Genetic hurdle halted bird flu
19 Nov 2009
UKPA [edited][FSNet]
A genetic hurdle that proved too great may have prevented deadly bird flu causing a terrifying pandemic, researchers have learned.
Scientists discovered the H5N1 strain would have to make at least two simultaneous genetic changes to transmit easily from person-to-person.
So far human victims of the H5N1 strain have been confined to people who have been in contact with birds. But when the virus first came to prominence at the turn of the century experts were worried about it causing a devastating pandemic.
When the strain does affect humans, it kills in 60% of cases. Latest figures show the virus has claimed 262 lives so far, with the vast majority of deaths occurring in Asia.

Experts divided on treatment for birdflu patients
23 June 2009
Reuters [edited] [CAHFS]
Experts on the H5N1 bird flu virus are divided on how to treat patients infected by the virus, which kills 60 percent of its victims.
In an article published in PLoS Medicine, a researcher at Mahidol University in Thailand argued that higher doses of the drug Tamiflu should be used to fight more resistant strains of the virus, but researchers in the United States said that would result in the virus becoming resistant.
The H5N1 has infected 433 people around the world since 2003, killing 262 of them, according to the latest tally by the World Health Organisation. The WHO recommends treating patients with Tamiflu at a dose of 75 mg twice daily for five days.
But the researcher believes higher doses were needed because of the high fatality rate of H5N1.

Avian Bacterium More Dangerous Than Initially Believed
18 Jun 2009
United States Department of Agriculture [edited][ProMed]
Until recently, B. hinzii was believed to be nonpathogenic in poultry. But Agricultural Research Service (ARS) scientists have shown that the bacterium caused severe disease in turkeys that was attributed to another Bordetella species.
B. avium is a pathogenic bacterium that causes upper respiratory disease in poultry and wild birds. It is very similar to B. hinzii, and the 2 species are difficult to distinguish without using highly specific, DNA-based tests.
Scientists at the ARS National Animal Disease Center (NADC) in Ames,
Iowa, used these tests to examine several Bordetella isolates, including some that had caused 100 percent morbidity in turkey poults. Although the isolates had been labeled as B. avium, the scientists found that they were actually B. hinzii, flouting conventional wisdom that the bacterium could not cause disease in poultry.
B. hinzii has been found in poultry with respiratory disease, but was believed to be nonpathogenic because previous attempts to cause disease in chickens and turkeys with the bacterium have failed.
This study showed for the 1st time that some strains of B. hinzii can cause disease in turkeys. The results of the study were published in the March 2009 issue of Avian Diseases. In a related study with chickens, no birds developed clinical disease, suggesting that the pathogenicity of B. hinzii does not extend to chickens.

World Health Organization- Scientists develop new basis for H5N1 vaccine
28 May 2009
Reuters [edited] [FSNet]
Scientists have used bird flu virus samples from Egypt to develop a new basis for a vaccine against the toxic H5N1 strain that continues to circulate, the World Health Organisation said on Thursday.
Avian influenza kills about half the people it infects, but unlike the quickly circulating swine flu story, H1N1 flu virus has not been shown to pass easily between humans to date.

Cambodia- Study shows hidden bird flu cases in Cambodia
21 May 2009
Thomson Reuters Foundation AlertNet [edited][ProMed]
The H5N1 bird flu virus can infect people without causing noticeable symptoms, but only rarely, according to a report published on Thursday [21 May 2009].
A survey of more than 600 people in Cambodian villages where 2 children died from the virus shows 7 more were apparently infected, but without having known about it. The study, published in the Journal of Infectious Diseases, also suggests that people may become infected by swimming in ponds where infected birds have dabbled.
The H5N1 avian influenza virus has been regularly causing outbreaks of disease in birds -- 250 outbreaks in February [2009] alone in Bangladesh, China, Egypt, India, Indonesia, Laos, Nepal, and Viet Nam, according to the UN Food and Agriculture Organization (FAO). It only rarely infects people but is often deadly when it does. WHO says it has killed 261 people out of 424 infected since 2003. The big fear is that is could change into a form that people can pass easily to one another, sparking a pandemic. These fears have been overshadowed at least a little by the near pandemic of much milder H1N1 swine flu that started in March [2009].
One big question has been whether some people have been infected without knowing it. If this is the case, the fatality rate would go down. With current numbers, the fatality rate appears to be around 60 percent but if there are more than 424 infections it would make for a lower rate.
Scientists know that birds can pass influenza viruses in their droppings and ducks, especially, can foul ponds with virus-infected droppings. The virus can live in droppings or water for up to 6 days.
They found genetic material from the H5N1 virus in specimens taken from ponds and pond plants.

Influenza A/H1N1 in Humans and Swine
20 May 2009
FAO AIDE news, Avian Influenza Disease Emergency Situation, Update 59, 20 May 2009, 17 pages [extracted Mod.AS, edited] [ProMed]
Avian influenza viruses, swine influenza viruses, and human influenza viruses all belong to the same class of viruses known as Orthomyxoviruses. Both H1N1 and H5N1 are subtypes of the influenza type A virus. Both viruses contain the neuraminidase 1 (N1) protein helping virus to become released from an infected host cell after replication. While there is some similarity between the viruses, the emerging H1N1 virus in humans does not in any direct way relate to the HPAI H5N1 virus circulating in poultry.
Avian influenza viruses circulate in wild and sometimes also domestic birds populations. Certain sub-types, including the highly pathogenic H5N1, are occasionally transmitted to mammals, including humans. Swine influenza viruses circulate in swine populations and are occasionally, albeit infrequently, transmitted to birds and to humans. Human influenza viruses are also transmissible to animals, pigs in particular. Pigs can therefore harbor viruses from avian and human sources, and act as "mixing vessels" for these viruses.
National authorities are encouraged to carefully investigate possible occurrences of influenza-like events in domestic animals. Virus samples may be collected and sent to national labs and/or international reference centers.
In order to reduce the risk for transmission of influenza A/H1N1(humans-to-animals or animals-to-animals), FAO recommends that surveillance for porcine respiratory disease should be intensified and all cases of porcine respiratory syndrome should be immediately reported to the national veterinary authorities. The international organizations -- OIE and FAO -- should be informed when presence of the new A/H1N1 influenza virus is confirmed in any pig populations. Furthermore, movement restrictions should be implemented for all farms or holdings with swine showing signs of clinical respiratory illness until diagnosis of the illness have been made. Where influenza A/H1N1 is confirmed, these restrictions should be in force until 7 days after the last animal has recovered. Animals suffering from swine influenza can be separated from healthy herd-mates and allowed to recover; there is no need to cull affected animals. Animal handlers and veterinarians should wear protective gear to minimize risk of being infected by zoonotic agents, including influenza.
Persons who work directly with swine should be urged not to go to work if they have any signs respiratory disease, fever or any influenza-like illness. In high risk areas a swine influenza vaccine could be used in swine as long as it is considered effective against the circulating strain, and is permitted by relevant authorities.
FAO is working in close coordination with the World Health Organization (WHO), the World Organization for Animal Health (OIE), as well as other national and international actors, to clarify and interpret the evolution of this new disease, and advise member countries on how to best deal with this worrying turn of events, with maximum efficiency.

Avian Influenza- H5N1 HPAI global overview February 2009
20 May 2009
FAO AIDE news, Avian Influenza Disease Emergency Situation,
Update 59 [extracted Mod.AS, edited] [ProMed]
Since 2003, 62 countries/territories have experienced outbreaks of H5N1 HPAI. Effective control measures for outbreaks in poultry have been associated with reduced risk of human infections in several countries. However, H5N1 HPAI remains entrenched in poultry in parts of Asia and Africa (Egypt) and thus the risk of human infection remains, as proven by the five human cases reported this month in two countries considered endemic.
Data from previous years have shown a peak in the number of outbreaks/cases during the January-March period in both poultry outbreaks and human cases. In fact, February 2009 represents a peak in this period.
It is difficult to undertake thorough epidemiological analysis of the situation of HPAI globally, based only on official disease reporting and the poor disease outbreak investigations carried out in some affected countries. HPAI prevalence and incidence are likely much greater. A number of countries that had not reported HPAI activity for some time have faced outbreaks in the last few months. That is the case of Cambodia, China, India, and Thailand. It remains unknown whether these new cases are because of a re-introduction of the infection, or if the virus was circulating at low level.
February 2009 showed a similar activity when compared to February 2008 both in terms of affected countries (8 vs 11) and the number of outbreaks (86 vs 116). When compared to February 2006 and 2007, however, HPAI activity seems to be much lower in February 2009. February 2006 experienced a particularly high activity (33 countries reporting 292 outbreaks/cases), reflecting when the panzootic was spreading across Europe. Although there has been an improvement in disease awareness, outbreaks/cases of HPAI are likely still underestimated and under-reported in many countries and regions because of limitations in the capacity of veterinary services to implement adequate and effective disease surveillance for HPAI, and because of the weakness in compensation schemes.

