Wednesday, May 26, 2010

FAO: Early and Rapid Diagnosis of Avian Influenza

20 May 2010 - Influenza A, including avian influenza, is a major public health threat in developed and developing countries. Early, rapid and accurate detection is a key component of strategies to contain, halt or mitigate disease transmission. In the context of highly pathogenic avian influenza (HPAI), the efficient diagnosis of this and other emerging and transboundary diseases is essential to protect animal and human health in the event of a major outbreak.

In a recent scientific consultation on influenza and other emerging infectious diseases at the human-animal interface held in Verona, Italy, it was concluded that there is an urgent need to gain a deeper understanding of host and susceptible population dynamics, along with a firmer grasp of the active and multifaceted interplay between domestic animals and wildlife in diverse agro-ecological systems.

In recent years, experts, scholars and practitioners have highlighted the benefits of using science-based laboratory applications to further elucidate the environmental characteristics used by actual and potential animal hosts in their natural settings. This can be done, for instance, by using stable isotope analysis (SIA), which is a technique that aids in identification of isotopic signatures, the distribution of certain light stable isotopes (for example, Hydrogen-2, Carbon-13, Nitrogen-15, Oxygen-18 and Sulfur-34), and specific chemical elements within complex chemical compounds. This technique, or variations thereof, such as isotope ratio mass spectrometry (IRMS), are utilised to trace food webs and track the origins of target animal species. Some of the substrates for these applications are feather, blood, faecal, hair and aqueous samples collected from animals and the environment.

These techniques are now used - and hopefully can be broadly adopted - to produce the tangible evidence needed to support anecdotal reports that resident animal species are picking up viral diseases from visiting species after they move out (for example, asymptomatic mallard ducks during their sojourn in Siberia shed HPAI in the environment) and also to generate data on the ecology of avian influenzas in key bird species worldwide. In fact, several research institutes around the world have been trying to gather evidence and generate data through careful and systematic tracking of migratory birds along their flyways by collecting and analysing samples from wintering and nesting sites to build up reliable isotopic profiles and comparing them to local profiles from where viral disease outbreaks are reported.

In addition to isotope tracing, classical molecular techniques such as Polymerase Chain Reaction (PCR) are being further refined to enhance detection of influenza viruses. In particular, given that HPAI is oftentimes reported in fairly inaccessible rural settings, field PCR tests are now being designed and tested to assess its applicability and usefulness. The advent of new applications and the differing diagnostic capacities of infected locations call for cross-validation of PCR technique between countries experiencing recurrent disease flare-ups.

Given that early and rapid pathogen detection has been posited as a pillar of comprehensive animal disease risk management programmes, the Joint International Atomic Energy Agency (IAEA)/Food and Agriculture Organization of the United Nations (FAO) Division, held the Final Research Coordination Meeting of the Coordinated Research Project (CRP) on "Early and Rapid Diagnosis of Emerging and Transboundary Animal Diseases" on 10-14 May 2010, in Rome, Italy, in which seasoned veterinary laboratory practitioners and diagnostic experts share their knowledge and expertise as the scientific and technical basis for developing or modifying the early and rapid diagnosis of avian influenzas.

The rapid molecular technology platforms developed and fine-tuned by the CRP has allowed improved turnaround time: early, rapid, and confirmed diagnosis has moved from weeks to a day or two, which has in turn improved field cooperation with surveillance programs. This has been critical to rapid and effective avian influenza control in a country with a confirmed incursion of avian influenza H5N1 (e.g. Nigeria). The infrastructure developed with the avian influenza CRP has allowed future development and growth of other laboratory services (the capability is generic in nature and can be utilized laterally). The avian influenza technology has been shared with public health laboratories where possible, and this has allowed new cooperation and collaboration between the public health and veterinary diagnostic community.

