Huang, a stout man in his mid-30s, walks with brisk steps, and arouses his 10,000 chickens into a cackling chorus. He asks me to dip my shoes into a shallow basin of liquid disinfectant before entering his farm.

"Were it not for bird flu, I would never have dreamed of making business out of it," Huang says, beaming with a broad smile. Huang is a changed man. In 2004, he locked himself in a deserted primary school refusing to meet busloads of journalists who flocked to interview him following the bird flu outbreak.

"I dreaded so much of contracting bird flu, and I was equally afraid of facing the media," he says.
Today, Huang is a spokesperson of Dingdang town, and even speaks on behalf of Longan, a county with 380,000 residents.

Back in 2004, Hui Liangyu, then China's vice-premier, came to Huang's town in the wake of the infection and encouraged local authorities to "help farmers to their feet from where they fell".
The Longan county authorities acted swiftly. Gan Qiangzhong, the then deputy magistrate, decided to modernize and develop a poultry industry out of the ruins.

"It had been a long tradition for farmers to raise fowls in their courtyard, without regular quarantine and disinfection," Gan says. "This meant they could not make decent money out of it, and it also increased the possibility of spreading disease."

The Fengxiang Poultry Co became a pioneer in Guangxi's poultry industry by investing 20 million yuan ($2.2 million) to build a breeding farm capable of supplying 18 million chicks a year to farmers. A skeptical Huang went to see the farm and attended the company's promotion sessions many times until he was convinced.

The company had no record of bird flu since it was founded in 1985 and provided veterinary services, such as drugs, monitoring technology and chicken feed. It also promised to purchase chickens at a preset prices, even when the market prices fluctuated. Huang's farm was the first in the Dingdang town to meet the parameters set by the company: it was far from the residential community, it had good ventilation, an adequate supply of clean water and also had fruit trees.
In July 2004, Huang became the first local partner of the Fengxiang company to raise chickens.
With a loan of 8,000 yuan and a subsidy of 2,000 yuan from local government, Huang built chicken pens for 5,000 baby chicks. To the envy of his peers, the farmer pocketed 4,000 yuan in the first deal. The local annual per capita income is 2,500 yuan.

"A chick grows up in 120 days, so you may raise about three rounds a year," he says. "On average, I can earn 20,000 yuan in profit a year."

Twice a day, Huang and his wife feed chicks and chickens, which also scratch around for insects beneath fruit trees. The couple also administers medicine to the chicks to warn off disease.
The Huangs' orange orchard has also become more profitable. They no longer need to buy tons of manure to fertilize the trees thanks to the steady source of chicken manure. Huang even sells manure to banana growers.

Occasionally, a few chickens die of bowel disease or from sudden temperature changes, and Huang reports the deaths to the Fengxiang company, which sends workers for checkups.
But bird flu has never again haunted his farm, he says."

Update on current outbreaks and human cases

It's begining to look a lot like avian flu season out there...

1. Cambodia has confirmed a new human case

"Cambodia's Health Ministry has confirmed the country's eighth human case of virulent bird flu since 2005.The ministry was quoted by news reports as saying in a statement issued with the UN's World Health Organisation on December 12 that a 19-year-old man from Kandal province, southeast of the capital Phnom Penh, was confirmed to have the deadly H5N1 strain of the virus. The man is being treated at Calmette Hospital in the capital. Cambodian health and agriculture ministry officials have been dispatched to the victim's village to ensure that there is no further spread of the disease. The case, the first this year in Cambodia, comes a day after a senior World Health Organization official warned that Asian nations must remain vigilant against the disease.-Enditem"

2. Culling operations in Assam, India are in their 17th day

"Culling operations continued for the 17th day today in Assam, with nearly 3.80 lakh birds culled in six bird-flu affected districts. Director of animal husbandry and veterinary department Dr A Kakati said 17,942 birds were culled, and 33,937 eggs were destroyed today. Culling is expected to be completed by tomorrow, he said. More than 900 members of the rapid response team are active in the affected districts for culling, mopping or combing, surveillance and for disinfection, he said. However, there was no report of avian flu being transmitted to humans, and a strict surveillance was being maintained and measures were being taken, to ensure that the disease does not spread to fresh areas."

3. New H5N1 outbreaks confirmed in birds in West Bengal, India

" Laboratory tests on dead birds have proven a new outbreak of the H5N1 bird flu virus in the eastern Indian state of West Bengal, a state government official said on Monday...West Bengal officials said several hundred birds could have been found dead but disputed local media reports that as many as 5,000 birds were dead."

Friday, December 12, 2008

Looking for human cases in the Assam outbreak in India

Some good news and some bad news this morning. The bad news first:

"India is sending bird flu experts to the northeastern state of Assam and setting up isolation units to treat up to 90 people showing signs of the virus, health authorities said on Friday.
Health workers have yet to confirm any human cases of H5N1, but they said some patients were suffering from fever and respiratory infections, which are symptoms of the virus in humans...

"So far none of the patients has a history of contact with infected poultry, but we are taking no chances. If the disease is transmitted to humans it will be a big disaster," Sarma said.
The medical teams brought supplies of equipment as a preventative measure in case the virus spreads to humans, including 10,000 Tamiflu capsules, 6,000 surgical masks and two ventilators."

Anytime we have large numbers of people with flu like illness there is a possibility that this could be a human to human cluster. The good news is seeing governments take this seriously and "taking no chances"

Tuesday, December 9, 2008

H5N1-confirmed death in Indonesia: Ending three-month stretch of no human deaths

The WHO released an update today announcing the Indonesian Ministry of Health confirmed two new cases of human infection with H5N1.

One patient, a 9-year-old who developed symptoms on November 7 and was hospitalized on November 12 recovered nearly two weeks later. Lab tests recently confirmed the illness was in fact H5N1. The infection was linked to poultry deaths near her home.

"The second case, a 2-year-old female from East Jakarta, developed symptoms on 18 November, was hospitalized on 26 November and died on 29 November. Laboratory tests have confirmed infection with the H5N1 avian influenza virus. Initial investigations into the source of her infection suggest exposure at a live bird market.

The case-fatality rate remains exceedingly high in Indonesia, more than 80% of the 139 confirmed cases in Indonesia have been fatal.

The full report can be found at:

Wednesday, December 3, 2008

More on the "One World, One Health" Movement

The Herald Tribue (Sarasota Florida) had a good article today about the "One World, One Health" concept. The concept for "One World, One Health" has been around for a while, but with the recent focus on it at the Sharm El Sheikh conference we may be seeing a renewed interest and commitment to concept by major institutional players and donors.

Guest columnist Bruce Kaplan describes the movement:

"The "One Health Initiative" is a movement to forge co-equal, all inclusive communications and collaborations between physicians, veterinarians and other scientific-health related disciplines. This has been limited or absent for much of the 20th century.

When properly implemented, the sharing of scientific information will help protect and save millions of lives in present and future generations. The One Health concept is a worldwide strategy for expanding interdisciplinary interactions in all aspects of health care for humans and animals. The synergism achieved will accelerate biomedical research, enhance public health efficacy, expand the scientific knowledge base, and improve medical education and clinical care."

