China, Vietnam & Egypt Continue to Make Headlines with Recent H5N1 Cases

The 55th case of human H5N1 infection in Egypt was announced yesterday on Feb. 9th. An 18-month boy with influenza symptoms was checked into a hospital in the Menia governate on the 7th. The boy reportedly had contact with sick poultry prior to being hospitalized. According to the World Health Organization, the boy is recovering and in stable condition.

A 28-year old women from the Quang Ninh province with H5N1 infection has been named Vietnam's first official human case of the virus in 2009. The woman has been hospitalized for nearly a week and is in critical condition. After WHO confirms the case, Vietnam's human H5N1 case will tally 108, with 52 of those cases resulting in fatalities.

For more information, go to CIDRAP.

In the Xinjiang Uygur Autonomous Region of China, over 13,000 fowl were culled Feb. 10th after dead birds in the area were confirmed to have died of bird flu. News of avian infection comes as a relief, since China has raised international speculation after reporting disproportionately high numbers of human H5N1 cases and little to no poultry outbreaks. China attempted to quell fears of human-to-human transmission by revealing that genetic analysis of the viruses isolated from the recent human cases did not indicate any additional mutations to enable it to spread from human-to-human.

For more information, go to the DNI Avian Influenza Daily Digest.

Poultry Outbreaks Continue Around the World

India: The district of Cooch Behar in West Bengal was declared “avian flu-affected” by the district magistrate on January 31st. In response to recent outbreaks and die-offs in birds, the government has ordered the culling of 45,000 backyard poultry in the villages of Uttar Dangkoba and Nagar Bhangni, to be conducted over the next three days.
Source: Crofsblog

Indonesia: Authorities in Bogor, West Java are taking protective measures in response to Jakarta’s most recent H5N1 case fatalities in humans by culling hundreds of poultry in Kelurahan Kedung Badak and Kecamatan Tanah Sareal after several poultry deaths were attributed to bird flu.
Source: Bird Flu Information Corner

Vietnam: After a promising 4 months without any reported AI cases, the district of Tran Van Thoi in the southern Ca Mau province has officially lost its bird flu-free status. The reemergence of the virus has already made a sizeable impact on the district’s poultry, wiping out 460 ducks on one local farm alone.
Source: Xinhuanet

CARE's AI & Pandemic Influenza Capacity Map

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New Human H5N1 Cases in Egypt

Two new human cases of H5N1 have appeared in Egypt since 2009. Behind Indonesia and Vietnam, Egypt has the third highest number of human cases of AI in the world. These two most recent cases bring the overall tally of human H5N1 infections in Egypt to 53.

Shebin Elkom District: A 2-year old girl developed influenza symptoms on January 23rd; she was admitted to a local hospital the same day and treated with Tamiflu. Laboratory diagnostics confirmed influenza A H5N1 infection, and the mother verified that the girl had previous contact with sick poultry. Health authorities reported the girl to be in stable condition on January 26th.

Kerdasa District: A 21-month old infant was brought in to a local hospital on January 10th after developing influenza symptoms one day earlier. Tamiflu administration followed diagnostics confirming infection with H5N1 on January 12th. The girl was reported to be stable and recovering on January 14th. Although the infant's family admitted to keeping sick, unvaccinated poultry that died the previous week, none of the other family members tested positive for H5N1.

Source: Strengthening Avian Influenza Detection & Response (SAIDR)

For more information, see the World Health Organization: Situation in Egypt

Economic Impacts of Recent Outbreaks Felt as Global Bird Culling Continues

The recent reports of bird culling around the world to contain AI outbreaks contain little mention of the economic impact on poultry farmers and their communities. While many governments offer some form of financial compensation for the loss of poultry, the exchange is not always equal, and farming communities often find themselves in a financial deficit. Below are some culling figures featured most recently in the news:

Nepal: After strains of H5N1 were found in dead poultry on January 16th, the Nepalese government ordered mass bird culling to contain the outbreak. To date, nearly 13,000 birds have been culled in the Jahpa district, the location of the outbreak.
Source: DNI Daily Digest

British Columbia: Canadian inspectors discovered strains of an H5 virus in turkeys on a poultry farm in Abbotsford over the weekend. Today, nearly 60,000 turkeys will be gassed in effort to quell the threat of an outbreak.
Source: The Vancouver Sun