Bangladesh- 3,000 chickens culled (Dhaka)
11 May 2009
AHN [edited] [FSNet]
Some 3,000 chickens were culled after bird flu was detected at a poultry farm in the country's Southeastern Cox's Bazar district town on Sunday night. Samples were collected from the poultry farm on Saturday and sent for testing.

Egyptian girl contracts bird flu, 69th case (Cairo)
10 May 2009
Reuters [edited] [FSNet]
A five-year-old Egyptian girl has contracted the highly pathogenic bird flu virus after coming into contact with infected birds, the state news agency MENA reported on Sunday.
The case brings to 69 the number of people confirmed to have contracted the H5N1 avian influenza virus in Egypt, which has been hit harder than any another country outside Asia.
While the avian influenza virus rarely infects people, experts say they fear it could mutate into a form people could easily pass to one another, sparking a pandemic that could kill millions.

Egypt- Age-specific infection and death rates for human A(H5N1) avian influenza
07 May 2009
Source: Eurosurveillance, Volume 14, Issue 18 [edited]
By J. P. Dudley, Science Applications
Abstract
The age-specific infection and death profiles among confirmed human cases of influenza A(H5N1) infection in Egypt differ markedly from those recorded in other countries. The case fatality rate among human H5N1 cases in Egypt is 34 percent, versus an average of 66 percent in other countries. In Egypt, children younger than 10 years comprise 48
percent of reported cases, nearly twice the global average of approximately 25 percent, and no H5N1 fatalities have been confirmed among individuals in this age group as of 23 Apr 2009. Females outnumber males among confirmed H5N1 cases by a factor of nearly 2:1, and 90 percent of reported fatalities in Egypt have been females. The evident age and sex biases in morbidity and mortality among H5N1 cases in Egypt are phenomena that warrant further investigation and analysis.

The Role of Environmental Transmission in Recurrent Avian Influenza Epidemics
14 Apr 2009
PLoS Computational Biology [edited][Promed]
Abstract
Avian influenza virus (AIV) persists in North American wild waterfowl, exhibiting major outbreaks every 2-4 years. Attempts to explain the patterns of periodicity and persistence using simple direct transmission models are unsuccessful. Motivated by empirical evidence, we examine the contribution of an overlooked AIV transmission mode: environmental transmission. It is known that infectious birds shed large concentrations of virions in the environment, where virions may persist for a long time. We thus propose that, in addition to direct fecal/oral transmission, birds may become infected by ingesting virions that have long persisted in the environment. We design a new host-pathogen model that combines within-season transmission dynamics, between-season migration and reproduction, and environmental variation. Analysis of the model yields 3 major results. First, environmental transmission provides a persistence mechanism within small communities where epidemics cannot be sustained by direct transmission only (i.e., communities smaller than the critical community size). Second, environmental transmission offers a parsimonious explanation of the 2-4 year periodicity of avian influenza epidemics. Third, very low levels of environmental transmission (i.e., few cases per year) are sufficient for avian influenza to persist in populations where it would otherwise vanish.

Egypt- Avian influenza virulence
13 Apr 2009
Bloomberg News online [edited] [Promed]
Egypt asked the World Health Organization [WHO] to help investigate an outbreak of bird flu after a dozen non-fatal cases of the disease this year [2009] prompted speculation the virus may be becoming less virulent. Two WHO doctors and a scientist will travel to Cairo later this week at the request of Egypt's Ministry of Health, said Gregory Hartl, a spokesman for the United Nations agency in Geneva, in an interview today [13 Apr 2009]. The UN team will assist local authorities to identify how the patients were infected with the H5N1 strain of avian influenza and whether there have been any significant changes in disease patterns in the virus itself.
Scientists have been following H5N1 for more than a decade because of concern it could spark a pandemic if it becomes as infectious for humans as it is for poultry. A less lethal strain could be more contagious because people would have longer to transmit it through coughing and sneezing. None of the 12 Egyptian cases reported to the WHO this year [2009] has been fatal.
These data do indeed suggest that there may have been a reduction in the virulence of the outbreak strain, and there is a perceived risk of progression of the virus to a less virulent but more transmissible form, the International Society for Infectious Diseases said today [13 Apr 2009] in an e-mail via its ProMED-mail program. The survival of H5N1 patients in Egypt also may reflect early treatment with antiviral medicines, ProMED said.
At least 417 people in 15 countries have contracted the virus since 2003. Three of every 5 cases worldwide were fatal. Most cases were caused by contact with infected poultry, such as children playing with them or adults butchering them or plucking feathers, according to WHO.
H5N1 is continuing to circulate in poultry in Egypt, though there is no evidence so far of any significant changes in the virus, said Joseph Domenech, chief veterinary officer with the Food and Agriculture Organization [FAO]. The Rome-based UN agency has also agreed to a request by Egypt's government to provide technical assistance, Domenech said in an interview today [13 Apr 2009].
Egypt has the highest number of avian-flu cases outside Asia, with 63 cases reported to WHO since 2006, of which 23 were fatal. In comparison, more than 80 percent of the 141 people reported to have been infected in Indonesia died.
Roche Holding AG says its Tamiflu antiviral medicine can reduce the severity and duration of flu symptoms if taken within 48 hours of the onset of disease. Early treatment for H5N1 may improve survival, some uncontrolled studies have shown.

Indonesia – Avian Influenza - Riau
13 Apr 2009
The Jakarta Post [edited]
The bird flu virus has spread within Sungai Apit district in Siak regency, Riau, following the death of a child infected with the virus at the end of March 2009, says a local official, adding prevention measures were being hampered by residents' reluctance to cull their poultry.
District chief Indra Atmaja said the spread of the virus was only discovered following reports of poultry dying abruptly on 4 Apr 2009.
"After checking by a team of veterinarians, 2 of the chickens tested positive for bird flu. A day earlier, we received reports that 12 chickens owned by other residents had died suddenly," Indra told The Jakarta Post by phone on Wednesday [8 Apr 2009].
He added the virus had spread to Teluk Masjid and Teluk Batil villages and Sungai Apit subdistrict.
"Seven chickens died suddenly the previous day in Sungai Apit subdistrict, while in Teluk Masjid and Teluk Batil, the number has reached 29," he said. "Based on field tests conducted by the Siak Animal Husbandry Agency, the chickens tested positive for bird flu."
Indra said the test results had been publicized through village chiefs and neighborhood unit chiefs to raise residents' awareness of the risk of infection.
The team from the Siak Animal Husbandry Agency has sprayed residents' poultry cages with disinfectant to prevent the virus from spreading further.
Indra also urged residents to cull their poultry. However, he said only few residents were willing, while most would only do so if paid to.
"It's not that we don't want to, but the district office has no such budget for the purpose. For now, we can only remind the residents, including through sermons at mosques, of the risks of bird flu. We cannot force the residents to cull their poultry if they don't want to," he said.

Bangladesh – Avian Influenza
7 Mar 2009
The Daily Star [edited] [Promed]
Avian influenza has started spreading in different poultry farms across the country again, as department of fisheries and livestock detected the bird flu virus and culled birds at different places. Up to 3 Mar 2009, a total of 1,663,702 chickens were culled since 2007 when bird flu was detected first in the country.
Authorities yesterday [6 Mar 2009] culled 2095 chickens and destroyed 205 eggs following detection of bird flu in Netrakona and Gaibandha. Earlier, on 28 Feb 2009, 188 chickens were culled and 60 eggs destroyed, according to the website of the Ministry of Fisheries and Livestock.
Our correspondent from Netrakona reported that a total of 1595 chickens and 205 eggs were destroyed at a poultry farm at Kendua upazila in Netrakona. Officials at Netrakona District Livestock office said they detected bird flu virus at a poultry farm at Rampur village under Kendua upazila Thursday night [5 Mar 2009].
"The virus was found when dead chickens of the farm were examined at the district livestock laboratory by rapid antigen detection test (RADT)," said an official. The laboratory test was conducted on information that over a dozen chickens died in the farm during the last 3 days, officials said.
Our Gaibandha correspondent reports: The livestock department of the district yesterday culled around 500 chickens at Uttar Kazibari village under Sadullahpur upazila immediately after detection of bird flu virus in the areas. Sources said some 18 poultry birds died at the Rampur village farm. Following the death of birds, Upazila Livestock Officer Dr. Uttam Kumar Das took samples of the dead chickens and found the existence of avian influenza in the body of a bird. A team later collected 500 poultry birds, including chickens, and destroyed the birds on Upazila Parishad Complex.
"The government has been alert enough this season to monitor bird flu cases. Wherever any bird flu virus is detected, authorities are taking measures to check its outbreak," said Dr. Giasuddin, chief scientific officer at Bangladesh Livestock Research Institute. The government with assistance from the UN Food and Agriculture Organisation (FAO) has employed field volunteers since October 2008 to strengthen surveillance of bird flu in rural areas, he said.
According to the official website, the government found the presence of the H5N1 virus at 308 farms in 47 districts and culled chickens of 568 farms up to 3 Mar 2009.
Outbreaks of the virus generally occur after the end of the rains in October and continue until early June when the rains return.

