Saturday, July 28, 2012

Treatment with neuraminidase inhibitors for critically ill patients with influenza A(H1N1)pdm09

Backgound. Neuraminidase inhibitor (NAI) antiviral drugs can shorten the duration of uncomplicated influenza illness when administered early (<48 hours after illness onset) to otherwise healthy outpatients, but the optimal timing of effective therapy for critically-ill patients is not well established.

We analyzed California surveillance data to characterize the outcomes of patients in intensive care units (ICU) treated with NAIs for influenza A(H1N1)pdm09 [pH1N1]. Demographic and clinical data were abstracted from medical records using standardized case report forms.

From April 3, 2009 – August 10, 2010, 1950 pH1N1 cases hospitalized in ICUs were reported. Of 1859 (95%) with information available, 1676 (90%) received NAI treatment and 183 (10%) did not. The median age was 37 years (range: 1 week - 93 years), 1473 (79%) had ≥1 co-morbidity, and 492 (26%) died. The median time from symptom onset to starting NAI treatment was 4 days (range 0-52). NAI treatment was associated with survival: 107 of 183 (58%) untreated cases survived, compared to 1260 of 1676 (75%) treated cases (p≤.0001). There was a trend towards improved survival for those treated earliest (p <.0001). Treatment initiated within 5 days after symptom onset was associated with improved survival compared to those never treated (p<0.05).

NAI treatment of critically ill pH1N1 patients improves survival. While earlier treatment conveyed the most benefit, patients started on treatment up to 5 days from symptom onset also had increased survival. Further research is needed on whether starting NAI treatment later than 5 days may also convey benefit.

Experts urge holding off on hazardous H5N1 studies

CIDRAP Robert Roos * News Editor
July 27, 2012
As leading influenza researchers prepare to meet in New York City next week, several eminent life-sciences authorities are calling for continuation of a moratorium on studies involving lab-modified H5N1 viruses with increased transmissibility, according to a story today in the British newspaper The Independent.

The veteran researchers assert that lifting the moratorium now would be a mistake because it would increase the risk of an accidental release of a deadly virus. Among them are Stanley Plotkin, MD, who played key roles in the development of several important vaccines, and Paul Berg, PhD, and Stanley Falkow, PhD, who helped organize the 1975 Asilomar conference, which led to guidelines on recombinant DNA research.

The scientists essentially say the moratorium should remain in place until the risks of the research and proposed precautions can be thoroughly examined in an open process, not one limited to flu researchers.

"History is full of incidents of escape of microorganisms from laboratories, and scientists are not always good at risk evaluation," Plotkin told the newspaper.

The moratorium was declared by leading flu researchers in January, amid the controversy over proposed publication of two studies involving lab-modified H5N1 viruses with airborne transmissibility in ferrets, which raised concern about the risk of deliberate or accidental release of a virus that could spark a human flu pandemic. Originally the moratorium was to last 60 days, but it has now continued for more than 6 months, and it's not clear how or when it will end.

The US National Science Advisory Board for Biosecurity (NSABB) recommended late last year that key details of the two studies be stripped out before publication. But after learning more about the studies, the board reversed its decision on Mar 30, though the panel split on one of the studies. The full studies were published in May and June, one in Nature and the other in Science.

Possible steps toward ending the moratorium are expected to be discussed in New York next week at the annual conference of the Centers of Excellence for Influenza Research and Surveillance (CEIRS). The network includes five academic centers, all funded by the US National Institute of Allergy and Infectious Diseases (NIAID). (One of the CEIRS groups is based at the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News.)

Plotkin, an emeritus pediatrics professor at the University of Pennsylvania and author of a standard textbook on vaccines, told the Independent that creating an H5N1 strains with airborne transmissibility would be like creating anthrax bacteria that could spread from person to person.

Berg said lifting the moratorium would be "a bit ludicrous" because there is no scientific rationale for doing so, according to the story. "There should be a serious review and evaluation of the concerns that led to the moratorium and a scientifically rigorous analysis of why the concerns can be managed before the moratorium could be lifted," he said.

Berg is a Nobel prize winner in chemistry and professor emeritus of molecular and genetic medicine at Stanford University.

Falkow, a professor of microbiology and immunology at Stanford, told the paper, "The moratorium is essential until such time as there is a dispassionate international meeting to address the issues brought to the fore by the H5N1 affair."

Joining them in calling for a continued hold on the research was Richard J. Roberts, PhD, a Nobel prize-winning molecular biologist who now works for New England Biolabs in Ipswich, Mass.. He said many experts privately oppose lifting the ban but are afraid of speaking out for fear that it might affect their funding from the National Institutes of Health, according to the story.