The associated molecular diagnostic training has also allowed improvements to laboratory capability and capacity-building. The sharing of information between the CRP members has assisted in the development of a better understanding of avian influenza diagnosis through molecular techniques including an increased knowledge about the disease's epidemiology, transmission and risks. The project has improved the profile of surveillance programs, including wildlife surveillance, and the capability of the laboratory to carry out the diagnostic components of surveillance efforts.

Additionally, as a complement to ongoing research initiatives and capacity-building efforts, the FAO/IAEA Agriculture and Biotechnology Laboratory, located in Vienna, specializes in research, development and transfer of nuclear methods in animal production and health, among other areas. The laboratory provides a broad range of specialized services and training of scientists, as well as guidance on the introduction of analytical quality control and assurance into counterpart laboratories, and training in the maintenance of laboratory equipment and instruments.


S. Korea to share bird flu quarantine knowhow with ASEAN countries

SEOUL, May 24 (Yonhap) -- South Korea will share its knowhow on bird flu quarantine with Southeast Asian countries as part of its effort to help contain future outbreaks of the disease, the government said Monday.

The National Veterinary Research and Quarantine Service said 30 quarantine experts from eight Association of Southeast Asian Nations (ASEAN) countries have been invited to the country next week.

The training program, which begins next Monday and runs through June 15, was arranged in cooperation with the Korea International Cooperation Agency -- an organization that offers free programs for developing countries.

Outbreaks of bird flu have posed a health problem for many parts of Asia with many deaths attributed to the potentially fatal disease, which can be passed from birds to humans.

In addition, the agency will also give lectures on various animal test kits and drugs manufactured in South Korea.

The local animal quarantine service, under the farm ministry, said ASEAN officials will also be briefed on Seoul's countermeasures to deal with other livestock diseases, such as foot-and-mouth disease and brucella.

South Korea is currently trying to contain an outbreak of foot-and-mouth disease that has caused authorities to cull around 50,000 animals.


FDA Clears H1N1 Test for General Use

WASHINGTON -- A test for the pandemic H1N1 influenza has been formally approved for use outside a public health emergency situation, the FDA announced.

Until the clearance of Simplexa Influenza A H1N1 (2009), which is used to test for the pandemic virus in patients with signs and symptoms of respiratory infection, tests for the new virus were available only through an Emergency Use Authorization (EUA).

Such use was allowed after the Department of Health and Human Services declared a public health emergency related to the new H1N1 virus on April 26, 2009. All EUAs expire when the emergency for which they are issued is considered over.

"With this clearance, the availability of the Simplexa H1N1 test will not be affected when the public health emergency expires," said Jeffrey Shuren, MD, JD, director of the FDA's Center for Devices and Radiological Health, in the agency's announcement.

Although a positive result on the test, which uses specimens from nasal swabs or nasal aspirates, indicates infection with H1N1 flu, a negative result does not rule out infection.

The Simplexa test is made by Focus Diagnostics.


No Pandemic but Endemic - Managing Avian Influenza Outbreaks in Nepal

Nepal has faced seven avian influenza outbreaks in animals since early-February this year. In the Central, Southern and Eastern Regions, these outbreaks were quickly spotted by field monitors and successfully contained by Rapid Response Teams, thanks to the Avian Influenza Control Project (AICP).

The project is helping the Government of Nepal to prepare, prevent and control avian influenza outbreaks together with our partner organizations, including USAID, FAO, OiE, WHO and UNICEF. Implemented jointly by the Departments of Livestock Services and Health Services, the project is strengthening surveillance, diagnostic capacity, and prevention and containment activities, improving bio-security in poultry production and trade, and raising awareness through communication activities.

With support from the partners, the AICP has trained field monitors and health workers in 26 High-Risk Zones, set up Rapid Response Teams in all 75 districts, and trained the Teams in stamping out operations, including culling, safe disposal, cleaning and disinfection. It has also established a compensation scheme for poultry farmers, and provided pre-positioned Personal Protective Equipment, antiviral and vaccines for 40-50% of high risk occupations groups.