Indonesia – Avian Influenza new cases suspected
4 Mar 2009
Gulf News online, Associated Press report [edited] [Promed]
A government official says 4 Indonesians have died of bird flu, bringing the death toll in the country hardest hit by the disease to 119. Bayu Krisnamurthi, chief of the National Bird Flu Commission, said on Tuesday [3 Mar 2009] the victims died in January and February [2009] and were all believed to have been infected by sick chickens.
Krisnamurthi would only say of the latest deaths that 2 were brothers from Bogor and that the others died in Surabaya and Bekasi, all cities on Java Island.

Viet Nam - Avian influenza situation - WHO update
11 Feb 2009
World Health Organization (WHO), Epidemic and Pandemic Alert and Response (EPR) disease outbreak news [edited] [Promed]
The Ministry of Health in Viet Nam has reported a new confirmed case of human infection with the H5N1 avian influenza virus. The case has been confirmed at the National Institute of Hygiene and Epidemiology (NIHE).
The case is a 23 year old woman from Dam Ha district, Quang Ninh province. She developed symptoms on 28 Jan 2009 and was hospitalized on 31 Jan 2009. She is currently in a serious condition and is known to have had recent contact with sick and dead poultry prior to the onset of her illness. Further investigations are currently underway. Control measures have been implemented and close contacts are being identified and monitored.

Egypt - Egyptian girl has bird flu, 52nd case, 2nd case this season
12 Jan 2009
Reuters India [edited] [Promed]
An Egyptian girl of 21 months has contracted bird flu [avian A/H5N1 influenza virus] and is in hospital in a stable condition, a health ministry official said on Monday [12 Jan 2009].
She is the 52nd human case of bird flu in Egypt and the second of this winter [2008/2009] season. The girl showed the first symptoms on Friday [9 Jan 2009] and was admitted to a specialist hospital on Saturday [10 Jan 2009], said assistant health minister Nasr el-Sayed, quoted by the state news agency MENA.
The other Egyptian to contract the deadly virus this year [2008], a woman near the southern town of Assiut, died on 15 Dec 2008. From the 52 human cases in Egypt over almost 3 years, 23 have died, but the number of cases seems to be diminishing.
The girl, from the village of Kerdasa on the western edge of Cairo [in the 6th October Governorate], had been in contact with infected birds and showed the usual first symptoms -- a high temperature, vomiting, and diarrhea, Sayed said. She is receiving the antiviral drug Tamiflu [oseltamivir], which has proven effective against bird flu if treatment starts early.
Related stories
12 Jan 2009 – A 21 month old girl has bird flu in Egypt
Egypt News [in Arabic] [Promed]
12 Jan 2009 – New human case of avian influenza - case number 52
World Health Organization (WHO), Eastern Mediterranean Regional Office [edited] [Promed] The Ministry of Health and Population (MOH), Egypt, reported a new confirmed human case of avian influenza on 12 Jan 2009. The case is a 21 month old girl from 6th October Governorate, Kerdasa District. The symptoms started on 9 Jan 2009. The patient was admitted to Imbaba Fever Hospital on [10 Jan 2009] with fever, cough, vomiting, diarrhea, and rapid respiration. The case was immediately suspected as avian influenza and given medical treatment, Tamiflu [oseltamivir], 40 hours after the onset of symptoms. Investigations showed very close contact with sick and dead poultry since one week. Currently, the patient is in a good health condition.
14 Jan 2009 – Laboratory confirmation
World Health Organization (WHO), EPR, Disease Outbreak News [edited] [Promed] Infection with the H5N1 avian influenza virus was diagnosed by PCR at the Egyptian Central Public Health Laboratory and subsequently confirmed by the US Naval Medical Research Unit No. 3 (NAMRU-3) laboratories.

Future of H5N1
01 Jan 2009
CTV.ca, The Canadian Press report [edited] [Promed]
Five years after the avian influenza strain H5N1 started killing poultry and people in Southeast Asia, researchers still don't know what to make of the dangerous and unpredictable virus.
After cutting an ever-widening swath through poultry flocks and infecting -- and killing -- mounting numbers of people in Asia, the Middle East, and Africa, the virus seemed to almost take a breather in 2008. The year that just ended saw fewer recorded human cases than any since 2003, when this cycle of H5N1 activity began.
Science knows too little about how flu viruses emerge, spread, and jump -- or don't jump -- from one species to the next to answer that question. Given the knowledge gap, influenza scientists are still pushing for pandemic preparedness.
"Whether or not H5N1 virus is going to cause a human pandemic -- nobody can predict that," says Dr. Tim Uyeki, deputy chief of influenza surveillance and prevention for the US Centers for Disease Control [& Prevention]. "I believe it's still a threat. But it's not the only threat," he adds, noting a 2-month-old Chinese girl was hospitalized in Hong Kong in late December [2008] with an H9N2 avian flu infection.

Indonesia - Avian influenza situation
9 Dec 2008
World Health Organization (WHO), EPR, Disease Outbreak News [edited] [Promed] The Ministry of Health of Indonesia has announced 2 new confirmed cases of human infection with the H5N1 avian influenza virus. A 9 year old girl from Riau Province developed symptoms on 7 Nov 2008 and was hospitalized on 12 Nov 2008. She recovered and was discharged from hospital on 27 Nov 2008. Laboratory tests confirmed the presence of the H5N1 avian influenza virus. Investigations into the source of her infection indicate poultry deaths at her home on 2 Nov 2008. The second case, a 2 year old girl from East Jakarta, developed symptoms on 18 Nov 2008, was hospitalized on 26 Nov 2008, and died on 29 Nov 2008. Laboratory tests have confirmed infection with the H5N1 avian influenza virus. Initial investigations into the source of her infection suggest exposure at a live bird market. Of the 139 cases confirmed to date in Indonesia, 113 have been fatal.

Vietnam – New human case
06 Jan 2009
China View, Xinhua News Agency [edited] [Promed]
An 8-year-old Vietnamese girl from the country's northern Thanh Hoa Province has been infected with bird flu and hospitalized, said an official with the National Steering Committee for Avian Influenza here on Tuesday [6 Jan 2009]. The girl ate chicken before being hospitalized, the official told Xinhua. Specimens from poultry raised in Dien Chung town, where the girl is from, have recently tested positive for bird flu virus, the official added. The girl is now being treated at the Viet Nam National Institute of Hygiene and Epidemiology, and she is in a stable condition, said the official.
About 7800 poultry have been culled in Dien Chung Town to prevent further spread of the disease, said the official. This is the first human case reported in the country this year [2009]. Vietnamese health officials warned last month [December 2008] that the country faced risks of bird flu reoccurrence and human infection of the disease due to the cool temperatures.
Bird flu outbreaks in Viet Nam, starting from December 2003, have caused 106 human infectious cases [and 52 fatalities] and led to the killing of tens of millions of fowl in the country, official figures showed.
Related stories
7 Jan 2009 – Avian Influenza
World Health Organization (WHO), EPR, Disease Outbreak News [edited] [Promed]
The Ministry of Health in Viet Nam has reported a new confirmed case of human infection with the H5N1 avian influenza virus. The case has been confirmed at the National Institute of Hygiene and Epidemiology (NIHE). The case is an 8-year-old girl from Dien Trung commune, Ba Thuoc district, Thanh Hoa province. She developed symptoms on 27 Dec 2008 and was hospitalized on 2 Jan 2009. She is currently in a stable condition. The case is known to have had recent contact with sick and dead poultry prior to the onset of her illness. Further investigations are currently underway. Control measures have been implemented, and close contacts are being identified and monitored. Of the 107 cases confirmed to date in Viet Nam, 52 have been fatal
8 Jan 2009- Another caseReuters UK News [edited] [Promed] The sister of Viet Nam's first confirmed bird flu patient of the year [2009] died with similar symptoms last week, and the director of the hospital where she was treated said she probably also had avian flu. "We suspect that it was bird flu that caused her death," said Truong Thi Mau, director of the Ba Thuoc district hospital. "But we can't be 100 percent sure because there was no sample for tests. At the time, we thought her illness was something else," Mau said by telephone from Ba Thuoc, about 150 km (95 miles) south of Hanoi in Thanh Hoa province. Earlier this week, Vietnamese authorities said the 13-year-old girl's younger sister was in hospital with an H5N1 virus infection. Both girls had eaten duck and chicken raised on the family farm, Mau said. The 13-year-old developed a high fever and severe cough on 25 Dec 2008 and died in the district hospital on 2 Jan 2009, Mau said. After her 8-year-old sister was confirmed to be infected with H5N1, about 50 children with flu symptoms were brought in by nervous parents in the area, but tests for avian influenza were negative on all of them, she said.