Though we often hear about the lack of collaboration, Kaplan gives three examples of success:

"1. A physician and veterinarian research team in 1893, Drs. Theobald Smith and F.L. Kilbourne, discovered the cause of cattle fever, Babesia bigemina, and that it was being transmitted by ticks. This work helped set the stage for the discovery by Walter Reed and his colleagues of the transmission of yellow fever in humans.

2. The Ebola virus was identified as the cause of Ebola hemorrhagic fever in the 1970s through the collaboration of veterinarian Fred Murphy and physician Karl Johnson. These two made history by working closely together at the CDC on this and other topics. Hemorrhagic fever viruses are now designated by CDC as bioterrorism agents.

3. Rolf Zinkernagel (physician) and Peter Doherty (veterinarian) working together as immunologists, discovered how the immune system tells normal cells from virus-infected cells. For this, they received the 1996 Nobel Prize for physiology or medicine."

While all of these examples are biomedical, CARE is working to focus efforts collaboration between human and animal health sectors in the community. It would be great to look at the work of outbreak response and prevention for successful collaboration.

Suspsected human H5N1 cases in Turkey & Indonesia

There are two spots we're watching for potential human cases of H5N1, including hospitalized patients in Turkey and Indonesia

From Avian Influenza Daily Digest

"Turkey: 5 Hospitalized due to Suspected AI in Ortaklar Village
12/1/08 ARGUS--A regional source reports that 5 people in Ortaklar Village, Vezirkopru District who were visiting each other were hospitalized at Vezirkopru Government Hospital due to suspected avian influenza (AI) after consuming an unspecified number of sick chickens and complaining of fever and nausea. According to the source, laboratory tests are underway. Reportedly, 1 child and 1 adult remain hospitalized. 3 were discharged."

The second location is in Rejoso Village, Ampel, Boyolali Indonesia where a family is being tested and observed. However, there is very little information at this time

Tuesday, December 2, 2008

Mapping CARE's programs and capacity in avian and pandemic influenza

Through collaboration with the CDC and our Avian and Pandemic Influenza Program, CARE’s Capacity Map of Avian & Pandemic Influenza programs has been completed and is now available on our AI & pan flu website. This compendium of programs, activities and staff capacity is a wonderful summary of the global efforts being administered by CARE to help prevent and respond to avian influenza and prepare for a pandemic.

The same information is also available in an innovative format - CARE’s work in avian influenza has been imported and mapped into Google Maps & Google Earth. It is now possible for anyone to view CARE’s AI work around the globe when a simple search through the Google Maps program is performed.

The following link will take you to the proper site on Google Maps: Alternatively, you can go to, select “Maps” and do a search for “CARE's Work in Avian & Pandemic Influ­enza.”

We have also embedded the map on the CARE AI website:

Friday, November 28, 2008

More media coverage of CARE Bangladesh's AI work

CARE Bangladesh continues to build NGO capacity through awareness raising workshops and the The New Nation reported this from a recent workshop:

"The speakers urged all concerned government and non-government organisations as well as poultry bird farmers should work together to protect this potential sector from any adverse impact.

Besides, they said, focus should be given on creating awareness among the grassroots people side by side with intensifying inter-departmental coordination to check bird flue.

Local unit of Mohila Sanghati Parishad (MSP) and CARE- Bangladesh jointly arranged the workshop styled "Influenza NGO Network" at the conference hall of Rajshahi Chamber of Commerce and Industry.

The speakers said that measures should be taken to gear up the activities of Bangladesh Rifles (BDR) and other law enforcing agencies to check smuggling of chicks and eggs into the country from neighbouring India.

Additional Deputy Commissioner (Education and Development) Satyendra Nath Sarker, Training Officer of Department of Agriculture Extension Dr Ittefaqul Azad, District Livestock Officer Khairul Alam and Journalists Mustafizur Rahman Khan Alam and Akbarul Hassan Millat addressed the workshop as guest speakers with MSP president Shahnaj Begum in the chair.

They said steps should be taken to impart motivational training to the poultry farmers, the concerned officers and employees of the Livestock Department and other law enforcers to check any kind adverse impact in this sector.

They said effective steps should be taken to prevent entry of any chick or poultry bird into the country from India.

Owners of the poultry hatcheries, they said, should also be brought under the close supervision and monitoring network of the Department of Livestock.

They also suggested involvement of religious leaders' in creating mass awareness, enforcement of bio-security in laboratory for bird flue test, ensuring availability of one-day chicks at reasonable price at home and raising inter-departmental coordination.

Great work CARE Bangladesh!

Wednesday, November 26, 2008

What will be the results of the Sharm El Sheikh?

I have finally found a website where they've posted all the presentations from the 6th International Ministerial Conferenceon Avian and Pandemic Influenza in Sharm El Sheikh, including the presentation from our own Dr. Zeinab!

David Nabarro's opening address layed out three priorities:
"1. Ensure that the world is ready to cope with diseases that can trigger a pandemic or
other surprising health events
2. Sustain efforts to control HPAI, especially in poultry; and – eventually – to
eradicate it
3. Initiate longer term action in response to infectious diseases that emerge at the
interface between animals and humans, within different ecosystems, that are
capable of causing severe damage and affecting livelihoods"

These are essentially CARE's strategic focus areas as well, with our efforts being focused on effective models at the community level that contribute to these goals. The third goal is still the most abstract but an important turning point as we start to achieve some results in controlling the virus - we have to build long term systems to detect and prevent emerging infectious diseases early on.

This is one of the main reasons CARE is focused on building effective models of community-based surveillance rather than just focusing on increasing awareness of the current H5N1 risk. The surveillance models that we pilot can be effective for identifying events of public health significance from a broad category of threats.

Unfortunately some of the links to the documents at the bottom of the web page are not working. I'm especially interested in reading "Contributing to One World, One Health " which is the joint document from FAO, WHO, UNICEF and WB outlining the new strategy for emerging infectious diseases. Another document I have a copy of myself but cannot access online, Highly Pathogenic Avian Influenza and beyond: the FAO response, is a good read as well. I'll continue to check back and let you know when these links are working again

Tuesday, November 25, 2008

CARE partners with ADPC for training: Community-Based Management of AHI in Asia

I had the opoprtunity this November to help facilitate the Asian Disaster Preparedness Center's pilot training workshop on community management of AHI in Bangkok. The training including staff from many NGOs and CBOs in the region and a contingent of CARE staff, including Peexiong Gniachong from Lao PDR, Robert DeGroot from CARE Indonesia, Jacquelyn Pinat from CARE Cambodia, and Mai Nguyen and Chi Nguyen from CARE Vietnam. I am certainly indebted to all of them for their help and guidance in presenting CARE's AI work in Southeast Asia.

The workshop covered methods for surveillance, biosecurity, behavior change communication, participatory action research, and emergency preparedness and response. Participants found the workshop helpful, not only from the practical tools and skills included in the materials, but also from sharing experiences and lessons learned with each other. Participants formed "energizer teams" each day and made sure things were never dull. CARE staff blew away the competition during one event - a race to get eggs and chickens at the market while demonstrating healthy behaviors.