"It's a big mistake at this point," he said. "The flu community is behaving as if they are the only show in town. I think for them to be allowed to create the most dangerous virus around is sheer lunacy."

"I'm not so much worried about terrorism but I am worried about an accidental escape from a laboratory. If it's as dangerous as they believe, it could kill half the world's population," Roberts added.

Also quoted in the story was David Relman, MD, an NSABB member and professor of medicine and infectious diseases at Stanford. He voted against full publication of one of the two studies, the one led by Ron Fouchier, PhD, of Erasmus University in the Netherlands. Relman called for a broad international discussion to consider the risks and benefits of the research.

NIAID Director Anthony Fauci, MD, is scheduled to attend the CEIRS meeting and lead a discussion on "The Way Forward in Influenza Research" on Jul 31. NIAID officials today declined to comment on the Independent story. Yoshihiro Kawaoka, DVM, PhD, lead author of the other controversial H5N1 study, did not respond to an e-mail request for comments today.

Adolfo Garcia-Sastre, PhD, director of the CEIRS center at Mt. Sinai School of Medicine in New York City, said this week that he doesn't think that a decision about lifting the moratorium will come out of the CEIRS meeting, according to media reports.

"A decision about lifting the moratorium? No. A decision about what it requires to lift the moratorium? Maybe," he told the Canadian Press (CP).

Garcia-Sastre noted that researchers are waiting for policy decisions by the federal government before they can resume government-funded research, including a ruling on what level of biosafety will be required, according to the CP story.

Indonesia: The majority of Traditional Market is Unhealthy

July 28, 2012
JAKARTA - AFP: The majority of traditional markets in Indonesia do not meet the criteria of a healthy market. From traditional markets 9559 (Ministry of Trade Survey 2010-2011) and the 7886 village market (Kemendagri, 2010), only five percent were considered healthy market criteria.

The fact that the Director of Environmental Health Ministry of Health stated Wilfried H. Ancient and Distribution Facility Management Kasubdit Ministry of Commerce M Anwar Ahmad, in Jakarta, Friday (27/7).

"The market is not healthy is the source of disease transmission," said Wilfried notify the risk of an unhealthy market.

Unhealthy market conditions are generally characterized by the exhaust system is not good, no zoning, drainage is not good, and poor hygiene.

Hence the means of buying and selling landscape looks shabby and chaotic, with a muddy floor, strewn garbage. Not surprisingly, odors arise and invite swarms of flies.

Markets such as, Wilfried further, the source of a wide range of disease transmission. Is one of the dangerous H5N1 virus, the cause of bird flu.

In some cases positive for bird flu in recent years, from tracing the epidemiology, some patients have a history of contact with poultry in the market.

"In the market, where cuts of chicken, chickens died, chickens that had a disease and so one. Actually, it is dangerous to health," he added.

The stuffy atmosphere of the market are also potentially infectious respiratory diseases and tuberculosis. Flies and rats that roam in the market, continued Wilfried, are at risk of transmitting the bacteria salmonella and leptosirosis the buyer and the traders.

While from the stagnant and dirty water can cause diarrhea and dengue fever outbreaks dengeu.

Reflecting this, the Ministry of Trade Ministry of Health and this year plans to build eight healthy market as a model for other traditional markets.

Eight markets are going to be built, the Market District Pangururan Naidoo (Sumatra), Bengkulu City Panorama Market, Market Grabag Purworejo, Klaten Clark Market, Market Minulyo Pacitan, the Great Market of Denpasar, Sikka regency Kowopante Markets and Market District Lambocca Bantaeng blue.

Total budget of the state budget to build a healthy market it as much as 8 Rp994 million. Later, the money will be channeled through the Department of Health in each region.

Wilfried said, every market will get stimulus funds worth Rp45 million. The fund is intended for the improvement of the trash, drainage, building a healthy toilet on the market and training.

"The fund is still not great. But it's for fishing areas in order to care for the traditional market. Head area not only been to the market only when the election kada," he said.

Thursday, July 26, 2012

Vietnam: Hai Phong #H5N1 #Birdflu in Poultry

July 27, 2012

Avian influenza complicated
Department of Animal Health (MARD), said the bird flu occurred in four farms in An Thai, An Lao District, Hai Phong city to 3110 ducks infected, must destroy 22,440 children.