China - Beijing bird flu patient dies
06 Jan 2009
Radio Netherlands Worldwide, International News [edited] [Promed]
A 19-year-old woman has died of bird flu in the Chinese capital Beijing. It is the first time in almost a year that someone in China has died after being infected with the H5N1 strain of avian influenza [virus], which is dangerous to humans.
The woman was admitted to hospital on 24 Dec 2008, and Chinese media report she had bought a duck at a market outside Beijing. She is thought to have become unwell after slaughtering the bird.
The bird flu virus is passed on via direct contact with infected birds or their droppings. Experts fear the virus could mutate into a strain transmitted from human to human. Since the H5N1 strain surfaced in Asia in 2003, about 250 people have died as a result of bird flu.
Related stories
06 Jan 2009 – No Avian Influenza Appears Near Residence of Deceased
Beijing Agricultural Bureau [translated from Chinese and abbreviated by Dan Silver, edited] [Promed]
Health agencies report a human case of avian influenza in Beijing's Chaoyang district. On 5 Jan 2009 after receiving a report from the Municipal Health Bureau, Beijing veterinary agencies carried out strict inspection in the area surrounding the patient's residence.
The inspection found that there is no poultry raised at the patient's residence or within a 10-km [6.2-mile] area.
An epidemiological investigation of Chaoyang, Tongzhou, Miyun and other districts found no abnormal circumstances among poultry. A national immunization investigation in December 2008 showed that Beijing's avian influenza immunization density was 100 percent. The qualified [confirmed] antibody rate was 100 percent. In 2008, Beijing took a total of 41,641 surveillance samples for avian influenza and all were negative.
7 Jan 2009 – Avian Influenza
World Health Organization (WHO), EPR, Disease Outbreak News [edited] [Promed]
The Ministry of Health in China has reported a new case of human infection with the H5N1 avian influenza virus. The case is a 19-year old female from Chaoyang District, Beijing. She developed symptoms on 24 Dec 2008, was hospitalized, and died on 5 Jan 2009. The case was confirmed by the national laboratory. The case had contact with poultry prior to her illness. All contacts have been placed under medical observation. All remain healthy to date. Of the 31 cases confirmed to date in China, 21 have been fatal.

India, Assam - Bird flu spreads its wings, affects 9 Assam districts
11 Dec 2008
ZeeNews [edited] [Promed] With the avian influenza spreading to fresh areas, 9 Assam districts are now bird flu affected and health minister Himanta Biswa Sarma on Thursday [11 Dec 2008] warned that it could become a major human disaster. The affected districts were Kamrup (Rural), Kamrup (Metro), Barpeta, Nalbari, Chirang, Baksa, Dibrugarh, Goalpara and Bongaigaon, official sources said.
Sale of poultry and eggs, either cooked or raw, has been banned in Guwahati and Kamrup (Metro) district which comprises Guwahati and adjoining areas.
Culling of poultry, ducks and other birds has been continuing in the affected districts with over 1.5 lakh [150,000] birds killed so far, the sources said.
"Chicken and ducks are being kept away from culling without realizing the seriousness of the disease," Sarma told reporters here. "We will not be able to handle it, if the disease spreads to humans from the birds. The human disaster will be immense. The health department is very worried about human transmission of the disease as it is not 100 percent equipped to handle a large scale outbreak as there are no isolation facilities here," he said.
The disease, starting from Hajo revenue circle in Kamrup (Rural) district about 20 km [12.4 miles] from here [Guwahati] on 2 Dec 2008 and spread to Guwahati in Kamrup (Metro) district, Nalbari, Barpeta, Chirang, Baksa, Bongaigaon and Goalpara districts in Lower Assam spreading to Dibrugarh district in Upper Assam.
Taking in view that the bird flu is spreading to new areas in neighbouring Assam, Meghalaya banned the entry of poultry and poultry products from Assam and Bangladesh.
Deputy commissioner of Ri Bhoi district that borders Khanapara in Assam's Kamrup (Rural) district is on a visit to the bordering areas along with a team of veterinary officials to take stock of the situation. The government has set up control rooms in all districts to facilitate information to the poultry farms. Veterinary officials have been regularly adopting measures to prevent spread of the disease into the state and deputy commissioners of all the districts have been alerted, sources said. Meghalaya already has in place 150 rapid response teams along with 2170 personnel protective equipment that were constituted last year [2007] after the outbreak of avian flu in West Bengal.

Bird flu makes mallards thin, study finds
3 Dec 2008 [edited] [Promed]
Thomson Reuters Foundation AlertNet
It is reported that avian flu viruses make mallard ducks thinner than other ducks, a finding that implies they do not spread the germs over long distances, researchers reported on Tuesday [2 Dec 2008]. Their tests of thousands of ducks migrating through Sweden showed the viruses do affect the birds, contrary to conventional wisdom that the pathogens have no effect on them. And, to their surprise, they found the birds only "shed", or release, virus for a few days, the researchers reported in the Proceedings of the Royal Society B: Biological Sciences. "Mallard ducks are a main reservoir for low-pathogenic avian influenza [LPAI] virus in nature, yet surprisingly little is known about how infection affects these birds," researchers at Erasmus Medical Center in Rotterdam wrote. The team found that infection did not affect how fast or far the birds migrated. On average, the ducks were infected 8 days and spread the virus for just 3 of them in their droppings. "The short virus shedding time suggests that individual mallards are less likely to spread the virus at continental or intercontinental scales," they wrote. But they may stay longer in one place when they are infected -- something that needs to be studied, they added.

Indonesia to test 17 for bird flu in Sulawesi
13 Nov 2008
Thomson Reuters Foundation AlertNet [edited] [Promed]
A health ministry official said on Thursday [13 Nov 2008] that 17 people from the same neighbourhood in the Indonesian city of Makassar in South Sulawesi are due to be tested for bird flu after falling sick. Chandra Yoga Adhitama, acting director-general of communicable disease control, said the group had been hospitalised after chickens in the surrounding area suddenly died. "Some were hospitalized yesterday [12 Nov 2008] and some today [13 Nov 2008]. I think it is a precaution by our officials after chickens died there," Adhitama said. He described the general health condition of the 17 as good and said that blood samples had been taken and would be sent to the health ministry laboratory in Jakarta for testing. "We are continuing to monitor their condition," he said, adding that only 4 of the group were adults. Suspected cluster cases can raise concerns about rare human-to-human transmission or that the virus might have mutated into a form that can pass easily among people. The country's largest known cluster of bird flu cases in humans occurred in May 2006 in the Karo district of North Sumatra province, where as many as 7 people in an extended family died. The World Health Organisation (WHO) said at the time that limited human-to-human transmission could not be ruled out but that the virus samples from the scene did not show any significant genetic mutations.