AICP was initially set up to respond to a potential global avian flu pandemic, which fortunately never happened. However, the avian flu is “here to stay” in Nepal as this is the second series of outbreaks after those in 2009. With no pandemic, the Bank has recently streamlined the project, to strengthen activities which would help Nepal prepare and prevent the outbreaks in animals and humans.

Surveillance has been intensified at commercial farms and at district level through engaging farmer groups, which helped the rapid detections of outbreaks in February in 2010. The project is strengthening existing diagnostic facilities, including upgrading central and five regional laboratories equivalent to the Bio-Security Laboratories 2 (BSL2) standard and operationalizing the National Public Health Laboratory.

The communication campaign through TV and radio spots and a travelling skit team has proven effective in increasing the level of awareness among Nepali. Surveys show that 76% of poultry farmers know and follow practices to prevent spread of avian flu to healthy chickens, such as separating sick chickens from a healthy flock, and reporting sick chickens to vet or local authorities. Moreover, 72% of health workers and almost 70% of general populations wash hands after handling birds, before cooking, etc., which would prevent avian flu to jump from animals to humans.

As the virus actively circulates in West Bengal, Sikkim and Bangladesh, AICP is also actively engaged in managing avian influenza in Nepal and at its borders. In addition to the already successful communication campaign, the project is organizing trans-border quarantine workshops, and successfully conducted one in the West with Indian and Nepali officers.

AICP is making a good progress in achieving its development objectives through effective containment and intensive surveillance and awareness raising activities. The capacity being built by AICP will be enhanced through the Regional Training Program in Epidemiology and Bio-security, which is implemented by Massey University, New Zealand.

The Program will provide 70 animal and human health practitioners in the Region with on-line training at Master’s level in epidemiology and establish centers of excellence in epidemiology or "One Health" hubs in Nepal and other six participating countries in the Region to control avian influenza and other zoonoses that emerge through the interface of animal, human and environment.

These activities will complement each other to help the Government of Nepal to further prevent and control outbreaks in avian influenza.


Thursday, May 20, 2010

The 2nd International Forum on Pandemic Influenza

24-25 July 2010, Qingdao, China

Cambodia: Survey finds low practice of prevention measures

May 2010 CBAIRRP Newsletter--To assess the needs of the newly selected areas in Prey Veng and Svay Rieng, CARE conducted six focus group discussions with villagers in four districts.

The FGD found that over 90 percent of the villagers raise chicken in small scale backyard system, mostly for household consumption, with around 10 to 20 percent of households raising ducks as small-scale business enterprise. There is high awareness of avian influenza but low practice of prevention measures.

Villagers believe that AI can be prevented through washing hands with soap after handling poultry and not eating sick or dead poultry, both actions are considered to be the most effective for AI prevention in humans. Direct contact with poultry without wearing protective clothing is believed to be the main route of AI transmission in humans, with eating sick or dead poultry as another key source of infection. Those who directly handle poultry are considered most vulnerable to AI.

Very few people wear masks or scarves and gloves when slaughtering poultry and those who do, do so only when handling sick or dead poultry suspected of AI. Around half of the villagers interviewed are frightened by AI while the rest don?t concern themselves with this disease.

Those who raise ducks practice more preventative measures but not because of
avian influenza but because it makes good business sense; any disease affecting their flock will impact on their ability to earn more income. Hand washing with soap topped the list of the prevention measures practiced by duck raisers as well as regular cleaning of poultry area , which is practiced by over 90 percent.

Most of the duck raisers are not willing to report sick or dead birds which are rather sold to the market to maximize earning potential. They are only concerned about AI infection when there is massive mortality. Even so, reporting is rarely done as duck raisers are concerned they will not get paid for the number of birds authorities will cull.

