AUG 06 Health Alerts
Bird Flu vaccine for Humans
30/08/06
The Chinese Xinhua news agency carries a report on 29 August 2006 that a vaccine against a strain of the bird flu virus has been successfully tested in volunteers at the Beijing China-Japan Friendship Hospital . Following vaccination antibody levels were achieved beyond the 70% European Union standard. No adverse effects were noted in the 120 volunteers and the manufacturing pharmaceutical company has applied to proceed to the second phase of testing. While this is very welcome news protection by this vaccine can only be assumed to be against the current strain of the H5N1 virus. For this strain to produce the feared human pandemic it would have to be transformed into a mutated strain which would have different antigens and there is no guarantee that the antibodies generated by this vaccine would be effective against the new antigens. The uncertainty about the structure of a mutated virus strain is what makes vaccine development difficult and companies world-wide developing vaccines for human use have to gamble on correctly predicting the nature of the mutation. It is only if and when mutation occurs that there will be any certainty about the type of vaccine needed, but given the time necessary for vaccine development and production it is encouraging internationally that about a dozen companies are already at work to be ready for a situation which we hope will never develop.
WHO: Situation in Indonesia - update 29
24/08/06
The Ministry of Health in Indonesia has confirmed the country's 60th case of human infection with the H5N1 avian influenza virus.
The case is a 6-year-old female from Bekasi, West Java Province. She developed symptoms on 6 August and was hospitalized on 11 August. She remains hospitalized but is recovering. The source of her infection is currently under investigation.
Of the 60 cases confirmed to date in Indonesia, 46 have been fatal.
WHO: Situation in Indonesia - update 28
22/08/06
The Ministry of Health in Indonesia has confirmed the country's 59th case of human infection with the H5N1 avian influenza virus.The case occurred in a 35-year-old woman from the remote subdistrict of Cikelet, West Java Province. She was hospitalized with severe respiratory disease on 17 August and died shortly after admission.She is the third confirmed case from this sub-district to be reported in the past week.
Preliminary findings from the Cikelet investigation
A team of experts is presently in the Cikelet subdistrict investigating the outbreak and monitoring for further cases. Three hamlets are the focus of investigation.The Cikelet subdistrict consists of around 20 isolated hamlets, each with a population of around 200 to 400 persons, many living in large extended families. The hamlets sit in a basin surrounded by steep mountains with rocky winding paths best accessed by foot or horseback.In this area, mortality from endemic diseases, especially malaria, is common, access to health care is poor, and medical records of deaths are scanty or non-existent.
Prior to late June 2006, no mass die-offs of poultry are known to have occurred in the area. At that time, live chickens were purchased from an outside market in preparation for a religious feast and were integrated into local flocks. Shortly thereafter, chickens began dying in large numbers in an outbreak that continued throughout July and the first week of August, gradually spreading from one hamlet to another.As the population had no experience with this disease, high-risk behaviours commonly occurred during the disposal of carcasses or the preparation of sick or dead birds for consumption. These exposures are, at present, thought to be the source of infection for most confirmed or suspected cases.Deaths from respiratory illness are known to have occurred in late July and early August, but no samples were taken and medical records are generally poor. Though some of these undiagnosed deaths occurred in family members of confirmed cases, the investigation has found no evidence of human-to-human transmission and no evidence that the virus is spreading more easily from birds to humans.
The cooperation of residents is good, house-to-house surveillance for febrile illness is continuing, and specimens have been taken from symptomatic persons and sent for testing. The team is well-supplied with antiviral drugs, and these are being administered prophylactically to close contacts of cases and therapeutically to persons showing symptoms of influenza-like illness.
WHO: Situation in Indonesia - update 27
21/08/06
The Ministry of Health in Indonesia has confirmed the country's 58th case of human infection with the H5N1 avian influenza virus.
The case occurred in a 9-year-old girl from a remote village in Garut district, West Java Province. She developed symptoms on 1 August, was hospitalized on 14 August, and died on 15 August. Recent chicken deaths were reported in her household.
Three hamlets within the village are currently under investigation. An additional case from the village, but from another hamlet, was confirmed by the Ministry of Health on 14 August. This 17-year-old male developed symptoms on 26 July and is now recovering. Another death from severe respiratory disease occurred on 5 August in a 20-year-old neighbour, who is also now known to be a cousin. As no samples were taken for testing, the cause of his illness remains uncertain. Based on idemiological and clinical findings, however, infection with the H5N1 virus is strongly suspected.
As both young men developed symptoms on the same day (26 July), epidemiologists assume that they acquired their infection from a shared environmental source. The currently recognized incubation period for H5N1 infection of 2 to 8 days makes human-human transmission between the two highly improbable.
Of the 58 cases confirmed to date in Indonesia, 45 have been fatal.
Asia Round-Up
21/08/06
A comprehensive report on the situation in Asian countries as at 31 July 2006 has been published by the Food and Agricultural Organisation of the United Nations. The summary does not deal with cases of human infections. Below is an edited summary of the report by the International Society for Infectious Diseases.