Role of migratory birds in the movement of the highly pathogenic (HP) avian influenza
24 Oct 2008
Molecular Ecology [edited] [Promed]
[Ref: Genetic evidence of intercontinental movement of avian influenza in a migratory bird: the northern pintail ( Anas acuta ). Molecular Ecology, 17(21): 4754-4762]
AV Koehler(1), JM Pearce(1), PL Flint(1), JC Franson(2), HS Ip(2)
Abstract
The role of migratory birds in the movement of the highly pathogenic (HP) avian influenza H5N1 remains a subject of debate. Testing hypotheses regarding intercontinental movement of low pathogenic avian influenza (LPAI) viruses will help evaluate the potential that wild birds could carry Asian-origin strains of HP avian influenza to North America during migration. Previous North American assessments of LPAI genetic variation have found few Asian reassortment events. Here, we present results from whole-genome analyses of LPAI isolates collected in Alaska from the northern pintail ( Anas acuta ), a species that migrates between North America and Asia. Phylogenetic analyses confirmed the genetic divergence between Asian and North American strains of LPAI, but also suggested inter-continental virus exchange and at a higher frequency than previously documented. In 38 isolates from Alaska, nearly half (44.7 percent) had at least one gene segment more closely related to Asian than to North American strains of LPAI. Additionally, sequences of several Asian LPAI isolates from GenBank clustered more closely with North American northern pintail isolates than with other Asian origin viruses. Our data support the role of wild birds in the intercontinental transfer of influenza viruses, and reveal a higher degree of transfer in Alaska than elsewhere in North America.
Related stories
27 Oct 2008 – Migratory ducks carry bird flu from Asia to Alaska
Environmental News Service (ENS) [Promed]

Poultry vs Migratory Birds : Swans
13 Aug 2008
Emerging Infectious Diseases [edited] [Promed]
[Ref: Kalthoff D, Breithaupt A, Teifke JP, Globig A, Harder T, Mettenleiter TC, et al: Pathogenicity of highly pathogenic avian influenza virus (H5N1) in adult mute swans. EID 14(8): 1267-1270]
Adult, healthy mute swans [C ygnus olor ] [were experimentally infected with highly pathogenic avian influenza [HPAI] virus A/Cygnus cygnus/Germany/R65/2006 subtype H5N1. Immunologically naive birds died, whereas animals with preexisting, naturally acquired avian influenza virus-specific antibodies became infected asymptomatically and shed virus. Adult mute swans are highly susceptible, excrete virus, and can be clinically protected by pre exposure immunity. According to this study, it is demonstrated that few adult swans might have the ability to survive infections with HPAI virus (H5N1). Survivors would most likely be older swans in good health infected with a low dosage (such as, less than 10 000 EID50 [50 percent egg infective dose]/animal). However, because of viral shedding for several days without showing severe clinical symptoms, adult mute swans could play a key role in the spread of HPAI virus (H5N1), a conclusion that contradicts those of other investigators .

Hong Kong - Expert warns Hong Kong's avian flu vaccine is waning
10 Jul 2008
Cidrap News [edited] [Promed]
A poultry vaccine designed to protect chickens in Hong Kong from H5 avian influenza has lost effectiveness over the past 7 years of use, an expert told the Chinese media recently. The expert, who heads the microbiology department at the University of Hong Kong, told the South China Morning Post newspaper that the virus is shifting away from the Fujian strain that it was developed for, according to a 8 Jul 2008 Deutsche Presse-Argentur (DPA) report. He told city officials that they must ban all live chickens from markets before the vaccine becomes completely ineffective, the DPA report said. Tests on birds in 2005 suggested that the vaccine generated only a quarter of the antibody response it did in 2001.

OIE Review – Avian Influenza – January 2007 – May 2008
13 Jun 2008
OIE 76th General Session, Paris, 25-30 May 2008. Doc 76sg/2 "Animal health status worldwide in 2007 and early 2008" [edited] [Promed]
[Promed by-line: During the 2008 annual General Session of the Office International des Epizooties (OIE) in Paris, 25-30 May 2008, the head of the Organisation's Animal Health Information Department, Dr Karim Ben Jebara, presented the traditional annual report addressing the evolution of the most prominent transboundary animal diseases since the beginning of the previous year. The following chapter on HPAI H5N1 has been derived from his report. - Mod.AS]
Between 2003 and early 2008, a total of 61 countries/territories reported the occurrence of highly pathogenic avian influenza (HPAI) virus subtype H5N1.
In late 2003 and in 2004 the disease was restricted to South East Asia and in 2005 spread to Central Asia, Russia, and Eastern Europe.
In 2006, it reached the African continent and the Middle East for the first time and spread to Western Europe, where mainly wild birds were infected. In 2006, a total of 47 countries/territories notified the OIE of the presence of the disease.
In 2008 (up to the end of May), 12 countries/territories had notified the reoccurrence of HPAI H5N1 following its previous eradication, thus indicating that the virus is continuing to circulate. These are the Republic of Korea, Hong Kong (SARPRC), India, Iran, Israel, Japan, Laos, Switzerland, Thailand, Turkey, Ukraine, and the United Kingdom (wild birds).
In 2007, 29 countries (4 in Africa, 14 in Asia, 3 in the Middle East, and 8 in Europe) reported HPAI subtype H5N1 in poultry, in wild birds, or in both poultry and wild birds. For Bangladesh, Benin, Ghana, Kuwait, Saudi Arabia, and Togo these were the 1st ever reports of the disease.
In 2007, the number of countries that reported outbreaks was smaller (29 countries)[see table 1] than in 2006, when 47 countries were affected. Starting in 2007, the trend has been for a decline in both the number of affected countries and the number of notified outbreaks. Benin, Germany, Israel, Myanmar, Nigeria, Poland, Romania, Saudi Arabia, Togo, and the United Kingdom submitted a final report indicating the resolution of the outbreaks of HPAI H5N1 and the absence of any new outbreaks. Germany, Israel, Myanmar, Poland, Romania and Saudi Arabia declared themselves free from HPAI in poultry.
In March 2008, Viet Nam notified the presence of this disease in a new host species. The affected animals were 6 Owston's palm civets ( Chrotagale owstoni ) in the Cuc Phuong National Park. The disease had been identified in civets in 2005 but the OIE was not notified at that time.
Regarding the evolution of the disease, 18 affected countries succeeded in eradicating the disease in 2007 and 11 countries did so early in 2008. However, 4 of the 18 countries where HPAI had been eradicated in 2007 notified the reoccurrence of the disease at the beginning of 2008 (see Table 2). In other countries, such as Indonesia, Egypt, and possibly certain parts of Vietnam, Bangladesh and the People's Republic of China, the disease is not under control, despite the vaccination strategy (excluding Bangladesh) put in place. Nine out of 18 countries that submitted a final report in 2007 declared themselves free from HPAI H5N1.
This epizootic of HPAI subtype H5N1 is unprecedented since there are no records of an epizootic having lasted so long a time and having covered such a wide geographical area in such a short period of time. While it is important to combat the disease at source, additional efforts are needed in order to monitor on a more regular basis the efficiency of the vaccines currently in use, to increase vaccination coverage and to decrease the interval between vaccinations in countries where the disease is endemic. It will not be possible to attain these objectives without a very real international and national commitment to apply effective vaccination, so as to achieve better control of the disease and ultimately its eradication once vaccination is no longer used.

North America - Mild American Bird-Flu Strains Gained Ability to Attack Humans
26 May 2008
Bloomberg.com [edited] [Promed]
It is reported in this story that according to government researchers, mild bird flu strains circulating in North America have gained some ability to infect human cells and should be monitored for dangerous mutations. According to a U.S. Centers for Disease Control and Prevention (CDC) scientist in Atlanta, the virus family called H7 is genetically different from the H5N1 strain and mutations in the H7 strain could make it dangerous to humans, especially as some strains of H7 have increased their ability to stick to proteins on the surface of human lung cells.
26 May 2008 – Scientists identify 2nd H7 strain of bird flu that could cause pandemic
The Times online
26 May 2008 – North American bird flu viruses becoming more adapted to humans
The Canadian Press
[ 27 May 2008 - The Abstract of Open Access paper is published in the issue of the Proceedings of the National Academy of Sciences USA, vol. 105, no. 21, 7557563, 1908
Title: Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility
Authors: Jessica A. Belser, Ola Blixt, Li-Mei Chen, Claudia Pappas, Taronna R. Maines, Neal Van Hoeven, Ruben Donis, Julia Busch, Ryan McBride, James C. Paulson, Jacqueline M. Katz, and Terrence M. Tumpey ]

Avian Influenza (H5N1) Strain Nomenclature
23 Apr 2008
Nature online [edited]
Names of flu viruses appearing in the scientific literature have undergone something of a mutation this year [2008]. The group of H5N1 avian flu viruses, once known as "Fujian-like," has morphed into "Clade 2.3.4," and its "Qinghai-like" cousin is now called "Clade 2.2." They are part of a complete revision of H5N1 nomenclature recommended by the World Health Organization (WHO).