Villagers believe in the following prevention measures but some consider them costly: confining new incoming poultry around 2 weeks; raising poultry in fence; not allowing sick or dead poultry coming to the raising areas; cleaning areas regularly; keeping middleman away from poultry pen; Among the members of Village Surveillance Team, the village chief is the most trusted source of information on AI as he plays a prominent role in disseminating or promoting AI messages, followed by the Village Animal Health Worker. Chicken raisers interviewed would report suspect case of AI to the village chief or village animal health worker since they are considered to be easily accessible and their response was expected to be more effective than those of other authorities. However, reporting will only be resorted to in the event of massive deaths.

Newly selected VST members strongly feel responsible for AI prevention in their village. VST and district vet have good collaboration in responding to AI issues rather than health center and other relevant agencies. The messages they will disseminate to villagers are: 1) do not eat sick or dead poultry; 2) look out for these symptoms in poultry (black/swollen head and combs and massive death of poultry); 3) wash hands and clean house and yard. Other messages included fencing poultry, and reporting to the VST if they have sick or dead poultry; 4) wear masks when handling poultry.

However, VST members consider it difficult to identify AI cases since the clinical signs in poultry and symptoms in humans are similar to common poultry diseases such as Newcastle Disease, Fowl Pox, Fowl Cholera and seasonal flu in humans. It is also a challenge to carry out regular surveillance as VST members do not receive any monetary incentive and they have other other community development activities to tend to. Their limited knowledge of technical aspects and prevention measures is also considered a barrier.

Wednesday, May 12, 2010

Southeast Asia aims to eradicate H5N1 by 2020

Maryn McKenna Contributing Writer

Apr 28, 2010 (CIDRAP News) – A multi-national meeting aimed at freeing Southeast Asia from H5N1 avian flu within 10 years wrapped up deliberations yesterday with a call for cooperation to keep animal diseases from crossing national borders.

The First Technical Working Group Meeting on Highly Pathogenic Avian Influenza (HPAI) Roadmap, a project of the Association of Southeast Asian Nations (ASEAN), met for 2 days in Jakarta to work out mutually agreed plans—the "roadmap"—that will be submitted to the 10 member countries later this year.

In the meeting's opening remarks Apr 26, H.E. S. Pushpanathan, ASEAN's deputy secretary-general, recalled the deep damage done to the Southeast Asian economy by the first sustained outbreak of H5N1 starting in 2003, in which 200 million poultry were culled and nations recorded a collective $10 billion in losses.

"HPAI is a transboundary animal disease. Successful eradication would require effective regional collaborative mechanisms and actions," Pushpanathan said in remarks posted on the ASEAN Web site. "Animal health and the issues related to it are important concerns to ASEAN as it will have a serious impact on ASEAN's continued growth and development."

The draft produced by the end of the meeting points the member countries toward establishing a single regional economic market in livestock and animal products by 2015 and eradicating H5N1 from the region by 2020, according to an Apr 28 Xinhua report. It pays particular attention to instituting a "One World, One Health" approach (a concept backed by 38 national and international health organizations) of treating animal and human diseases as a continuum that requires consistent policy responses across government and development agencies.

The move to strengthen Southeast Asian responses to avian flu comes at a time when H5N1, which had slipped behind novel H1N1 in activity and in public health attention, appears to be rising again in both realms.

Vietnam's Department of Animal Health reported yesterday that the country's central province of Quang Tri has recorded an outbreak that killed 250 ducks out of 1,500 on one farm, according to an Apr 27 Xinhua story. Three other provinces have had recent outbreaks, including Quang Ngai (three provinces to the south of Quang Tri), and Bac Kan and coastal Quang Ninh in northern Vietnam.

Bangladesh announced plans to upgrade 19 live-bird markets in Dhaka (the capital) and 11 other cities, using a $575,000 grant from the UN Food and Agriculture Organization (FAO) that funds worker training and sanitation improvements, the Bangladesh Daily Star reported today. Five other markets in the capital have already been upgraded.

