China Following a Best Practice: Market Rest Days

I caught this on another avian flu blog and was glad to see it - China is implementing market rest days

Regular rest days help stop the spread of H5N1 because poultry vendors are required to stop selling and slaughtering and clean and disinfect their area of the market. Also, it gives the government a chance to clean larger areas of the market, ensure that there is proper drainage of waste, etc.

http://www.news.gov.hk/en/category/healthandcommunity/070423/html/070423en05001.htm

Market clean up days are recommend by WHO - you can find the guidelines at the Communications Initiative website

http://www.comminit.com/avianinfluenza/ma2006/materials-2797.html

Pan Flu Disproportionately Targets the Poor

According to a recent Lancet article by Christopher Murray et al. (see citation below), the vast majority of those affected by the next pandemic influenza will be people living in resource poor settings. Murray and his colleagues used information from the previous 1918 pandemic influenza and made appropriate adjustments for the current (2004) situation to construct a mortality model for the next pandemic. The model suggests that 96% of estimated deaths will take place in the developing world. The death toll is predicted to be 31 times higher in some developing settings when compared to developed settings. The model suggests that nearly half of the difference in projected mortality was due to differences in income.

During the next pandemic, morbidity and mortality will most likely be mediated through factors such as medical infrastructure, nutritional status, the presence of other diseases, and other poverty-related factors. While it is uncertain how the next pandemic influenza will play out, it is certain that its effects will disproportionately target poor and vulnerable groups. As Neil Ferguson suggests, more work needs to be done to explore the means by which poverty affected mortality in the 1918 pandemic so we can prevent and mitigate mortality in these populations during the next pandemic influenza.

Murray, CJL et al. (2006). Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-1920 pandemic: a quantitative analysis. The Lancet 368: 2211-2218.

Is there a uniform case definition of avian influenza?

It seems weird to ask for a set case definition of the bird flu, but if different health departments are looking at different things, some cases may go undetected, and therefore untreated.

Here's New Zealand's case definitions of avian influenza in humans. Are they similar to your country's definition? What's different?

Under Investigation

A person who has been referred to the Public Health service for investigation of possible H5N1 infection.

Suspect case of Influenza A (H5N1)

Person with acute lower respiratory tract illness of abrupt onset, characterised by:

• fever (temperature >38 C) and
• cough and/or
• dyspnoea (difficult or laboured breathing).

AND, in the seven days prior to the onset of symptoms, one or more of the following:

1. having been in close contact (less then 1 metre) with a suspect, probable or confirmed case of influenza A (H5N1)
2. exposure to avian species or their remains, or to environments contaminated by their faeces in an area where H5N1 infection in animals or humans have been suspect or confirmed in the last month
3. consumption of raw or undercooked poultry products in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month
4. close contact with a confirmed H5N1 infected animal of a species other than avian
5. handling samples from persons or animals that are suspected of H5N1 infection
6. working in a laboratory that is handling samples from persons or animals that are suspected of H5N1 infection.

Probable case of Influenza A (H5N1)

1. a person meeting the definition of a suspected case and
2. limited laboratory evidence for Influenza A (H5N1) (such as IFA+ using H5 monoclonal antibodies).

Confirmed case of Influenza A (H5N1)

1. a person meeting the definition of a suspected case; and
2. laboratory testing demonstrates one or more of the following:
   1. positive PCR for Influenza A (H5N1) or
   2. positive viral culture for Influenza A (H5N1) or
   3. immunofluorescence antibody (IFA) test positive using Influenza A/H5 monoclonal antibodies or
   4. a four-fold rise in H-5 specific Ab titer.

Source: New Zealand. Ministry of Health. http://www.moh.govt.nz/moh.nsf/wpg_index/About-Influenza+-+avian+influenza+-+case+definition#top

Oh, have the times change...for Tamiflu

Tamiflu, one of the two main treatments for avian flu, doesn't seem to be as popular anymore. Scattered reports of resistance to Tamiflu and smaller than expected orders for the drug have forced Roche to reduce its production capacity.

http://www.cnbc.com/id/18330713

I guess this begs the question: well, what's next? More countries are working on their own vaccines using strains found within their borders in hopes of creating a cheaper vaccine that's more effective to their own cases. Is this a vaccine race or a struggle between developing countries and developed nation pharmaceutical corporations?

WHO Stockpiles for the Poor

As WHO considers stockpiling 60 million bird flu vaccine doses to be used in developing countries, the world's most affected nations hope to benefit. Many nations hit hardest by the virus, including Indonesia and Thailand, frequently share samples of the H5N1 virus with the international community. These samples are often used to develop vaccines that are too costly for these countries to purchase for themselves. Therefore, this stockpile may be viewed as a long awaited return on an investment. While WHO officials declare the stockpiling feat "feasible," questions remain in regard to the funding of this task.

With this article, and others like it, we remain hopeful that vulnerable populations will remain in the forefront of our minds as we prepare for a possible pandemic influenza.For further details, view the full article:
http://www.alertnet.org/thenews/newsdesk/L2557204.htm

CARE Afghanistan helps communities report and respond to outbreaks quickly

Our AI point person in Afghanistan, Zohra Shamszai just filled me in on CARE's role in helping report an outbreak in poultry in March.

One of CARE's project beneficiaries brought in several dead chickens to a livestock center and CARE took down the case history. The high mortality rate and symptoms pointed to suspected H5N1, so CARE sent the samples to the nearest reference laboratory. It was confirmed H5N1 and within 2 days of the beneficiary bringing in the dead poultry, outbreak response was happening on the ground. CARE followed up with project beneficiaries in the area, reinforcing the AI prevention messages that they have been including in many of their projects.

WHO to support vaccine technology transfer

Since the beginning of our work in avian flu, equitable access to vaccines and anti viral medications has been a major advocacy point for CARE. It's encouraging to see this press release, that WHO will give grants to six developing countries to establish in-country manufacturing capacity for influenza vaccine. The countries are Brazil, India, Indonesia, Mexico, Thailand and Viet Nam.

Another great point about this, it will boost production capabilities of seasonal flu shots as well.

It's a great step forward, but it will take 3-5 years for production to start locally!

http://www.who.int/mediacentre/news/notes/2007/np18/en/index.html