Oseltamivir Therapy
[This document, which originated as a press release form Roche Pharmaceuticals, is reproduced here in abbreviated form on account of its intrinsic interest and usefulness
Promed.] [Edited]
International symposium reports on the use of antivirals in patients with H5N1
The magnitude of effect of Tamiflu in treating and preventing novel strains of influenza (such as those that may be involved in a pandemic or associated with avian flu) cannot be predicted as it has not been studied or approved in a pandemic scenario. The World Health Organization (WHO) has recommended that higher doses and longer treatment durations may be required to combat novel strains of influenza.
In the most recent clinical management guidelines issued by the WHO, Tamiflu remains the primary antiviral agent of choice for the treatment of H5N1 virus infections.
Symposium findings
In Indonesia, of the total of 119 H5N1 human cases reported, 22 survived -- an 18 per cent survival rate overall. Of the 119, 33 patients received no Tamiflu, all of whom died. Tamiflu was administered to the other 86 patients, with a 26 per cent survival rate overall. Time from onset of illness to initiation of treatment appeared to influence survival. Both of the 2 patients who received Tamiflu within 24 hours of illness onset survived. If given the drug within 4 days, 55 per cent survived (6/11), and 35 per cent survived if given Tamiflu within 6 days (13/37).The survival rate of those receiving it later than 6 days after illness onset was 18 per cent (9/49).
Recent information about 8 Vietnamese patients infected with H5N1 was also presented. All 8 patients received Tamiflu, but all 8 patients presented to the hospital later than 5 days after onset of illness. Only 3 of the 8 patients survived, reinforcing that treatment benefit is reduced for patients that receive the drug later in the course of illness. In 2 patients who were unable to take the drug orally due to the severity of their illness, physicians administered the drug by nasogastric tube and found it was well absorbed and there was a reduction in H5N1 virus in these patients.
Susceptibility of circulating H5N1 strains to Tamiflu
These clinical findings are supported by animal data, also presented at ISRVI, which shows that oseltamivir treatment was effective against H5N1 influenza viruses representing different clades/subclades. However, higher doses were required for the more pathogenic H5N1 viruses.
"Multiple factors can affect the susceptibility of antiviral therapy with highly pathogenic H5N1 influenza viruses and it is reassuring that oseltamivir, in mouse models, demonstrates activity even to the most pathogenic circulating strains," comments study author Dr Elena Govorkova, St Jude Children's Research Hospital, Memphis, TN, USA.
Data also confirm the low level of resistance reported to-date with Tamiflu to H5N1 avian influenza in the field; there are only 5 cases of published reports of H5N1 resistance or reduced susceptibility to Tamiflu to date. Laboratory results have shown 96 per cent of H5N1 strains (53 out of 55) tested in the laboratory were sensitive to Tamiflu.
This compares to the around 14 per cent of isolates tested this year [2008] of the seasonal influenza A H1N1 virus showing resistance to Tamiflu, reported at the conference It is important to note that these increased levels of resistance have only been reported spontaneously in this year's H1N1 (Solomon Islands) seasonal strain, and not an avian strain such as H5N1, and not in patients who have been administered Tamiflu.

Japan - Proposed vaccine trial
15 Apr 2008
CIDRAP News [edited]
Japan's health ministry today [15 Apr 2008] said it was on the verge of approving a plan to administer pre-pandemic vaccine to healthcare workers, which would make it the world's 1st country to tap its national stockpile for this purpose.
An official from Japan's health and welfare ministry, said the plan, which awaits approval tomorrow [Wed 16 Apr 2008], would allow the vaccination of about 6000 quarantine officials and healthcare workers by the end of the year, the Associated Press (AP) reported today. Japan has already approved and stockpiled pandemic vaccines for 10 million people that are based on H5N1 viruses from China, Indonesia, and Viet Nam, according to a report today [15 Apr 2008] from Reuters. The same official told the AP that if initial tests show that the pre-pandemic vaccine is safe and effective, the ministry would consider vaccinating 10 million more people, including such vital workers as lawmakers, police, and other healthcare workers. Reuters reported that the 2nd vaccination wave would also include those who maintain infrastructure networks such as gas and electricity.
International health officials have been cautious about taking steps toward vaccination in advance of a pandemic, because researchers are uncertain whether vaccines that are currently in national stockpiles will offer cross-protection against a future pandemic strain. Also, it's not clear whether any adverse events would arise from the use of the vaccine, which makes it difficult to weigh the usefulness of the strategy.
In a May 2007 bulletin, the WHO acknowledged that as pre-pandemic vaccines become available, they could be used in poultry workers, healthcare workers, and whole populations. However, the WHO did not recommend that countries undertake the strategy. Gregory Hartl, a spokesman for the WHO, told the AP that pre-pandemic vaccination is "a big roll of the dice" but said the WHO doesn't oppose countries using the vaccines. The European Centre for Disease Prevention and Control in 2007 praised the development of pre-pandemic vaccines but said it did not support countries using them until the WHO elevates its pandemic phase to 5 or 6 (from the current phase 3), which would indicate that significant human-to-human transmission is occurring.

Avian Influenza – Poultry vs. Migratory birds
16 Feb 2008
Daily Times, Islamabad [edited]
Wild migratory birds may suffer from avian influenza (commonly known as bird flu), but they are not the main source of the disease's outbreak in Pakistan, according to a study statement issued by the World Wildlife Fund (WWF) Lahore chapter on Friday [15 Feb 2008]. The WWF said there were no sound grounds to support the allegations that migratory birds were solely responsible for the spread of H5N1. It said the Food and Agriculture Organisation (FAO) collected samples from between 300 000 to 350 000 wild birds across the world. None of these were found H5N1 positive. Likewise, a sampling of 5000 water birds after the outbreak in Nigeria during 2006 found no traces of the virus (according to the Wildlife and the Environment Web). Despite increased sampling around the world, no fully documented migratory wild birds have tested positive for H5N1.The WWF said the mapping of bird flu outbreaks across the world had shown that they followed poultry trade routes rather than the migratory birds' flyways. Therefore, after a comprehensive critical review of recent scientific literature, it was concluded that poultry trade, rather than bird migration, was the main mechanism of the global dispersal of the H5N1 virus. The organization said the illegal trade of caged birds had transported the H5N1 virus the world over. It said: "Bird flu virus is transmitted farm to farm by the movement of live birds, people (especially with contaminated clothes), and contaminated vehicles, equipment, feed, and cages. Highly pathogenic viruses can survive for long periods in the environment, especially when temperatures are low. For example, the highly pathogenic H5N1 virus can survive in bird feces for at least 35 days at a low temperature (4 C). At a much higher temperature (37 C), H5N1 viruses have been shown to survive in fecal samples for 6 days (WHO).
"The WWF called for the media to educate the people about the bird flu virus and how it was being spread. It also called for the authorities to monitor any suspicious mortality of birds in the wild. It asked the zoos to vaccinate all birds against the virus. The organization said poultry farms should have tracking numbers, because once their birds got out in the market, they could not be tracked back to the farms. The WWF said strict hygiene and bio-security measures should be taken at poultry farms and zoos. People and vehicles going to the farms should be disinfected; the birds' caretakers should meticulously clean utensils, their hands and feet. The statement said the organization did not support mass culling of wild birds or the destruction of their habitats. It said the birds' habitats should be left undisturbed so that they do not seek refuge near human settlements.