The need in Bangladesh is critical: According to the World Organization for Animal Health (OIE), there have been 12 new farm and village outbreaks in Bangladesh since the beginning of March.

And in Indonesia, the Metro Riau news site in Riau province on Sumatra is reporting illness among chickens, believed to be flu, that may have spread to children in a family.


WHO panel offers clinical profile of H1N1

Robert Roos News Editor

May 5, 2010 (CIDRAP News) – A panel of experts assembled by the World Health Organization (WHO) has published a clinical profile of pandemic H1N1 influenza, using data from scores of studies to fill in details of the broad picture that has emerged over the past year.

The report, released today by the New England Journal of Medicine, affirms that the disease has taken its heaviest toll on young adults and children but otherwise generally resembles seasonal flu.

The international team of 15 authors writes that the overall estimated case-fatality rate (CFR) has been less than 0.5%, with estimates ranging all the way from 0.0004% to 1.47%, reflecting uncertainty about the true number of cases. The US CFR has been estimated at 0.048%, a bit higher than the United Kingdom's estimate of 0.026%.

About 90% of those who have died of the virus were younger than 65, while hospitalization rates have been highest in children under 5 years old and lowest in the elderly, the report notes.

The virus seems to be about as contagious as seasonal flu or slightly more so, with estimates of the basic reproduction number (the number of secondary cases caused by the primary case in a susceptible population) ranging from 1.3 to 1.7. But in school outbreaks the number may be about twice as high: 3.0 to 3.6.

The report says that about 25% to 50% of H1N1 patients who were hospitalized or died had no coexisting medical condition. Risk factors for complications are generally the same as those for complications in seasonal flu, including age under 5 years, pregnancy, cardiovascular disease, asthma, diabetes, immunosuppression, and several other conditions. Obesity is "suggested but not yet proved to be an independent risk factor" for severe disease or death.

The virus's incubation period is about 1.5 to 3 days, similar to that of seasonal flu, the report says. But viral replication may persist longer in H1N1, as some studies have found that patients with uncomplicated cases still carried infectious virus 8 days after illness onset.

A mild illness with no fever has been reported in 8% to 32% of cases, the article says. It affirms that gastrointestinal symptoms have been more common in H1N1 than in seasonal flu, especially in adults.

The most common clinical syndrome leading to hospitalization and intensive care, the experts write, is "diffuse viral pneumonitis associated with severe hypoxemia, ARDS [acute respiratory distress syndrome], and sometimes shock and renal failure." This has been seen in about 49% to 72% of intensive care unit (ICU) cases.

Other syndromes seen in severe cases include severe exacerbation of chronic obstructive pulmonary disease (COPD) and asthma. About 24% to 50% of hospitalized patients have had a history of asthma, and COPD has been reported in about 36% of hospitalized adults.

Secondary bacterial pneumonia has been suspected or confirmed in 20% to 24% of ICU patients and found in 26% to 38% of patients who died. The most common pathogens are Staphylococucs aureus (often methicillin-resistant), Streptococcus pneumoniae, and S pyogenes.

The article affirms the established advice about early treatment with oseltamivir (Tamiflu) or zanamivir (Relenza) for high-risk patients and adds that doubling the dose and duration of oseltamivir therapy is reasonable in patients with pneumonia or evidence of disease progression.

The report notes that antiviral resistance has been seen sporadically, mainly in treated patients. The His275Tyr mutation confers resistance to oseltamivir (and to peramivir, a drug that is used intravenously under an emergency use authorization) but does not cause resistance to zanamivir.

Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic 2009 Influenza A (H1N1). Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med 2010 May 6;362(18):1708-19 [Full text]


WHO Update - Pandemic (H1N1) 2009 - update 99 (7 May 2010)

Weekly update
7 May 2010 -- As of 2nd May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18001 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and Member States and through monitoring of multiple sources of information.