This workshop was born out of a partnership between ADPC, CARE, the International Federation of Red Cross and Red Crescent Societies, the International Rescue Committee, the Academy for Educational Development, and the Kyeema Foundation.

Given CARE's innovative work on community-based surveillance, CARE was asked to develop the training on surveillance methods, giving me the opportunity, along with my colleagues from each country office, to highlight the work of CARE Vietnam, CARE Cambodia, CARE Lao PDR, and CARE Indonesia in applying different surveillance models to detect and respond to AHI.

The pilot concluded at the end of November and the materials are undergoing a revision and refinement process for the first of what we hope will be many trainings in the region. The next training will be held in Bangkok in early December, with CARE's own Jacquelyn Pinat facilitating the training on surveillance methods. We wish her luck and know she will do an excellent job representing CARE.

The materials and resources from the finalized training should be available on ADPC's website following the December workshop. Please stay tuned to hear about Jacquelyn's experience at the second workshop and for updated materials from ADPC.

The Daily Star reports on CARE Bangladesh's AI project

CARE Bangladesh, working with Academy for Educational Development (AED), is building NGO capacity on avian influenza through their project "Civil Society Organisations Network Initiatives for Avian Influenza (bird flu)”. Their most recent workshop was reported on by the Daily Star.

The workshop included presentations by the Department of Livestock, FAO and our own Avian Influenza Coordinator, Dr Quazi Md Emdadul Huque! Great work CARE Bangladesh.

Saying thanks to the NGOs working in avian and pandemic flu

Michael Coston, who writes the popular blog Avian Flu Diary, gave thanks and shout outs to people and institutions around the world working to prevent and mitigate an influenza pandemic. CARE, Save the Children and the Red Cross were the three NGOs he called out!

"As we head into this short Thanksgiving Holiday week it is a good time to give thanks to those who are out there, trying to make a difference in this battle against the pandemic flu threat. You may know some of these people by name, and some by the organizations they represent, while others you may not be aware of at all...So, in no particular order, a tip of the hat and a world of thanks go to...There are also many NGO's, or non-governmental agencies, like American Red Cross, CARE, and Save The Children that are working to prevent or prepare for a pandemic as well.

(Each of the aforementioned organizations has a pandemic flu page: Red Cross, CARE, Save The Children.) "

Thanks for the the recognition Michael!

Thursday, November 20, 2008

Indonesia says 17 ill patients in Sulawesi not H5N1

If you've been following the news lately you may have seen reports of 17 people being monitored (and hospitalized) for possible H5N1 infection in Makasar, Sulawesi. A spokeswoman from the ministry of health announced today that the test results were negative. No other details, however, were released.

Reports such as these are very important for NGOs to stay alerted to as a small cluster of infections may one day be the starting point of a pandemic.

For the full story please visit Reuters:

Wednesday, November 19, 2008

CARE Egypt presents on behalf of CARE International & NGOs at the 6th International Ministerial AHI conference in Sharm El-Sheikh

Governement ministries and donors recently convened at the Sixth International Ministerial Conference on Avian and Pandemic Influenza in Sharm El-Sheikh, Egypt. This annual conference is held to review progress and pledgede future funding and action. This year, the conferences aims were stated as:

"1. Encouraging urgent and continued relevant actions by governments, international and regional organizations, non-governmental organizations, and the private sector to build long-term capacity to confront the spread of avian influenza and to prepare for a potential human pandemic.
2. Introducing and examining medium-term strategies for control of avian and pandemic influenza and, more broadly, on emerging and re-emerging infectious diseases at the animal-human ecosystem interface and considering options for their implementation, and
3. Reviewing the use of international funding for HPAI control and pandemic preparedness during 2007-8, and assessing the needs for additional resources in 2009. Countries and donors will have the opportunity to pledge additional funds for support to nations as they seek to confront avian influenza and prepare for a pandemic." (

CARE was invited by UNICEF to present on Challenges and Promising Practices in Communication: Facilitating Community Action to Prevent Avian Influenza

Dr. Zeinab Heada from CARE Egypt did a fantastic job of delivering the key messages from CARE's experience about the role of NGOs. Dr Zeinab shared experiences from CARE's work in Southeast Asia, noting the importance of community participation, gender and poverty as key factors in our forming our approach. Dr Zeinab spoke on 4 key factors in effective communications and community programs for AI:

1. Targeting resources
2. Participation
3. Hollistic technical support to communities
4. Using a lens of gender and poverty

Lora Wuennenberg, Country Director of CARE Egypt reported,

"It was especially refreshing to be able to talk about real situations of people in the midst of many theoretical presentations. One of the co-presenters from Thailand from our session on community mobilization and communication, also recognized CARE as a key partners for community outreach in Thailand."

Great job CARE Egypt!

CARE works with government to respond to HPAI outbreak in Lao PDR

In a recent outbreak of HPAI in Sayabouli District, Sayabouli Province in Lao PDR, CARE has been working closely with government partners in outbreak response, including the following activities:

-Broadcasting information avian influenza prevention via loud speaker to every morning and evening at both Nator and Simeuang markets and distributing IEC (information, education and communication) materials.

Radio & Television
- Ensuring provincial radio and television are using IEC materials for daily broadcasts
- Writing updates on the current situation for announcement on provincial radio

Community awareness activities
- Conducting awareness raising activities in yellow zone villages
- Conducting community awareness activities in 5 schools in the red zone

- CARE has provided their truck for use in transportation of dead poultry (appropriate biosecurity measures are being followed)

Surveillance and reporting
- CARE staff are looking for and reporting any additional poultry die offs as they conduct awareness raising activities in communities and markets and encouraging market traders and community members to report

Community members and traders are appreciative and interested in information. Some of the questions being asked include:

- How do you prevent AI?
- Can we still eat eggs?
- When can we resume normal trading?
- Does AI spread to other mammals?
- Where was the first H5N1 virus found? How did it spread to Laos?
- When will the virus disappear from Laos?

Wednesday, November 12, 2008

New case study on CARE's work in avian and pandemic influenza preparedness

Greetings from CARE USA Headquarters!

It’s been a while since we did an avian and pandemic influenza update, but we have recently completed 3 case studies that chronicle the successes, lessons learned and experiences of the AI programs of different CARE country offices that we will be sharing with you over the coming weeks.

The first documents CARE Nicaragua’s experiences: “Championing Preparedness: A Case Study of NGO Leadership in Public Health Preparedness for Avian and Pandemic Influenza.” This case study charts the evolution of CARE Nicaragua’s AI preparation strategy from developing a preparation plan to protect CARE activities and staff during an AI outbreak to playing a critical role in multi-sectoral pandemic preparedness training on both national and regional levels. The success and growth of CARE Nicaragua’s avian and pandemic influenza program is largely attributed to strong partnerships and networking with organizations like NICASALUD, which in turn paved the way for CARE Nicaragua to play an even more pivotal role in government and national-level preparedness.

Please feel free to email us at CARE Headquarters with questions and comments. You can also directly contact Harold Rugama at CARE Nicaragua ( to discuss this case study and learn more!

