WHO Global Influenza Update: Distribution, Spread and Resistance

Though pandemic flu activity stayed stable in most parts of the world, Chile is reporting new detections of the pandemic virus in at least three regions in advance of the start of its flu season, with other hot spots occurring in Bangladesh and parts of Africa, the World Health Organization (WHO) reported today.

Localized pandemic flu transmission is persisting in Tanzania and Rwanda. Several countries in the tropical zones of the Americas are reporting localized flu activity as well, including Cuba, Guatemala, Peru, and Bolivia. WHO said in its weekly flu report that the significance of the rise in pandemic flu in parts of Chile to the rest of its flu season is unknown.

Data from Mexico suggest that several states reported localized activity throughout March, particularly in Federal district, an area that has reported recent spikes in severe and fatal pandemic H1N1 infections, the WHO said. Brazil, which has reported increased levels of influenza-like illnesses over the past month, has reported that most of the severe and fatal pandemic H1N1 infections are occurring in the country's northern regions.

In some parts of the world, including China and European countries such as Italy, flu activity is occurring at expected levels, much of which is influenza B. Other countries reporting increased detections of influenza B strains include Hong Kong and Chinese Taipei. Some parts of Africa, such as Cameroon, are also reporting influenza B illnesses.

Small number of seasonal H3N2 viruses have been detected in West and East Africa, the WHO said. Indonesia is still the most active area for seasonal H3N2 transmission, though activity is leveling off there, the WHO said.

In addition, the seasonal H1N1 virus has been reported sporadically by the Russian Federation.

Most pandemic virus samples that countries have submitted to WHO collaborating center laboratories are closely related to the strain recommended for pandemic influenza vaccines.

Ten more cases of oseltamivir-resistant pandemic H1N1 were reported last week, most of which occurred in the last quarter of 2009, WHO said. All 278 samples so far have the H275Y substitution, and all remained sensitive to zanamivir. Most cases were linked to treatment or postexposure prophylaxis or occurred in severely immunocompromised patients. Only 7% had no known association to treatment.

In addition, WHO said it has received preliminary notification about a pandemic H1N1 isolate that has reduced sensitivity to neuraminidase inhibitors.

So far more than 213 countries and overseas territories or communities have reported lab-confirmed pandemic H1N1 cases, the WHO said. The agency has received reports of more than 17,700 deaths, a number it says greatly underestimates the true burden of the disease.

Source: CIDRAP http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/apr0910global.html

WHO http://www.who.int/csr/don/2010_04_09/en/index.html

FAO: Egypt one of five countries where H5N1 still persists

Via H5N1 (Crofsblogs) and Daily News Egypt Excerpt:

"Egypt is listed as one of five countries where the H5N1 virus, or avian influenza, still persists, said a statement by the Food and Agriculture Organization of the United Nations (FAO).

The H5N1 virus has been combated in 135 countries while an outbreak remains a threat in Egypt, China, Bangladesh, Indonesia and Vietnam.

'Unfortunately, H5N1 may have slipped off the radar screen for some people, but it continues to be a major problem, especially in Egypt and parts of Asia, where it is having a huge impact on food security and the livelihoods of farmers and local communities,' said Juan Lubroth, FAO's chief veterinary officer.

Bangladesh, Indonesia and Vietnam reported bird flu outbreaks resulting in the deaths of thousands of birds thus far while Egypt reported more human cases.
Poor farm biosecurity and trading of infected poultry are the main causes of the disease spread, according to the FAO.

Last Sunday, Egypt’s Ministry of Health announced the 34th bird flu-related death in the country; an 18-year-old woman from Fayoum. The number of bird flu cases witnessed a hike in 2010; the 18-year-old is the seventh reported this year.

A total of 109 cases have been reported since the virus first appeared in Egypt in 2006."