India: Rapid Response Teams (RRT) were deployed on January 19th in a week-long effort to contain bird flu outbreaks in the Ravangla region of Sikkim. Culling procedures stopped Jan. 23rd after 3,900 birds were eliminated.
Source: The Morung Express

Questions about tamiflu resistance

Jackie (from Cambodia) recently sent me a question regarding the recent news about influenza viruses being more resistant to tamiflu and whether this might have an impact on our own staff safety plans and guidelines. As it so happens, we have a new a Senior Director for Health Programs from CARE USA, Dr. Benjamin Schwartz who also happens to be an expert in pandemic influenza issues! He previously worked at HHS (Department of Health and Human Services) and CDC. He was the lead at HHS for pandemic vaccine and antiviral drug planning and the author of the national recommendations on antiviral drug use. So, I've asked Ben to answer Jackie's question

From Ben:

“The emergence and spread of Tamiflu resistant influenza viruses have led to questions on whether pandemic planning and preparedness should change. Before answering those questions, it's important to understand a bit about antiviral drug resistance among influenza viruses. Resistance occurs due to a chance mutation occurring at the active site where the neuraminidase inhibitor drug (e.g., Tamiflu) binds to the virus. Historically, resistant viruses did not spread between people because the mutation also reduced the fitness of the virus, reducing its transmissibility. The newly emerged resistant virus (which can spread between people) is a specific influenza A (H1N1) clone that has a mutation not only at the neuraminidase inhibitor active site but also another "compensatory" mutation that restores the virus's fitness. All other circulating influenza viruses - with the exception of this H1N1 clone - remain susceptible to Tamiflu. The resistance mutations cannot spread from one influenza virus to another; and the likelihood of these mutations developing in another influenza virus is very small.

Given this understanding, the emergence of the resistant H1N1 has no direct implications on whether a pandemic virus may become resistant to Tamiflu to or Relenza (the other antiviral drug in the same neuraminidase inhibitor class). A fit and resistant pandemic influenza virus remains highly unlikely. U.S. policy on antiviral drug stockpiling and plans for pandemic use have not changed (and in fact, antiviral drug recommendations recently were expanded to include preventive ["prophylactic"] use). Some have suggested stockpiling Relenza rather than Tamiflu. However, there is an FDA warning on the use of Relenza in people with airway disease such as asthma or emphysema and there is not the same body of evidence that Relenza is effective in preventing severe or fatal influenza seasonally or with H5N1 (whereas such data do exist for Tamiflu). The U.S. national stockpile includes 80% Tamiflu and 20% Relenza. Such diversification may be prudent. If the proposed antiviral drug use strategy is prevention (as opposed to treatment), both drugs have been equally effective and a greater proportion of Relenza could be considered. If there are any questions about strategy or drug choice, I'd be glad to provide further thoughts.”

Rising Concern for Bird Flu Outbreaks as Chinese New Year Approaches

An excerpt from The Telegraph:

"Hundreds of millions of Chinese are preparing to travel home during Chinese New Year this weekend, and the authorities are concerned that the world's biggest human migration could help spread the disease further.

After not reporting a single human death from bird flu since 2003, the last two weeks have seen three cases in three separate provinces. The Agriculture Ministry said it was moving quickly to quarantine anyone who came into contact with the victims.

"As the Spring Festival approaches, there are frequent movements of poultry products and the risk rises of virus outbreaks and transmission," the ministry said in a statement. "We have already asked the relevant provinces to strengthen their bird flu prevention work," it added...

More than 180 million Chinese will travel home on the rail network for Chinese New Year, with several million more flying. Dishes prepared from freshly slaughtered chicken and duck feature prominently in celebration feasts. This means a potentially greater risk of exposure to sick birds as people shop in markets and handle poultry or when the birds are transported to be sold, the World Health Organisation said.

Health Ministry spokesman Mao Qun'an said last week that the public should minimise contact with poultry, especially sick or dead ones, and that medical institutions should step up surveillance of flu cases."


For the full story, go this site:
The Telegraph http://www.telegraph.co.uk/news/worldnews/asia/china/4289319/China-moves-to-prevent-bird-flu-pandemic.html

See also:
Reuters AlertNet http://www.alertnet.org/thenews/newsdesk/PEK359731.htm
BBC News http://news.bbc.co.uk/2/hi/asia-pacific/7839099.stm