Tuesday, July 22, 2008

Interesting perspectives from the Gates Foundation on a pandemic vaccine

The Bill and Melinda Gates Foundation is funding initiatives to support the development (and feasibility) of a vaccine for an influenza pandemic. Tadataka Yamada, the executive director at the foundation, recently co-authored a commentary in Nature, stating their perspective on feasibility:

"Several recent developments make this stockpile feasible. H5N1 vaccines with
adjuvants that reduce the required dose as much as fourfold have been developed
and one has been licensed for medical use. Furthermore, the manufacturing
capacity of 500 million doses is calculated on a requirement for three strains
of flu virus for standard vaccinations; in crisis mode, three times as much
monovalent pandemic flu vaccine could be produced. Together, these
considerations could increase global vaccine production capacity to 5 billion–6
billion doses over 12 months. Moreover, adjuvant-enhanced vaccines may provide
cross-protection against strains that have undergone up to seven years of
genetic drift3. If this is true, appropriate planning, manufacture and
stockpiling of currently effective vaccines might provide the basis for an
immediate response to an H5N1 outbreak."

In detailing how the support needed for vaccines to be a feasible option, they mention the importance of surveillance :

"We must build robust mechanisms; for surveillance of an outbreak of pandemic flu
and for delivering prevention and treatment, particularly vaccines, as quickly
and broadly as possible. There must be full integration of vaccine strategies
with other approaches, and we must coordinate research strategies for dealing
with zoonotic and human influenza infections"

It's very important to keep in mind the goals of our prevention efforts are certainly to prevent a pandemic but we can also hope to stall a pandemic as well, which are global efforts may have already done. Also, the work we do in H5N1 surveillance is just the beginning for emerging infectious disease surveillance systems.

For the full commentary see:
(must be a subscriber)

Wednesday, July 16, 2008

This is only a test

This is just a test, it's not real.

The State of Idaho is running a simulation from a blog, which you can find at:

So far they've posted one fake newscast showing a scenario where the world moves to Pandemic Alert Phase 5. So far, it's a good exercise - check it out.

Tuesday, July 15, 2008

A global look on avian influenza

Two things happen during the summer: generally, flu news tends to dip a bit and my blogging interns go off to do field work, so a little less posting happens to this blog.

It is a good time to step back and reflect, however. This latest article from Margret Chan "A Global Perspective on Avian Influenza" published Annals of the Academy of Medicine of Singapore
touches on an important point for me: the world has never before tried to prevent a pandemic (of any sorts) at this scale. I think it's very important that we remember just what it is we've set out to do in order that we don't get discouraged when it's not easy.


"Global public health security is both a collective aspiration and a mutual responsibility that demands cooperative action at all levels. The expansion of the current H5N1 avian influenza enzootic and its incursion into human health presents a real and significant threat of an influenza pandemic.

The world has for the first time an unprecedented opportunity for pandemic preparation. Current global efforts to tackle the H5N1 pandemic threat are centred around the framework of the International Health Regulations (2005) that requires countries to openly share disease intelligence including clinical samples, viruses and epidemiological information.

Present international initiatives also seek to establish more equitable allocation and sharing mechanisms for developing countries, of therapeutic resources, public health interventions and other broad-based support in the event of a pandemic.

To be sustainable, country preparatory efforts need to be integrated within wider national emergency preparedness frameworks and emphasise the strengthening of basic capacities in disease surveillance, outbreak response and health systems
that can respond to a range of public health emergencies.

Such capacity building represents permanent investments in health that will have enduring benefits beyond a pandemic. Preparations must also go beyond the health sector; greater promotion of intersectoral cooperation and an adoption of a whole-of-society approach to preparation is recommended.

Broad collaboration is vital in addressing the complex challenge posed by influenza to our collective security."

For more, read:

Tuesday, July 8, 2008

Ducks die in Southern Vietnam

The week of July 4th, around 1,000 ducks died in Southern Vietnam (Tra Vinh province). Reports indicate the ducks were not vaccinated and included this comment:

"Although Vietnam has been culling and vaccinating poultry for several years, H5N1 remains endemic in the area and is continuously reported in unvaccinated birds.However, recent reports from Hong Kong and Egypt raise concerns that the current vaccination approaches have limited utility, and the continuing reports of H5N1 in Vietnam may reflect these shortcomings."

It's true that number of countries are looking at the long term sustainability and efficacy of mass poultry vaccination. One alternative option being considered is improved surveillance now that the virus is considered endemic in some places.

Thursday, July 3, 2008

Institute of Development Studies plans research on "policy and politics" of the global AI response

A research initiative supported by the Pro-Poor Livestock Policy Initiative will be examining the impacts of the the global HPAI response, the "winners and losers" and how this might impact disease control strategies in the future.

"Dr Anni McLeod, FAO Senior Officer (Livestock Policy), attended the recent planning workshop for this project at IDS. ‘This research comes at a particularly interesting time because the global focus is shifting from Avian Influenza as a single disease and an emergency, to thinking about how we might deal with zoonotic diseases in the future. That is going to require a very good understanding for the political economy in which the diseases are situated and the way that institutions work together to deal with them,’ she said.

‘We have got so much experience with Avian Influenza, there are so many narratives running through this on which we can draw, but there has been very little documentation of those narratives; most of the research that has been done doesn’t take that angle. This is quite a unique project coming at a really interesting time,’ Dr McLeod added.

The research will focus on both the international level, working with the key agencies involved in the global response, and the country level, engaging with four countries in SE Asia – Cambodia, Indonesia, Thailand and Vietnam. The overall analysis of the political economy of policy will reveal key challenges, obstacles and opportunities for responding to avian flu – and potentially other global epidemics. This project is part of a broader initiative of the STEPS Centre on ‘Global epidemics: pathways of disease and response’.

Working with collaborators in international agencies and national programmes, as well as funding agencies, the aim will be to develop a fresh and critical reflection on the current response to the HPAI challenge, asking questions about the distributional and sustainability consequences of the existing policy response"

Tuesday, July 1, 2008

New Resource! Community-based Surveillance Case Study from CARE Vietnam

CARE Vietnam has been at the forefront of our avian and pandemic influenza programming and with them we’ve produced this case study concerning their community-based surveillance system and an outbreak of avian influenza that was caught by CARE trained and supported surveillance volunteers.

Other CARE country offices, including Laos, Indonesia, Cambodia and Myanmar, have also been working to pilot and strengthen community-based surveillance. We are excited about this innovative work that has ramifications for community-based surveillance of many disease, both animals and humans, and could significantly contribute to both current health systems and detection of emerging infectious diseases. We hope to be publishing further case studies on models of community based surveillance in the coming months.

Click here for the case study and check out our previously disseminated work at:

Friday, June 27, 2008

Local training in Cambodia

More than 6000 village vets were trained by the Food and Agriculture Organization (FAO) and the Department of Animal Health in Cambodia. An additional 186 district veterinary officers from 24 provinces were trained to be become trainers so the the project will continue once the FAO pulls out. The trainings target village animal health workers, focusing on surveillance, bio-security, and outbreak response and communication. According to the FAO, animal health workers who have received training "have more confidence to speak in public and can answer questions from the villgagers".

Full story at

This is a great example of the importance of surveillance networks and the need to collaborate. By working with other agencies such as the FAO, we can increase impact rather than duplicate efforts.