Department of Animal Health to test directly, urging fight against epidemics, animal health agencies and the Department of Animal Health II Hai Phong city coordinated direct local authorities implement the necessary measures quickly extinguished not to spread the epidemic. Currently, there are 3 provinces of Quang Binh, Hai Duong and Hai Phong with AI less than 21 days. While avian influenza is complicated in the provinces, PRRS has basically been controlled. Now there are four provinces of Dong Nai, Binh Duong, Nghe An province of Dak Lak and PRRS less than 21 days.

Surveillance at airports tightened

July 27, 2012
Semarang, Semarang Central Quarantine Class I began to improve oversight of the luggage out of the passenger ship or aircraft. This was done to prevent the entry and spread of pests and diseases from overseas or outside the island.

The quality of operation to be performed by Customs officers was increased, with increasing number of passengers in the spring of this year's homecoming Lebaran.
"Heightened Supervision we started, both at airports and seaports. We work closely with the Customs officer checks a passenger's belongings, "said Head of Institute of Animal Quarantine Quarantine Class I Semarang, drh Afriantoro Wikantandi Heli told reporters on the sidelines of birds and destruction of food products in Central Quarantine Installation Class I Semarang in Karangroto , District Genuk, Semarang, Thursday (26/7). Witnessed the event, police officers and Customs Genuk A Yani Airport.
The carrier animal pest destroyed, a few birds of Pontianak, such as birds cucakrowo (1 tail), kacer (4), and trucuk (1).

The carrier material of animal origin category (BAH) and the material of animal origin (HBAH) is a meat rendang, beef burger / chicken, chicken sausage, whole chicken, beef meatballs, beef, beef offal, beef jerky, pork meatballs, meat auam , chicken nuggets, fish balls and chicken, and cow skin (Malaysia). In addition, pork, pork sausage, pork and beef jerky (Malaysia and Singapore).

Heli said further, that activity in anticipation of the entry of pests and diseases that developed in foreign countries, such as the entry of bird flu virus (AI), foot and mouth disease.

"Do not let a virus or pest that entered Indonesia through the port or airport. The goods were destroyed during the operation from May to June 2012,
"he said.
Head of Quarantine Class I Semarang Ir Sugiyanta added, it is the institution most responsible for the prevention of animal disease quarantine pests (HPHK). Harbor the Golden Horn and A Yani Airport is home masukknya carrier pests.

"Destruction of the carrier of Malaysia is to prevent the spread of foot and mouth disease (FMD). Malaysia has not been declared free of the disease by Wold Organization of Animal Health, "he said.
Containment measures and the destruction of it, obviously Sugiyanta, refers to Law No. 16 of 1992 regarding Animal, Fish and Plants. In addition, based on Government Regulation No. 82 of 2000 on BAH and HBAH, "he said.

Processed Meat Origin Malaysia and Singapore Destroyed

July 26, 2012
Institute for Agricultural Quarantine Class I Semarang destroyed 76 kg of meat and processed products brought by the Labor Indonesia from Malaysia and Singapore in the Central Animal Quarantine Semarang, Thursday (07/26/2012). In addition, the Central Quarantine also destroyed six bird species cucak Rowo, kacer and trucuk from Pontianak.

Head of Animal Quarantine Heli Afiantoro said the items seized from the workers who were taken by Ahmad Yani Airport Internasiol. Said the animal products, and consumed banned because of alleged health hazard.

"Destruction is a form of protection to the public as consumers, particularly to prevent foot and mouth disease and bird flu," he said.

A number of items that were destroyed, among others, in the form of beef, chicken, sausage, meatballs, beef rendang, beef and chicken burgers, beef jerky, beef offal, salt pork, chicken nuggets and cowhide. Goods were confiscated in the period May to July 2012.

While the origin of birds culled pontianak who are also transported through the Port of Tanjung Golden Semarang is not accompanied by the animal quarantine documents. "The animal was then our quarantine and during the quarantine period the birds were dead," he said.

Destruction activities are conducted in accordance with the said Act No 16 of 1992 on animal quarantine, fish and plants. In addition, based on Government Regulation No. 82 of 2000 on the destruction of materials of animal origin (BAH) and the material of animal origin (HBAH).

Still associated with many animal and dairy goods from entering Indonesia illegally, he claimed to have conducted a number of socialization on the workers. It also called for the workers no longer carry the items that violates the rules. The workers are found to carry the goods are also given guidance.

"Materials of animal origin from Malaysia was destroyed in an attempt to prevent the spread of animal diseases given the country of Malaysia has not been declared free of foot and mouth disease by the WHO, while Indonesia has been declared free, "he added.