Avian Influenza – WHO Review
16 Jan 2008
CIDRAP (Center for Infectious Disease Research & Policy) News [edited] This 2008 update is published in the 17 Jan 2008 issue of the New England Journal of Medicine (Volume 358(3): 261-273, (<http://content.nejm.org/cgi/content/full/358/3/261>) and is entitled "Update on Avian Influenza A (H5N1) Virus Infection in Humans," by the Writing Committee of the "Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus."
Exposure source unclear in 25 percent of human H5N1 cases In at least 25 percent of human infections with the H5N1 avian influenza virus, just how the person was exposed to the virus remains a mystery, according to a report by an expert panel set up by the World Health Organization (WHO). "In one quarter or more of patients with influenza A (H5N1) infection virus infection, the source of exposure is unclear, and environment-to-human transmission remains possible," says the report, which appears today [16 Jan 2008] in the New England Journal of Medicine The predominant source of exposure in H5N1 cases is contact with infected poultry in the week before onset of illness, the article notes. But in cases involving no such contact, patients might have touched contaminated objects (fomites) or fertilizer containing poultry feces, or have inhaled aerosolized infectious material. The only known risk factor for some patients was visiting a live-poultry market, the article says. The discussion of exposure sources is part of a review of all aspects of human H5N1 cases, including epidemiology, clinical features, diagnosis, treatment, and prevention. About a quarter of all human cases have occurred in clusters of 2 or more that were epidemiologically linked, the report says. More than 90 percent of the clusters have involved blood relatives, suggesting a possible genetic susceptibility to the infection. Most people in the clusters probably were infected through common exposure to poultry, "but limited, non-sustained human-to-human transmission has probably occurred during very close, unprotected contact with a severely ill patient," the article states. Regarding the virus's evolution, the report has a chart that shows a total of 10 different clades (including the original 1997 strain from Hong Kong), or lineages, plus 5 subclades in clade 2. "Changes in multiple viral genes" -- not just the surface protein known as hemagglutinin -- "are probably required to generate a potentially pandemic influenza A (H5N1) virus," the article says.
[T]he report repeats previous WHO advice against the routine use of corticosteroids in H5N1 patients. Corticosteroid therapy has not been effective, and prolonged or high-dose corticosteroids can lead to serious adverse events. As for antiviral drugs, the panel says that clade 1 viruses and most clade 2 viruses from Indonesia are fully resistant to M2 inhibitors (amantadine and rimantadine), but the other clade 2 viruses from other parts of
Eurasia and Africa are usually susceptible to these older drugs. The article repeats the standard recommendation for early treatment with oseltamivir, a neuraminidase inhibitor. The panel also reiterates previous WHO statements that doubling the standard oseltamivir dose and duration of treatment may be reasonable. Resistance to the drug has been seen in a few patients, and clade 1 viruses seem to be more susceptible than some clade 2 viruses, though the clinical relevance of this difference is unclear.

WHO tracing system announced
22 Jan 2008
CIDRAP News, corrected version 23 Jan 2009 [edited]
WHO catalogs H5N1 viruses, launches tracking system Countries affected by H5N1 avian influenza have sent material containing 734 H5N1 virus isolates to the World Health Organization (WHO) over the past 5 years, and from now on the public will be able to track particular isolates that have been submitted and what is being done with them, according to WHO. An online chart published by WHO yesterday [21 Jan 2008] shows that countries submitted 8763 samples from humans and animals from 2003 through 2007, and 734 H5N1 viruses were isolated from those samples. WHO needs the isolates so it can monitor the virus's evolution, potential for human transmissibility, and susceptibility to antiviral drugs. Viet Nam contributed the most H5N1 isolates: 375, derived from 1199 samples. But Indonesia provided the second most: 171 isolates derived from 4774 submitted samples. This, despite the fact that the country stopped sending H5N1 samples for several months last year [2007] because of concern that vaccines derived from such samples are too expensive for developing countries. In 2007 Indonesia sent WHO 92 clinical samples, from which 20 viruses were isolated, the WHO chart shows. The country had withheld H5N1 samples from the WHO for about 5 months starting at the beginning of the year, according to previous reports.
Tracking system announced On the heels of the report on H5N1 specimens submitted, the WHO today unveiled an online system to provide information on H5N1 specimens shared with the WHO through its Global Influenza Surveillance Network. The system permits anyone to search for particular isolates by date of submission, source country, host species, and several other variables. The system provides a page of detailed information for each isolate, including a list of all the laboratories to which the virus has been distributed, including pharmaceutical companies. WHO describes the current system as an interim version. At this point it contains most of the viruses and clinical specimens that have been submitted to WHO since 24 Nov 2007, plus all H5N1 viruses that have been developed into vaccine viruses, according to a WHO statement. Information on the remaining viruses submitted since 24 Nov 2007 is being added to the system. Both the tracking system and the country-by-country report are results, at least in part, of Indonesia's concerns about the fairness and openness of the WHO system for the sharing, monitoring, and use of influenza viruses.
A WHO statement today [22 Jan 2008] said the tracking system was developed following the intergovernmental meeting on flu virus sharing that was held 21-23 Nov 2007 in Geneva. At the meeting, a WHO working group tried unsuccessfully to resolve Indonesia's concerns about sending H5N1 specimens to WHO. The November meeting and other discussions in 2007 were held in response to a resolution passed at WHO's World Health Assembly last May [2007]. The resolution called on the WHO director-general to come up with a system for equitable sharing of the benefits of flu-virus sharing, to set up an international stockpile of vaccines for H5N1 and other potential pandemic viruses, and to revise the "terms of reference" for international sharing of flu viruses. Viruses chosen for vaccines The WHO chart of H5N1 viruses submitted in the past 5 years says 13 isolates were selected for development into vaccines. So far, 8 engineered viruses derived from these isolates, "suitable for vaccine development and production, are available for distribution," WHO reports. The agency says 292 institutions have received one or more copies of the 8 engineered viruses, and 46 institutions have received "wild-type" vaccine viruses. Numerous other countries besides Viet Nam and Indonesia have submitted samples that yielded H5N1 isolates over the years, according to WHO. For example, Hong Kong submitted 380 specimens that yielded 4 isolates, China (other than Hong Kong) submitted 26 samples with 22 isolates, Egypt sent 758 specimens with 26 isolates, and Turkey provided 335 specimens with 6 isolates.

Indonesia - Mortality analysis
24 Jan 2008
Reuters Foundation AlertNet [edited]
Medical experts are worried about how death rates for H5N1 bird flu have shot up in places like Indonesia, and studies are being carried out to see if victims require higher dosages of drugs. Although the H5N1 has only infected 352 people since 2003, it has killed 219 of them, with mortality rates rising to more than 80 percent in places like Indonesia in the past 2 years. "It could be they are treated later, or the virus is different, more virulent. There are many maybes, including differences in susceptibility of [to?] the virus," Menno de Jong, a doctor who has treated bird flu victims in Viet Nam, told Reuters on the sidelines of a bird flu conference in Bangkok. He said a major concern was the H5N1 variant in Indonesia appeared to be less susceptible to oseltamivir, the antiviral used to combat the disease. "It's not a (drug) resistant virus, it's just that a bit more drug (may be) needed to inhibit these (H5N1) clade 2 viruses," he said, referring to the sub-category that Indonesia's H5N1 virus has been classified under. Studies are being conducted in Thailand, Viet Nam and Indonesia to see if H5N1 patients need to be given higher dosages of oseltamivir. Indonesia is the worst hit of the 14 countries where H5N1 has infected people since 2003. Although bird flu remains an animal disease, experts fear the virus could mutate into a form easily passed from human to human and kill millions. But details emerged on Thursday [24 Jan 2008] on how the virus had been passed from mother to fetus in the case of a pregnant 24-year-old Chinese woman who died of the disease in 2005. Jiang Gu, a leading scientist at Beijing University, said the virus was detected in most organs of the foetus, including the brain. "It is capable of penetrating the placental barrier and infecting the foetus. [This is the] 1st evidence of such human-to-human transmission," Gu said.

FAO – Avian Influenza, global update
19 Dec 2007
CIDRAP News [edited]
Despite recent spikes in H5N1 avian influenza activity in humans and birds, there have been fewer bird outbreaks in fewer countries this year [2007] than in 2006, according to a preliminary report from the United Nations Food and Agriculture Organization (FAO). As of 10 Dec 2007, 30 countries had reported H5N1 cases in birds this year [2007], compared with 54 in 2006, the FAO reported. This year, 5 countries have reported their 1st outbreaks: Bangladesh, Benin, Ghana, Saudi Arabia, and Togo. Except for sporadic outbreaks in wild birds, most of the H5N1 cases this year occurred in domestic poultry, such as chickens, turkeys, geese, ducks, and quail. The H5N1 outbreaks seemed to follow a seasonal pattern, in line with evidence that cooler temperatures are more favorable to influenza viruses. The FAO said outbreak numbers in 2007 were high between January and April, declined until September, and then started rising again in November and December. Increased awareness and improved disease surveillance have enabled countries such as India, Romania, Malaysia, and Turkey to detect and control the spread of the H5N1 virus, the FAO reported. However, the disease persists in Asia, Africa, and Europe and poses a risk for countries that have controlled outbreaks in the past and those that have not experienced infections yet, the organization stated.
The FAO said Indonesia is still having a large number of H5N1 outbreaks in poultry, which largely reflects a new "participatory disease search" program designed to detect infections in backyard poultry. The program, with support from the FAO, is operating in 162 districts and 9 provinces. Among other Asian hot spots for the disease, Viet Nam reported H5N1 outbreaks in 22 provinces in May 2007, the FAO reported. It said the disease appears to be endemic in Bangladesh. China had H5N1 outbreaks in Tibet in March 2007, Hunan province in May 2007, and Guangdong province in September 2007, the agency said. In addition, routine surveillance detected the virus in March and April 2007 in the southern Chinese provinces of Fujian, Guangdong, Hunan, Hubei, Sichuan, and Chongqing, the FAO reported. Also, wild bird deaths were reported in Hong Kong but not in mainland China. The only Middle Eastern country reporting an H5N1 outbreak so far this year [2007] has been Saudi Arabia, which had its 1st cases in March 2007, followed by several outbreaks near Riyadh in November 2007. In Africa, 4 countries have reported H5N1 outbreaks in 2007, and the FAO said the virus is considered endemic in Egypt and possibly in Nigeria. "Several countries in West, Central, South, and North Africa are at risk of becoming infected, and early warning, surveillance, and preventive measures should urgently be taken," the organization reported. Eight European countries have reported H5N1 outbreaks in 2007, the FAO noted.