Tuesday, May 27, 2008

Second H7 strain of avian flu identified

Researchers from the CDC in Atlanta have identified H7 strains of the flu virus that have demonstrated some of the traits needed to infect humans. Scientists say that although there is no immediate indication that H7 will acquire damaging mutations, it is critical that global surveillance systems cover H7 in addition to H5.

Dr. Tumpey, who led the team from the CDC, found that H7N2 is capable of replicating in the respiratory tract of mammals and can be passed from animal to animal.

"This suggests that the virus could be acquiring an ability to bind to sugars found on the cells of the human windpipe. This happened during all three of the 20th-century flu pandemics, which occurred in 1918, 1957 and 1968. “These findings suggest that the H7 class of viruses are partially adapted to recognise the receptors that are preferred by the human influenza virus,” Dr Tumpey said. "

Full story at

Tuesday, May 20, 2008

H5N1 vaccine approved by EU

GlaxoSmithKline has created a vaccine, Prepandrix, against the H5N1 strain of avian influenza which has been approved by the European Commission.

"Prepandrix targets an antigen from an H5N1 strain called A/Vietnam/1194/04, which has been detected in birds in Asia, Europe and Africa. Clinical tests have shown that the vaccine is also effective against other closely related variants of H5N1, such as H5N2. The release of the vaccine is seen as a gamble that any future pandemic strain will closely resemble the Vietnamese version used to derive the vaccine."

Although there are concerns regarding the efficacy of the vaccine and how best to implement a vaccine coverage campaign, researchers are optimistic that the development of the vaccine will aid the public health community in the event of a pandemic.

"In the event of an outbreak, the causative agent first needs to be characterized by researchers so that a vaccine can be designed against that strain. Influenza travels very rapidly, so responding rapidly to control its spread is paramount.

In the event that a pandemic strain differs from that used to make the vaccine, a preemptive vaccination programme with Prepandrix would at least give researchers time to respond to develop a new vaccine."

Full story at:

Monday, May 19, 2008

A really important approach for disease surveillance

Over the past few years, FAO, ILRI and a few others have been applying participatory techniques to disease surveillance (in animal health) and I think it's one of the most important breakthroughs in how we'll learn to cope with emerging infectious diseases and zoonosis.

This summary from the Communication Intiative:

"As described in the article, participatory epidemiologists rely on local knowledge to gather data on how a disease is spreading and is kept in circulation, and which diseases have the most impact on livelihoods, from the perspectives of those affected. It is called a 'customer-oriented' approach to disease control and surveillance....

An example is avian influenza reporting in Indonesia, where participatory epidemiologists, as stated here, "highlighted the true extent of bird flu.... When the programme was initiated, the extent of bird flu infection was not known. However, participatory epidemiologists found that bird flu was circulating unimpeded in backyard poultry, and within the first 12 months of operation, 800 disease events were detected..."According to the authors, "traditionally, there is little collaboration or sharing of information between the veterinary and public health sectors." The authors argue the need for veterinary and public health to work together more closely and to apply participatory approaches. They make the following recommendations:
  • Expand the field of participatory public health through active research to identify public health surveillance and response gaps that can be filled using participatory methods.
  • Provide advocacy for policies that recognise veterinary services as integral to public health.
  • Devise innovative ways to integrate participatory disease surveillance workers and participatory public health practitioners in the field; and
  • Create effective models for integrating public health and veterinary surveillance, including the development of unified ‘public health’ databases.

One step forward has been the establishment of the Participatory Epidemiology Network for Animal and Public Health. Its purpose is to advance the science of participatory epidemiology through targeted research, capacity building, policy enhancement and practitioner education. The network is coordinated by ILRI and includes FAO, OIE, AU-IBAR, and non-governmental organisations experienced in participatory epidemiology methods."

For the full paper, go here:

Friday, May 16, 2008

Indonesia says it will share bird flu information

On Thursday, Indonesia announced that it will start sharing all information about bird flu with a new global database after a year long boycott of the WHO's virus sharing system.

"Experts said participation by Indonesia, the country hardest hit by avian influenza, will be a great help after its yearlong boycott of the World Health Organization's virus sharing system.
China, Russia and other nations that have withheld virus samples and genetic data are taking part as well, saying it offers transparency and, for the first time, basic protection of intellectual property rights.
With nearly half the 240 human deaths recorded worldwide, Indonesia is seen by many scientists as a potential hotspot for a pandemic. But its health minister started withholding virus samples and data from the WHO in January 2007. She feared that pharmaceutical companies would use it to make vaccines her people could not afford."

Fort Worth Star Telegram

Two siblings died of suspected bird-flu on May 4 and May 14 in Indonesia with another sibling being treated for bird flu like symptoms. Bird-flu has not been confirmed as the cause of death as the government needs time to confirm suspected cases.
Via The Jakarta Post

Hopefully, with the collaboration of more nations, a comprehensive database will be able to provide valuable information on the mutation and transmission of AI.

Friday, May 9, 2008

WHO is updating Pandemic Preparedness Guidelines

WHO is just wrapping up a 3 day meeting where experts are working on updates for the pandemic preparedness guidlines.

"Since 2005, there have been scientific advances, such as the development of H5N1 vaccines and greater experience with clinical treatment of H5N1 cases. Moreover, legal developments such as the entry into force of the new International Health Regulations will influence how Member States and WHO respond to potential and actual pandemic influenza threats.

Working groups will focus on areas such as disease control, surveillance, medical interventions, non-medical interventions (such as continuation of emergency services, organization of mass gatherings and school closures) and the role of communications during an influenza pandemic. Once the content is agreed upon, new draft guidelines will be circulated for comment. The guidelines are expected to be published by the end of 2008."

I'm glad to see this happening, but I hope we get to see drafts before the end of the year!

Monday, May 5, 2008

Planning for an Influenza Pandemic: Social Justice and Disadvantaged Groups

From the Communication Initiative...

"This paper builds from historical evidence from the 1918-1919 influenza pandemic that lower social classes and oppressed groups had higher mortality rates than the dominant or ruling population and suffered more from severe social and economic disruption. It examines the application of social justice to the situation of a pandemic and asks for attention to groups characterised by severe economic poverty or subordinate social status and power in the context of planning for and responding to a pandemic. Its specific analysis is of national pandemic planning using criteria set forth in a checklist created from the bio-ethics principles set forth by the Bellagio Group

Because the World Health Organization (WHO) Checklist for Influenza Pandemic Preparedness Planning and most subsequent pandemic preparedness documents do not specifically address the needs of socially and economically disadvantaged groups, an international panel of experts met in Bellagio, Italy, in July 2006, "to identify current and potential responses to pandemic influenza that are likely to have profound effects on the world’s disadvantaged, and to recommend concrete steps to prevent - or at least mitigate - those outcomes that are the most unjust." The group developed a statement of principles and checklists intended to provide specific guidance to planners and those working in the field. The checklist criteria for the development of pandemic preparedness and response plans used for this analysis are:
1) explicitly identify disadvantaged groups within society;
2) engage these groups in the planning process, either directly or through their representatives; and
3)identify and address the special needs of disadvantaged groups in the context of a pandemic. "

To take a look at the paper:

Friday, May 2, 2008

Scientists can make human antibodies faster than ever before...

