Two possible human H5N1 cases in Vietnam.

From CIDRAP:

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

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


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

UK study reveals "complacent" doctors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

16th Province with H5N1 in Vietnam

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

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

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

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

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

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


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

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

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

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

Indonesia reporting 79th death from H5N1

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

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

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