Bird Flu Expert Calls For Changes In Early-warning System
11 Dec 2007
Sciencedaily.com [edited]
The international science community is not doing enough to track the many avian influenza viruses that might cause the next pandemic, a UC Davis researcher says. Global surveillance is critical for identifying and tracking potential pandemic viruses such as highly pathogenic H5N1. According to this commentary written by Walter Boyce, to really understand the role of wild birds in spreading H5N1, more surveillance should be done in places where the virus is endemic, such as China, Southeast Asia and Africa. Characterize all of the influenza viruses they collect: Currently, the narrow focus on H5N1 misses other viruses that also pose pandemic risks. Share samples and data more promptly: Whether caused by regulatory hurdles or researchers' concerns about intellectual property rights, a reluctance to share hampers health officials' ability to track and respond to potential pandemic viruses. Boyce recommends that the scientific community set a standard of releasing data no more than 45 days after it is generated. The full commentary is published in Nature 7 Dec 2007: < http://www.nature.com/nature/journal/v450/n7171/full/450791a.html >

Europe – Avian Influenza, Poultry vs Migratory birds
25 Oct 2007
FAO News [edited]
The avian influenza virus H5N1 could become entrenched in chickens and domestic ducks and geese in parts of Europe, FAO warned today [25 Oct 2007]. The agency stressed that healthy domestic ducks and geese may transmit the virus to chickens and play a more important role in the persistence of the virus in the region than previously thought.
H5N1 surveillance in countries with significant domestic duck and geese populations should be urgently increased. FAO's warning followed the detection of H5N1 in diseased young domestic ducks by German scientists. "It seems that a new chapter in the evolution of avian influenza may be unfolding silently in the heart of Europe," said FAO's Chief Veterinary Officer, Joseph Domenech. "If it turns out to be true that the H5N1 virus can persist in apparently healthy domestic duck and geese populations, then countries need to urgently reinforce their monitoring and surveillance schemes in all regions with significant duck and geese production for the presence of H5N1. Europe should prepare for further waves of avian influenza outbreaks, most probably in an east-west direction, if the virus succeeds in persisting throughout the year in domestic waterfowl. This heightens the need for increased surveillance and monitoring of possible virus
circulation in domestic ducks and geese.
Importantly, the Black Sea area serves as a main wintering area for migratory birds coming from Siberia and moving also to the Mediterranean and other regions. All countries bordering the Black Sea have experienced outbreaks of avian influenza in the past, favored by traditional open poultry systems with poor separation between wild and domestic birds. The link between the H5N1 virus and domestic ducks and geese has recently been confirmed in Germany. Scientists of the Friedrich-Loeffler-Institut in Riems detected the H5N1 virus in diseased young ducks on a farm at the end of August 2007. Further scrutiny at 2 other farms revealed that, despite the absence of clinical signs and mortality in these ducks, the animals had been in contact with the H5N1 virus, because their immune defense system showed antibodies developed in response to the virus. Intensified monitoring finally confirmed pockets of H5N1 on one of the farms.

China – Avian Influenza – Human transplacental transmission
27 Sept 2007
Reuters Foundation AlertNet [edited]
The H5N1 bird flu virus can pass through a pregnant woman's placenta to infect the fetus, researchers reported on Thursday [27 Sept 2007]. They also found evidence of what doctors had long suspected – that the virus not only affects the lungs, but also passes throughout the body into the gastrointestinal tract, the brain, liver, and blood cells.“The work helps us to understand H5N1's high fatality rate, as well as serving as model for global collaboration in the field of emerging infectious diseases," said Dr. Ian Lipkin of Columbia University in New York, who collaborated in the study. A team at Peking University in Beijing studied tissue taken from 2 people killed by H5N1 in China - a 24-year-old pregnant woman and a 35-year-old man. The study is the first to come out of the Infectious Disease Center at Peking University in Beijing, established after the epidemic of severe acute respiratory syndrome or SARS. The center is now looking at victims of H5N1 avian influenza. The virus mostly infects birds, but occasionally infects people and has killed 200 out of 328 infected since 2003. Because experts fear it could cause a pandemic that would kill millions, they are studying it in great detail. Jiang Gu and colleagues at Peking University looked at tissue samples from throughout the bodies of the victims. They found genetic material from the virus in the lungs, as expected, but also in the brain, the placenta, the intestines, and in immune system cells in the blood and the liver. The 4-month-old fetus, which died with its mother, was also infected, the researchers reported in the Lancet medical journal. Their findings support the theory of a "cytokine storm" -- the idea that the immune system overreacts to the virus in some cases, and sends out an overwhelming swarm of signaling chemicals that end up killing the patient. "Many people have talked about cytokine storm," Lipkin said in a telephone interview. "Here the lung findings are that the amount of damage appears to be disproportional to the number of cells that were infected. This supports the hypothesis that there might be indirect methods of damage." They also found evidence the virus had damaged immune cells including macrophages, which they said suggests the virus not only over stimulates parts of the immune system but can also suppress other parts. Previous studies of H5N1 victims have produced evidence the virus may have evaded their immune system's defenses by suppressing them. The researchers noted that no one had thought human influenza could cross the placenta and affect unborn babies. "But there just isn't that much information," Lipkin said. Reference: The Lancet 2007; 370:1137-1145 DOI:10.1016/S0140-6736(07)61515-3

MIT explains spread of 1918 flu pandemic
18 Feb 2008
Massachusetts Institute of Technology (MIT) News [edited]
Researchers at MIT [The Massachusetts Institute of Technology] have explained why 2 mutations in the H1N1 avian flu virus allowed the disease to spread during the 1918 pandemic that killed at least 50 million people. The work could help scientists detect and contain a future bird flu outbreak among humans. The team showed that the 1918 influenza strain developed 2 mutations in a surface molecule called hemagglutinin (HA). This, in turn, allowed it to bind tightly to receptors in the human upper respiratory tract. This new work could aid researchers in monitoring the HA mutations in the H5N1 avian flu strains currently circulating in Asia. Epidemiologists fear these mutations could enable the virus to jump from birds and spread between humans -- a possibility that could trigger millions more deaths than the 1918 pandemic.

Dominican Republic – Avian Influenza H5N2, Poultry
3 Jan 2008
VOA News (edited)
Dominican authorities have quarantined and sacrificed a number of birds after detecting a strain of bird flu last month [December 2007]. The World Organization for Animal Health (WHOA) said in a report that 130 birds were slaughtered after authorities discovered a case of the virus near the capital, Santo Domingo, and another some 145 kilometers [90 miles] to the east in the village of Higuey. Officials say the virus is the H5N2 strain, which does not affect humans. The government livestock director said officials believe the virus reached the Dominican Republic through birds introduced into the country illegally. Other sources 6 Jan 2008 OIE WAHID (World Animal Health Information Database) Disease Information 2007; 20(52)

Poultry workers carry antibiotic-resistant germs
19 Dec 2007
World Poultry Net (edited)
It has been revealed in a US study that poultry workers are 32 times more likely to carry antibiotic-resistant E. coli bacteria than non-poultry workers. Researchers at Johns Hopkins University's Bloomberg School of Public Health reported they found that E. coli are common in the industrial broiler chicken environment, the researchers said their study is the first US research to show exposure occurring at a high level among industrial poultry workers. According to the study's lead author, for over 50 years the use of antimicrobials has been present in the United States. There are estimates indicating well over half of the antimicrobial drugs produced in the US are used in food animal production.

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