"A new method of producing antibodies to fight infections has been developed. Researchers have stated that they have found a way to create monoclonal antibodies which could fight the avian flu, as well as other diseases, at record speed.
The research was published in the journal Nature and states that scientists, for the first time, were able to produce proteins which could attack and kill a disease quickly and efficiently.
This new method of manufacturing antibodies could one day lead to many lives being saved as it could quickly battle an epidemic.
Up until now, kit usually took around three months to actually try and create a human antibody that would be effective at all.
With this new method, it could be created within a month, allowing for many more people to survive.
The new method was carried out at the Emory University School of Medicine in Atlanta. It uses antibodies produced by white cells of B cells in the body. The method takes genes out of the cells and builds the antibodies off of those.
Researchers expect the technique to become very common in a few years if all goes according to plan."

Story retrieved from:

Tuesday, April 29, 2008

Indonesia: FAO Case Study

The Community-based Management of AHI in Asia newsletter was initiated by the AHI-NGO-RC/RC Asia Partnership, comprised of the IFRC, CARE, and IRC and funded by the Asian Development Bank. The newsletter shares lessons learned with NGOs and other international organizations using participatory, community-based methods to manage avian influenza in high-risk areas. The full newsletter for April can be viewed here:

In June 2008, the partnership will be releasing a toolkit for community-based work aiming to strengthen community-based prevention and control of H5N1 in Asia by "highlighting experiences in community-based management of (H5N1) in Asia through the collation of case studies and the identification of key issues." The toolkit will be available in June at this link:

Below are some truncated highlights from this month's case study about the FAO's work in Indonesia:


FAO in Indonesia has been working with the Ministry of Agriculture and local governments to establish the Participatory Disease Surveillance and Response (PDSR) system, a village poultry HPAI prevention and control programme nationally coordinated via provincial-level Local Disease Control Center (LDCCs). The general concept is that participatory tools and processes serve as a platform for the rapid mobilization and coordination of animal health services in a community-based Highly Pathogenic Avian Influenza (HPAI) control programme.

With rapid detection and response to HPAI outbreaks in village poultry considered key to bringing the disease under control in Indonesia, the PDSR project was piloted in early 2006 to train and operationally support government veterinarians and other animal health officers in a participatory disease control programme for village poultry enabling rapid detection and response. By the end of May 2008, the project will have approximately 2,100 fully operational PDSR officers, with local support provided by provincial-level LDCCs.

The major outcome of the project so far has been a significant strengthening of veterinary services – i.e. increased technical expertise as well as increased technical and operational capacity to conduct activities in the field.

The project has also facilitated direct engagement of communities with local government livestock services, improved national coordination between national and local governments, increased awareness of AI at the community level, improved detection and response to HPAI outbreaks, facilitated HPAI prevention and control activities by communities and the government, and increased the overall understanding of HPAI disease epidemiology.

Some Lessons Identified for Community-Based Management of AHI
The PDSR project recognized that the optimal disease control unit is the village, not the household. Furthermore, due to the endemic nature of the disease as well as the lack of immediate compensation for culled flocks, PDSR teams face significant challenges in maintaining their relations with communities.

Perhaps the most significant lesson identified so far is that village poultry are not ‘the problem’: controlling HPAI does not require ‘fixing’ a problem with village poultry, but rather protecting them as a means to ensure healthy and economically viable villages and communities.

Stakeholders now understand that the role of commercial producers in maintaining and spreading poultry disease should not be underestimated.

Link to full newsletter:

Thursday, April 24, 2008

2 New Suspected Cases of Bird Flu Reported in South Korea

"Two more suspected cases of bird flu have been reported in the southwestern region of South Korea amid intensifying efforts to prevent further spread of the deadly disease, government officials said Tuesday. The Ministry for Food, Agriculture, Forestry and Fisheries said it is checking cases reported at two chicken farms in Iksan, North Jeolla Province, to determine whether the recent deaths of poultry there were caused by avian influenza. The two farms, which reported the deaths of 2,500 and 450 chickens, respectively, are located around 25 kilometers from an area where a bird flu outbreak was confirmed last Thursday, the ministry said. Samples tested positive in preliminary tests but the ministry said further investigation is required.The latest cases in Iksan brought the number of suspected avian influenza outbreaks to 49 as of Tuesday morning. Of them, 26 have been confirmed to be related to a highly pathogenic avian influenza virus, according to authorities."

Story found here:

Thursday, April 17, 2008

Epidemic and Pandemic Alert and Response

"Epidemics and pandemics can place sudden and intense demands on health systems. They expose existing weaknesses in these systems and, in addition to their morbidity and mortality, can disrupt economic activity and development.
The world requires a global system that can rapidly identify and contain public health emergencies and reduce unneeded panic and disruption of trade, travel and society in general.
The revised International Health Regulations, IHR(2005) provide a global framework to address these needs through a collective approach to the prevention, detection, and timely response to any public health emergency of international concern.
An integrated global alert and response system for epidemics and other public health emergencies based on strong national public health systems and capacity and an effective international system for coordinated response is necessary. Epidemic and Pandemic Alert and Response (EPR) has six core functions:
* Support Member States for the implementation of national capacities for epidemic preparedness and response in the context of the IHR(2005);
* Support national and international training programmes for epidemic preparedness and response;
* Coordinate and support Member States for pandemic and seasonal influenza preparedness and response;
* Develop standardised approaches for readiness and response to major epidemic-prone diseases;
* Strengthen biosafety, biosecurity, and readiness for outbreaks of dangerous and emerging pathogens outbreaks;
* Maintain and further develop a global operational platform to support outbreak response and support regional offices in implementation at regional level."
Article retrieved from:

Wednesday, April 16, 2008

Challenges for pandemic preparedness in developing countries

The Communications Intiaitive has done a nice summary of the recent paper from the CDC on challenges to preparedness in developing countries. Improving the planning process and developing feasible mitigation strategies are two things we're very concerned with in the CORE and H2P projects on pandemic preparedness. The highlights below:

"Improving Planning Processes
To minimise the impact of an influenza pandemic, good preparedness plans need to be developed. With the increasing risk for a pandemic caused by the spread of avian influenza A virus (H5N1), most countries have started such planning. ...[T]he approaches used by industrialised countries may not be feasible or appropriate for developing countries. Feasible, user-friendly tools are needed to assist these countries. [The World Health Organization] WHO has developed several such tools, including a checklist for national preparedness. However, these tools describe the general approaches to pandemic preparedness and are not specifically designed for countries with limited resources. For developing countries more practical tools are needed, among them models to estimate the impact of a pandemic in developing countries, a list of feasible interventions to mitigate the impact of pandemic without available pharmaceutical interventions, and planning guidelines for hospitals with limited resources.

Increasing Availability of Antiviral Agents and Vaccines
If the next pandemic occurs in a few years, vaccines and antiviral agents, particularly neuraminidase inhibitors, may not be available as a main intervention in developing countries. Availability needs to be increased to fill the gaps between developed and industrialized countries.