Highly Pathogenic Avian Influenza (HPAI) type H5N1 continues to spread in Asia . In addition to the 10 countries affected in Southeast Asia (2003 - 2004), India , Pakistan , Myanmar and Afghanistan were newly affected by new outbreaks of HPAI in 2006 in poultry and wild birds. More than 220 million birds have been culled as a consequence of HPAI outbreaks in Asia with a major impact on food security and people's livelihoods, backyard poultry farms and the international trade in live poultry and poultry products. In addition, the unproductive"downtime" forced on affected poultry farms has had a negative effect on such farms, public health issues and contact with HPAI H5N1 contaminated environments.
China , Cambodia , Lao PDR, Malaysia and Thailand reported new outbreaks of HPAI during 2006. Although there is an increase in knowledge and public awareness of HPAI in poultry, it is not yet clear what is the exact role of wild birds in the epidemiology of
HPAI, the susceptibility of wild bird species, the mechanisms underlying virus persistence and virus transmission between and among wild migratory wild birds, resident wild birds, free range birds and domestic poultry populations.
In Asia , 2 sources of infection of HPAI virus probably coexist: the introduction, transmission and circulation of the virus in domestic poultry populations (particularly on backyard farms), live bird markets and commercial poultry farms with low biosecurity systems, and migratory wild birds. However, the link between domestic poultry and wild bird habitats and the true risk posed is still unclear.
WHO: Situation in China - update 14
15/08/06
The Ministry of Health in China has confirmed the country's 21st case of human infection with the H5N1 avian influenza virus.
The case occurred in a 62-year-old male farmer from the north-western province of Xinjiang . He developed symptoms on 19 June and died on 12 July. Initial tests on patient specimens produced negative results. As a precautionary measure, tests were repeated during July and August and eventually produced positive results, which were confirmed today by the Ministry of Health.
An epidemiological investigation of the case was unable to uncover a history of exposure to dead or diseased birds. The man had no history of travel during the month prior to symptom onset. No recent poultry outbreaks have been reported in the vicinity of the man's home. Xinjiang Province had not previously reported a human case.
Of the 21 cases confirmed to date in China , 14 have been fatal.
WHO: Situation in Indonesia - update 26
15/08/06
The Ministry of Health in Indonesia has confirmed the country's 57th case of human infection with the H5N1 avian influenza virus.
The case is a 17-year-old male from a remote village in Garut district, West Java Province . He developed symptoms on 26 July and was referred to hospital on 9 August. Medical staff suspected H5N1infection based on his respiratory symptoms and a history of exposure to dead poultry. Results received on 12 August were positive for H5N1 infection. The patient is presently recovering.
Chicken and duck deaths occurred in the patient's household and neighbourhood during the week prior to symptom onset. The case reportedly had direct contact with diseased chickens during the disposal of carcasses.
A 20-year-old male who lived in a neighbouring household where chickens were also dying developed symptoms on 26 July and sought care at the local health centre on 5 August. He died of respiratory disease on 6 August, before arrangements could be made for transfer to hospital and before samples could be taken for testing. The cause of his illness and death remain
undetermined.
Of the 57 cases confirmed to date in Indonesia , 44 have been fatal.
WHO: Situation in Indonesia - update 25
9/08/06
The Ministry of Health in Indonesia has confirmed the country's 56th case of human infection with the H5N1 avian influenza virus. The case occurred in a 17-year-old female from Jakarta Province. She developed symptoms on 28 July, was hospitalized on 4 August, and died on 8 August An investigation into her source of infection found that pet pigeons were kept inside her home and that several neighbouring households maintained flocks of backyard poultry. Of the 56 cases confirmed to date in Indonesia, 44 have been fatal.
Interim Report West Papua
09/08/06
Agence France-Presse reported on 8 August that samples taken in the Mimika area after chickens from a local farm died proved positive for avian influenza H5N1 strain in 3 out of some 30 samples. The virus has already been detected in 27 other Indonesian provinces but this is the first report from Papua.
This report has still to be confirmed by the World Health Organisation
WHO: Situation in Indonesia - update 24
09/08/06
The Ministry of Health in Indonesia has confirmed the country's 55th case of human infection with the H5N1 avian influenza virus.
The case occurred a 16-year-old male from West Java Province . He developed symptoms on 26 July, was hospitalized on 4 August, and died on 7 August.
Prior to symptom onset, the case had contact with sick and dying chickens in his household. A joint investigation by health and agricultural officials detected the H5 virus subtype in chickens from the household. Family members and close contacts have been placed under surveillance.
Of the 55 cases confirmed to date in Indonesia , 43 have been fatal.
WHO: Avian Influenza - situation in Thailand - update
08/08/06
The Ministry of Public Health in Thailand has confirmed the country's 24th case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 27-year-old man from the central province of Uthai Thani . He developed symptoms on 24 July, was hospitalized on 30 July, and died on 3 August.
Investigation of his source of infection revealed contact with household chickens, which began dying around one week prior to symptom onset.
This is the country's second case of H5N1 infection, and second fatality, within the past two weeks. Confirmation of these cases follows an 8-month period in which no human cases were reported in the country.
Recent outbreaks in poultry have been officially reported in two provinces, Phichit and Nakhon Phanom, both located in the northern part of the country.