News source: http://www.thedailynewsegypt.com/article.aspx?ArticleID=29023

No adverse effects to influenza antiviral medications in pregnancy: Maternal and neonatal outcomes after antepartum treatment of influenza antiviral m

Via CIDRAP News:

Researchers from the University of Texas Southwest Medical Center report that neither oseltamivir nor amantadine/rimantadine caused any adverse events in pregnant women treated at the medical center during the H1N1 influenza pandemic. The 104 women given amantadine or rimantadine and the 135 women given oseltamivir had the same rates of preterm birth, premature rupture of membranes, gestational diabetes, and preeclampsia as the 82,097 women who did not receive antivirals.

http://journals.lww.com/greenjournal/Abstract/2010/04000/Maternal_and_Neonatal_Outcomes_After_Antepartum.7.aspx?rss

FAO says Avian Influenza Pandemic Still Evident in Nigeria

The Avian influenza (AI) pandemic is not yet over in Nigeria says the Food and Agricultural Organization (FAO).

Chief Technical Adviser of the Emergency Centre for Trans-boundary Animal Diseases (ECTAD) of FAO Dr. Tesfia Tseggai said this in Abuja during the launching of products from FAO-media fellowship project.

He said despite successes recorded in bringing the disease under control, AI can still be found in some very remote rural settlements.

The media fellowship project seeks to promote interaction between media persons, veterinary experts and the rural poor who interact with birds as part of everyday with a view to creating awareness on issues bordering on animal and human health.

"Media fellowship is about giving voice to ordinary Nigerians especially rural dwellers to talk to the media on their experiences with birds and Avian influenza," he said.

Country Representative of FAO in Nigeria Dr. Helder Muteia said many countries are still battling with Avian influenza but Nigeria has been able to bring it under control and has not recorded any new outbreak since July 2008.

Muteia observed that history has shown that successes must be recorded and properly managed for sustainability.

Media products that were launched included documentaries, in photograph, film and radio.

"There are documentaries that reveal the complex relationship between birds and their human neighbors, there are radio and television programs that reveal the immense contribution of birds to the livelihood of Nigerians and pictures as well," he said.

Participants visited selected communities across Nigeria affected by the disease and documented the experiences of the locals and cultural practices involving the use of birds in Nigeria.

Ten media persons were awarded fellowship certificates after participating in the project.

Source: http://allafrica.com/stories/201004060109.html?

H5N1 Avian Influenza Outbreak in Tien Phong commune, Yen Hung district, VIetnam

Quang Ninh province has officially confirmed a new outbreak of H5N1 in Tien Phong commune, Yen Hung district. Information released on April 7 by the Chairman of the Yen Hung district People’s Committee, called for urgent measures to prevent the spread of H5N1 Avian Influenza (AI).

On March 19, Quang Ninh province also declared bird flu recurrence in Dong Mai commune, Yen Hung district. Local farmers claimed that although their poultry had been vaccinated they were still infected by bird flu virus.

The provincial Veterinary Department has introduced urgent measures to quarantine infected areas and sterilize breeding farms. The Department has also banned the transport and trading of sick poultry.

Source: http://english.vovnews.vn/Home/Bird-flu-hits-Quang-Ninh-and-Bac-Kan-provinces/20104/114405.vov

Possible H1N1 Outbreak in Ghana

The National Disaster Management Organisation (NADMO) and the Ghana Health Service, in conjunction with the Ministry of Health have warned of a threat of possible outbreak of 2009 H1N1 in Ghana.

A statement signed by the NADMO Coordinator, Kofi Portuphy, said the threat was heightened by the recent sporadic outbreaks of the disease in a number of schools in some regions leading to their closure.

Those affected include Merton Primary School, Tema Parents Association, Achimota Basic School, Lincoln Community School and American International School, all in the Greater Accra Region.

Others are Okuapeman Secondary School in the Eastern Region, Nankpanduri Senior High School in the Northern Region and Nfantsipim School and Ayipey in the Central Region.

The statement said minors and children were the vulnerable groups, and added that those from the affected schools might be incubating the disease without showing any signs or symptoms and could easily infect others.

Due to the mode of transmission, crowding at social events, especially for children coming from different schools, would be highly fertile grounds for easy spread of the disease to family members, friends, and the community,? it said.

The statement, therefore, cautioned the general public to minimize crowding at social events, especially those meant for children.

It reminded the public that transmission of the disease was from human to human, through droplets released during coughing, sneezing and touching surfaces contaminated with body fluids secreted by infected persons and touching the eyes nose and mouth without washing hands.