Providing Better Medical Care
Several issues need to be addressed to provide adequate medical care during a pandemic. First, essential medical supplies such as masks, gloves, and antimicrobial agents should be available in hospitals and clinics. Second, healthcare personnel should be trained for infection control measures. Third, healthcare and public health systems need to be maintained to minimize the impact of a pandemic.

Developing Feasible Mitigation Strategies
More feasible and effective strategies should be developed as soon as possible to mitigate the negative impact of an influenza pandemic in developing countries. Since the availability of pharmaceutical interventions in developing countries is less likely, nonpharmaceutical interventions such as social distancing and personal hygiene may be the only available interventions.

Strengthening Core Capacities
Improving pandemic preparedness without establishing a proper national program for seasonal influenza is unrealistic. For example, increasing the availability of pandemic vaccines without increasing the use of vaccines for seasonal influenza is difficult. It is also difficult to implement infection control measures in hospitals and personal hygiene during a pandemic if they are not routinely implemented for seasonal influenza and other infections."

For the Communications Initiative Summary and link to the full article:

Friday, April 11, 2008

22nd H5N1 Death in Egypt

"A 30-year-old woman died of bird flu in Egypt on Friday bringing the total death toll from the deadly H5N1 strain in the country to 22, the local health ministry said. Walaa Ahmed Abdel Geleel first showed signs of the lethal virus on April 2 and was admitted April 9 to a Cairo hospital, where she died, the MENA news agency reported. A total of 49 Egyptians, mostly women and children, have been infected by bird flu since the first case was reported in the Middle East country in February 2006."

Full story here:

Tuesday, April 8, 2008

Human to Human Transmission in China

Chinese doctors confirmed that a son recently passed the H5N1 virus to his father. However, testing of other close relatives has not indicated any further spread. Human to human transmission occurs from time to time when there is close contact and doesn't necessarily mean the virus has mutated to pass more effeciently to humans. It's extremely important that the global health community pay close attention to all clusters, though.

"Chinese doctors have reported that human-to-human transmission likely occurred in a small family cluster of H5N1 avian flu cases in China late last year.
A 52-year-old man from Jiangsu province fell ill with the virus after helping care for his son, 24. The younger man died from his infection Dec. 2 but the father recovered.
In an article published electronically by the British journal The Lancet on Tuesday, Chinese doctors reported that molecular analysis showed that viruses from the two men were virtually identical. They were fully avian viruses, meaning they hadn't swapped genes with any human flu viruses or viruses from another mammal."

Friday, April 4, 2008

H5N1 returns to South Korea

South Korea recently experienced its first outbreak in poultry this year and it's coming later than usual:

"It is the first time an infection of the highly pathogenic strain of bird flu has been reported this late in the year here. So far in Korea, highly pathogenic bird flu cases were only reported between November and February. Authorities have linked the later outbreak to climate change.
The deadly H5N1 strain can affects humans and even kill them if they come in contact with infected birds.

Authorities will cull 308,000 chickens and destroy eggs at seven farms within 500 m from the infected farm. The first bird flu case was reported in Korea in 2003. No human victims have been reported. Between 2003 and March this year, 372 people were infected and 235 died in China, Vietnam, Indonesia, Cambodia, the Philippines and Thailand. "

Thursday, April 3, 2008

Situation in Indonesia

"The Ministry of Health of Indonesia has announced three new cases of human H5N1 avian influenza infection. The cases are not linked epidemiologically. The first is a 15-year-old male student from Subang District, West Java Province who developed symptoms on 19 March, was hospitalized on 22 March and died on 26 March .
The second case is an 11-year-old female student from Bekasi City, West Java Province who developed symptoms on 19 March, was hospitalized on 23 March and died on 28 March.
The third case is a 21-month-old female from Bukit Tinggi, West Sumatra Province who developed symptoms on 17 March, and was hospitalized on 22 March. She is presently recovering in hospital.
The source of infection for all three cases is still under investigation.
Of the 132 cases confirmed to date in Indonesia, 107 have been fatal." Retrieved from:

Thursday, March 27, 2008

STMicro launches speedy chip to detect influenza viruses

SINGAPORE (Reuters) - "Europe's top semiconductor maker, STMicroelectronics, said it has developed a portable chip to detect influenza viruses including bird flu in humans. The device, which functions as a mini laboratory on a chip, can screen and identify multiple classes of pathogens and genes in a single diagnostic test within two hours, unlike other tests available on the market that can detect only one strain at a time and require days or weeks to obtain results. The chip can differentiate human strains of the Influenza A and B viruses, drug-resistant strains and mutated variants, including the Avian Flu or H5N1 strain.
There have been 236 human deaths globally from the H5N1 strain, according to the World Health Organisation, though it remains mainly a bird virus.
'ST sees new high growth opportunities in the healthcare market, especially in areas like patient care,' said Francois Guibert, STMicro's Asia Pacific chief executive, at a briefing in Singapore on Monday marking the commercial launch.
The VereFlu Chip was developed by the Franco-Italian chipmaker together with Singapore's privately held Veredus Laboratories after more than a year of research. The application underwent extensive evaluation trials at Singapore's National University Hospital last year. It allows users to process and analyze patient samples -- comprising human blood, serum or respiratory swabs -- on a single disposable thumbnail-sized microchip.
Guibert said revenue contributions from its biomedical chip business would remain 'negligible' for at least another three to five years.
Veredus Chief Executive Rosemary Tan said the company had obtained 'very promising' sales orders from hospitals and non-hospital customers, but declined to provide details.
Another big potential market is the screening of travelers at airports and border checkpoints, Tan said.
Experts are monitoring the H5N1 virus for signs of mutation into a form easily transmitted from person to person, a development that could trigger a deadly pandemic. So far most human cases can be traced to contact with infected birds.
STMicro and Veredus have set up a joint laboratory in Singapore, where their experts will work on developing new biomedical applications using STMicro's chip platform for other infectious diseases, oncology and heart-disease markers."
Retreived from:

Wednesday, March 26, 2008

Important new study in mapping the risk of avian influenza

A new study published in the Proceedings of the National Academy of Sciences this week tells us more about high risk areas for H5N1 outbreaks in Vietnam and Thailand.

Interestingly, they found that duck "abundance", human population and rice cropping intensity were all associated with outbreaks. The numbers of chickens had a relatively low association. The model derived from Thailand was predictive of outbreaks in Vietnam, which is also surprising and good news. The model has some implications for Cambodia and Laos, but is probably not as applicable to Indonesia, where socio-ecological factors are very different.

For the full article:

Tuesday, March 25, 2008

Check out's perspective on avian flu and other emerging infectious diseases, the philanthropic wing of, has announed their initiatives, one of which is called "Predict and Prevent". Google is interested in indentifying hot spots for emerging infectious disease and improving rapid response.

Check out Google's video on "Predict and Prevent" below:

Thursday, March 20, 2008

Vietnam begins testing the H5N1 vaccine on humans next month

"HA NOI — Human tests of a Vietnamese-produced H5N1 virus vaccine will begin at the Military Medical Institute next month. Vaccine and Bio-Technology Products Company Number 1 (VABIOTECH) director Nguyen Thu Van confirmed the tests to Viet Nam News yesterday.
The eight-month-long tests would be done with about 270 healthy volunteers aged between 18-45, he said.