Situation update:
The most active areas of pandemic influenza virus transmission currently are in parts of West Africa, the Caribbean, and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected sporadically across Asia, Africa, Europe, and the Americas, however, low levels of late season virus circulation have primarily detected in East and Central Asia, southern Europe, and central Africa.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus persists in parts of West Africa while low levels of seasonal influenza type B viruses continue to circulate in parts of central Africa. In Ghana, pandemic influenza virus detections may be declining after peaking during early April 2010; during the most recent reporting week, 14% of respiratory specimens tested positive for pandemic influenza virus. In Cameroon, low levels of pandemic and seasonal influenza type B virus continue to co-circulate, though the latter have been predominant during April 2010. In the Democratic Republic of Congo, circulation of seasonal influenza H3N2 viruses during February and mid-March 2010 has been largely replaced by circulation of seasonal influenza type B viruses during April 2010. Localized, low level pandemic influenza virus circulation continues to be observed in parts of East Africa, particularly in Rwanda and Tanzania. Sporadic detections of seasonal influenza H3N2 viruses continue to be reported across eastern, central, and western Africa.

In tropical zone of the Americas, limited data suggest that pandemic influenza virus transmission remains active in several countries. In Central America, Guatemala reported three consecutive weeks of an increasing trend of respiratory diseases activity associated with regional spread of pandemic influenza virus and detection of severe cases. In Cuba, detections of pandemic virus and numbers of severe cases have increased since late March, however overall pandemic influenza activity may have recently peaked during the most recent reporting week. In Peru, the number of pneumonia cases in children under 5 years of age in the capital area has been increasing for the past seven weeks and remains above the epidemic threshold; however, the extent to which these pneumonia cases have been due to pandemic influenza H1N1 virus versus other respiratory viruses circulating in the region, is not known. Although the overall intensity of respiratory diseases across the region remained low to moderate during April 2010, for short periods of time, circulation of pandemic influenza virus was reported to widespread (in Cuba and Barbados) or regional (in Mexico, Honduras, Nicaragua, Columbia, Venezuela, Brazil, Ecuador and Bolivia).

In Southeast Asia, pandemic influenza virus continues to actively circulate in several countries of the region, however, respiratory disease trends in the region are variable. In Malaysia, limited data suggest that pandemic influenza virus transmission persists with ongoing reports of new cases (including severe cases) and media reports of several school outbreaks, particularly during late April and early May 2010. In Singapore, the national level of ARI has been steadily increasing since early April 2010 and now exceeds the epidemic threshold; 37% of sentinel respiratory specimens tested positive for influenza during the most recent reporting week. In Thailand, the proportion of sentinel outpatients with ILI and sentinel inpatients with pneumonia testing positive for pandemic influenza virus infection has declined significantly since peaking during late March 2010.

In South Asia, the most active area of pandemic influenza virus transmission continues to be in Bangladesh, which continues to report increasing respiratory diseases activity associated with co-circulation of pandemic and seasonal influenza type B viruses since mid April 2010. However, persistent low level co-circulation of both viruses has been detected since late February 2010. In India, localized low level circulation of pandemic influenza virus continues to be detected in parts of western and southern India.

In East Asia, very low levels of pandemic influenza virus continue to be detected. Although overall rates of respiratory illness remain low across the region, recent low levels of influenza activity in a number of countries in the region have been largely due to circulating seasonal influenza type B viruses. Three countries in region, Mongolia, China, and South Korea, each experienced a period of sustained seasonal influenza type B virus circulation following an earlier, generally more intense, wintertime period of pandemic influenza virus transmission. China and South Korea continue observe active but declining levels of seasonal influenza type B virus circulation.