The signs and symptoms of the disease include coughing, sneezing, fever, chits, running nose, headache, vomiting, sore throat and body aches, and complications may lead to pneumonia and difficulty in breathing.

The statement said an effective way of preventing infection was through observance of good personal hygiene by washing hands with soap and water as often as possible, especially after touching surfaces and hand shakes.

Meanwhile from Mpraeso, Agnes Opoku Sarpong reports that the pandemic has broken out at the Mpraeso Senior High School in the Eastern Region with two students confirmed as having the virus, out of 33 suspected cases.

Source: GhanaWeb http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=179999

Entry Screening to Delay Local Transmission of 2009 H1N1

After the WHO issued the global alert for 2009 H1N1, many national health agencies began to screen travelers on entry in airports, ports and border crossings to try to delay local transmission.

The authors of this study reviewed entry screening policies adopted by different nations and ascertained dates of official report of the first laboratory-confirmed imported H1N1 case and the first laboratory-confirmed untraceable or ‘local’ H1N1 case.

Screening policies adopted by countries included:

• Temperature checks onboard aircraft prior to disembarkation.
• Health declaration forms collected from every traveler or all travelers from countries identified with confirmed H1N1 cases.
• Arriving travelers were observed by alert staff for influenza symptoms (e.g. cough).
• Travelers were scanned for elevated body temperature by thermal scanners.

Of the nations looked at in the study, two (China and Japan) implemented all four tools. Five nations did not implement any of the four. Overall, implementation of the four tools alone or in combination were associated with on average additional 7-12 day delays in local transmission compared to nations that did not implement entry screening.

The authors' results suggest that entry screening did not lead to substantial delays in local H1N1
transmission which is consistent with theoretical results from previous modeling studies and findings from previous pandemics. While longer delays in local transmission to the summer in countries in the Northern hemisphere could have substantially aided pandemic mitigation, due to seasonal factors and school vacations leading to lower peak attack rates, the observed delays in the present pandemic suggest entry screening provided around 1-2 weeks of additional time for
preparation and planning.

While this study focused on the impact of entry screening, some nations also implemented other containment and mitigation measures, such as isolation of suspected or confirmed cases, quarantine of their contacts with or without antiviral chemoprophylaxis, school closures or other social distancing measures, and public health campaigns to improve hygiene. Most nations enhanced their influenza surveillance. If countries that expended greater effort into entry screening also had more effective containment and mitigation measures in the general population, these might have led us to overestimate the effect of entry screening.

Conversely, if countries that expanded greater effort into entry screening also tended to have better influenza surveillance and were able to identify local transmission earlier, we may have underestimated the effect of entry screening. Other differences between countries in laboratory capacity and availability of public health resources may also have confounded our evaluation, and all of these factors are limitations of our study.

Previous mathematical modeling studies have questioned the value of entry screening, since it could only delay rather than prevent local epidemics. However, most models assumed that source countries would conduct exit screening and infectious cases would not travel. In such a scenario it is not surprising that entry screening would add little benefit, since most journeys are shorter than the average 1.5-2 day incubation period for influenza A virus infections. Screening is unlikely to identify 100% of ill travelers, while some might use antipyretics to reduce a fever prior to passing through thermal scanners, or fail to report symptoms on declaration forms. Many individuals with subclinical or asymptomatic illness would not be identified, and could initiate outbreaks after arrival. In Hong Kong, only one third of confirmed imported H1N1 cases were identified through screening on entry to Hong Kong, the majority of imported cases were
identified through the local health care system after arrival. A similar experience has been reported in Singapore.

Nevertheless, entry screening could act as a deterrent to traveling when ill or lead to other indirect benefits such as improving public awareness of the pandemic. For entry screening to be successfully employed, substantial resources are required to identify the small fraction of travelers who may have H1N1 infection. Further resources may be needed to isolate identified cases, and trace and quarantine close contacts.

The authors go on to discuss other caveats that may limit the accuracy of their model.

Source: BMC Infectious Diseases http://www.biomedcentral.com/content/pdf/1471-2334-10-82.pdf