The purpose of the tests was to evaluate the effectiveness of the vaccine; its safety and dosage.
The vaccine had been developed by VABIOTECH – a subsidiary of the National Hygiene and Epidemiology Institute – from the kidney cells of monkeys using the latest bio-technology available in Viet Nam.

The Health Ministry and the State Science and Technology Council agreed in principle to tests of the made-in-Viet Nam H5N1 vaccine on humans earlier this month. The approval followed the successful testing of the vaccine on animals. VABIOTECH started development of a H5N1 vaccine in mid 2004 when avian flu was spreading throughout Viet Nam.

The Nha Trang Vaccine and Bio-medical Institute reports that it is also completing its research of an influenza type A/H5N1 vaccine for humans. The institute had developed its vaccine on eggs with embryos and produced nine batches, or 10,000 doses, that met the verification standards of the on-the-spot laboratory, said its director, Le Van Hiep. Half the doses had been sent to the National Vaccine and Bio-medical Verification Institute for testing."

Tuesday, March 18, 2008

What is AI?

From the Communication Initiative...

"What Is AI?" draws on the medium of film as part of a strategy for raising awareness about avian influenza. Specifically, organisers originally prepared the 4 short film modules as public service announcements (PSAs), which may be viewed [in Bahasa Indonesia] online. These modules were then linked together to create a 12-minute video/film called "What is AI?", which features animated graphics in an effort to clearly illustrate how the virus can transmit not only from bird to bird directly, but also how it can live in the environment and be transmitted indirectly as well.

Subsequently, Lao adapted the original to meet that country's specific needs related to avian influenza; research figured into this process, as the film was pretested among a range of stakeholders and the provincial training teams that will be using the film as a training tool. According to organisers, further translations/adaptations may be forthcoming.
Interpersonal communication and print materials are also central to this effort, complementing the film as part of a training programme designed to build the capacity of local leaders to communicate with villages about avian influenza.

Specifically, in all 17 provinces of Lao PDR, "What Is AI?" is part of a training programme that also includes booklets, posters, and other materials that are provided to village leaders and chiefs for use in community meetings about avian influenza. Training of trainers (ToT) sessions involve such participatory tactics as mock trainings conducted with village leaders..

AI-BCC. Also, Ogilvy acted as the production and design team for the original production. In Lao, the training package was developed as a joint project with members of the information, education, and communication (IEC) Task Force in Laos, the government, and United Nations (UN) and non-governmental organisations (NGOs), led by UNICEF - and including the Food and Agriculture Organization (FAO), CARE, AED and the World Health Organization (WHO). The film was dubbed and adapted into Lao by Lao Art Media (production firm)."

Monday, March 17, 2008

Vietnam - 1 H5N1 death confirmed in Ha Nam

"A child infected with type A flu (H5N1) from Van Lam village, Thanh Liem district, northern Ha Nam province has died, Nguyen Lam Quyet, director of the provincial Department of Health affirmed on March 17.

The child was said to have eaten sick chicken raised in the garden. He was hospitalised on March 8 and died a week later. After analyzing his blood sample, the National Institute for Hygiene and Epidemiology concluded that the child was infected with H5N1 – a lethal strain of bird flu.
Currently, Ha Nam provincial authorities are carrying out sterilization and quarantining around the commune and have sent five blood samples of birds in Van Lam village for tests."

Tackling bird flu in Laos

"Vientiane, Laos - When the latest avian influenza outbreak hit northern Laos this month, a local veterinarian picked up the phone and called the new national avian influenza hotline. The free hotline, which is being officially launched this week, is a crucial early warning system that helps the government to track and monitor possible cases of bird flu in Laos. Early warning means early action, fewer infected birds, and less impact on the poor farmers who rely on poultry for food and trading. Here in Vientiane capital, many residents are still recovering from last year’s outbreak of the virus. In Dongbang village, all 150 families lost their ducks and chickens when bird flu ripped through Vientiane capital and Vientiane province last year. But before ducks started turning up dead, none of the village residents had ever heard about avian influenza.

This is the kind of situation CARE is working to prevent. With education, people learn how to identify potential cases of avian influenza, how to protect themselves and their poultry from infection, and how to report a potential case of the virus. The hotline is the latest joint initiative between CARE, the government and several other agencies, and is funded by the Centers for Disease Control.“It is critical for people to report any suspected avian influenza case as quickly as possible,” said Monica Spedding, CARE Laos’ Avian Influenza Project Coordinator. “Last year people moved poultry from the red zone to other areas to avoid culling, so the outbreak spread quite quickly.”Avian influenza, or ‘bird flu’, re-emerged in Asia in 2003 as a threat to poultry. But the virus, which has been found in more than 60 countries, gained international attention because the H5N1 strain can make the jump to humans, sparking a fear of a global flu pandemic.

More than 234 people have died of bird flu since 2003, mainly in Indonesia, Vietnam and China. There have been two human cases of bird flu in Laos – both victims died. But the threat to livelihoods is a more immediate concern to the poor farmers living in countries affected by bird flu. In Laos, where a quarter of the population lives on less than a dollar a day, poultry and eggs are a crucial source of extra income to send children to school or buy extra food for the family. And so in Dongbang village last year, when dead ducks started appearing along the river, the free meat was too tempting to ignore.“We saw many of the poorer families take the ducks home to cook,” said Keth Bangkhame-Phao, the village women’s union volunteer. “And then the poultry in that family all died. Within days, all the poultry started to die. We were very scared. We didn’t know anything about avian influenza. We couldn’t do anything.”In rural areas, chickens and ducks run free through the village, scavenging for food. Many families can’t afford the materials to build fences, or the chicken feed they would have to buy if the birds couldn’t roam free to find food for themselves. So like children in a schoolyard, if one bird gets sick, they all get sick. Government authorities confirmed avian influenza in Bangkhame-Phao’s village, and proceeded to kill all chickens, ducks, poultry and pet birds. Across the province, all poultry were killed to stop the spread of the disease.

CARE and government staff came to work with the villagers, teaching them important information about the virus, but also to learn from the villagers – why did the outbreak spread so quickly, and how can that be minimized in the future.“When the two people died last year, it made an impact. But people forget,” said Spedding. “People know what’s going on in other countries, but they think ‘that’s them, this is us’.”But the disease does not respect borders – the current outbreak in northern Laos is on the border with Myanmar and China, which have also suffered outbreaks in the same area. A regional approach is crucial, which is why CARE’s avian influenza programs are coordinated across four countries: Laos, Vietnam, Cambodia and Myanmar.

It is a group effort, and CARE works closely with the local governments, the World Health Organization, UNICEF and other agencies to reach as many people as possible. Posters, short plays, education sessions – even karaoke and a “Super Chicken” mascot: CARE teams use everything they can to spread the word. The hotline is one more step in the process, enabling people to quickly report dead poultry, but also ask questions and access information about avian influenza.“When we saw dead poultry before, we just thought it was normal. Now, we know what bird flu is,” said Bangkhame-Phao. “We are not afraid because we follow good protection. If there is a dead duck we will call the authorities right away.”

For more information, please contact Bill Dowell, CARE International, Geneva,