In the temperate zone of the southern hemisphere, overall pandemic and seasonal influenza activity remains sporadic, except in Chile, where there is evidence of low level community circulation of pandemic influenza virus, including detection of small numbers of severe cases; however it too early to know if this signals an early start to wintertime influenza season. The national level of ILI in Chile remained near baseline; however, in at least two southern regions the region specific level of ILI was elevated above baseline, and in one region, Los Lagos, the region specific baseline has been elevated slightly above the epidemic threshold for the past four weeks. Of note, 6% of sentinel respiratory samples in Chile tested positive for a respiratory virus, of these 32% were positive for respiratory syncytial virus (RSV), and 27% were positive for influenza viruses (half of which were subtyped as pandemic H1N1 virus).

In Europe, overall influenza activity remained low with very low level co-circulation of pandemic and seasonal influenza type B viruses. The overall proportion of sentinel respiratory samples testing positive for influenza remained stable at about 5.3%; and the total number of sentinel influenza B virus detections continued to exceed that of influenza A viruses, primarily due to low level seasonal influenza type B virus circulation in the Russian Federation and Kazakhstan.


WHO panel to review H1N1 pandemic status in coming weeks

The Emergency Committee is waiting for the onset of winter in the southern hemisphere before making its recommendation, spokesman Gregory Hartl said.

That meant the 15-member independent panel would probably meet at the end of May or in early June, after the WHO's governing World Health Assembly next week, he told a briefing.

"They have to look at the information that exists at that time on the activity of the H1N1 virus," Hartl said.

The WHO's guidance on whether a disease constitutes a pandemic determines how its 193 member governments handle an outbreak, including stockpiling vaccines and antivirals.

The United Nations body has been accused of exaggerating the dangers of the H1N1 outbreak, which was declared a full pandemic in June 2009 after dominating last year's health assembly.

The current virus appears to have been less severe than the two previous influenza pandemics in 1957 and 1968, which killed about 2 million and 1 million people respectively, with most victims suffering only mild symptoms.

Confirmed deaths from H1N1 since the outbreak emerged in April last year number at least 18,000, but it will be a few years before the real -- much higher -- figure is known.

John Mackenzie, who chairs the emergency committee and is the only one of its 15 members to have been publicly identified, said last month that the current pandemic was as severe as the two previous ones and remained a threat.

Members' identities are kept secret to protect them from pressure from drugs companies or other interest groups.

Hartl said the committee was likely to have three options: conclude that the pandemic was still in force and retain the WHO's current phase 6 on its 6-level pandemic scale; state that the pandemic had moved into a transitional "post-peak" phase; or declare that the pandemic had passed.

(Reporting by Jonathan Lynn; Editing by Stephanie Nebehay and Reed Stevenson)


U.S. official says scientific cooperation with Indonesia to benefit both

5/11/10 Xinhua--A U.S. senior official promised Indonesian government here on Monday that the further possible science and technology cooperation between the United States and Indonesia would be benefiting to each other.

Speaking on the sidelines of his meeting with Indonesian President Susilo Bambang Yudhoyono, the visiting U.S. special envoy for science and technology affairs Bruce Alberts said there has been misunderstanding of such cooperation, particularly when it was established with developed countries.

"The reason of my appointment as the envoy was not to take something. I was tasked to encourage towards good cooperation," the U.S. envoy said.

Bruce said that Indonesia would eventually be a great and powerful nation only if it is using the science and knowledge.

"Indonesia can be a rich country should it use the correct science and knowledge. We can help Indonesia to attain that condition. Some fears (related to the scientific cooperation with the U.S.) had persisted in a number of cooperation with Indonesia in the past," Bruce was quoted by the Antara news agency as saying.

Due to the fear that results from bird flu research conducted in U.S-Indonesia 'Namru' joint laboratory would be misused by the U.S.military for its own interest, Indonesia closed down the laboratory last year.

Indonesian president is scheduled to sign documents on several cooperation wrapped in comprehensive agreements with the United States during the visit of U.S. President Barack Obama scheduled for June this year.

Indonesian presidential spokesperson Dino Pati Djalal said that President Yudhoyono preferred cooperation in science, knowledge and other non-political sectors would dominate the comprehensive agreements with U.S.