Culling is done by burning and witnessed by the structural BKP I Semarang, the witness of Customs officers and airport police.

Egypt: The discovery of poultry infected with bird flu in Fayoum

July 26, 2012
Monitored the competent organs of anti-bird flu in Fayoum and presence of injuries among poultry farm, a private village commons of the Department of Veterinary Medicine Psonors, the province of Fayoum, and got them on the samples and after laboratory testing showed that the samples were obtained and sent for analysis positive for the disease.

And confirmed the central laboratory of the Ministry of Health a positive sample was obtained from a poultry farmer in Fayoum Center Snurs'' bird flu'', and that the sample infected with the disease, and the Department of Preventive Medicine Department of Veterinary Medicine in Fayoum has received over the past week.

Notified the Department of Veterinary Medicine Snurs police station of the reservation to non-poultry markets and leaked to the Preventive Medicine Department for disposal of health through the application and instructions of the Ministry of Health on how to get rid of the infected chickens epidemiological fear of transmission of the citizens.

He was also Engineer Ahmed Ali Ahmed, Governor of Fayoum, crisis management, follow-up to maintain the disposal of poultry infected health burials prepared for this purpose outside the residential block.

Malaysia: Kelantan holds exercise to contain bird flu

26 July 2012

PASIR MAS: Two departments in Kelantan conducted a joint exercise to contain the spread of H5N1, or bird flu, which was reported in several countries.

Kelantan Veterinary and Health Department officers sanitising the pit where culled chickens are supposed to be buried in an exercise to contain bird flu yesterday.

The exercise in Kampung Jintan here yesterday involved 80 officers from the state Veterinary and Health Departments.

Kelantan Veterinary director Datuk Dr Mohd Zairi Serian said they decided to conduct the exercise in case the disease hit the state.

"We have to conduct the exercise from now on so that we can identify our weakness.

"From here, we can also improve our skill in handling the problem in the event that the flu outbreak hits our country.

"Besides, we also want to ensure our officers are prepared."

He said it was important to take precautions as the disease had hit several countries such as in Indonesia and Hong Kong.

Dr Zairi said Kelantan was the third state to organise the exercise after Johor and Penang.

The department was expected to hold similar exercises once a year.

During yesterday's three-hour exercise, officers were seen taking swabs from chicken reared by villagers to be sent for analysis to see if they contained the H5N1 virus.

On Aug 17, 2004, the virus was reportedly detected in a farm in Kampung Baru Pasir Pekan, Tumpat.

Following the discovery, about 200 chickens, ducks and other birds in the village were culled.

The village and surrounding areas within a 10km radius were quarantined.

The virus was reportedly discovered in poultry during a check on the village following reports that chickens in Narathiwat, Thailand, had been infected by the virus.

Read more: Kelantan holds exercise to contain bird flu - General - New Straits Times

Wednesday, July 25, 2012

CDC: Usefulness of School Absenteeism Data for Predicting Influenza Outbreaks, United States

[Bolding in red is mine]
Volume 18, Number 8—August 2012

To the Editor: School closure has been proposed as a strategy for slowing transmission of pandemic influenza (1). Studies of influenza A(H1N1)pdm 2009 (pH1N1) suggested that early and sustained school closure might effectively reduce communitywide influenza transmission (2,3). However, empirical evidence identifying the optimal timing of school closures to effectively reduce disease transmission after an outbreak occurs is limited.

That school absenteeism data improve school-based disease surveillance and response has been suggested (46). In 2009, Sasaki et al. demonstrated that the pattern of influenza-associated school absenteeism in the days before an influenza outbreak predicted the outbreak course with high sensitivity and specificity (7). However, that study used absenteeism data from Japan, which are generally not applicable to the United States, because most US absenteeism data collected at the local level do not specify cause. Furthermore, few US jurisdictions collect electronic health data for students.


Thus, non–disease-specific absenteeism data alone are of little use for school-based influenza surveillance. Use of all-cause absenteeism data cannot inform influenza mitigation policies, such as school dismissal, at the school or the school district levels. Not surprisingly, the influenza-specific absenteeism data from Japan were better able to predict an influenza outbreak than were our data because our data were not influenza specific. Other factors specific to the school system in Japan might have also played a role.

In the future, it might be beneficial for schools to collect causes of absenteeism, particularly if is it not feasible to electronically collect data on school nurse visits. Creation of school-based early warning systems for pandemic influenza remains a priority. In NYC, efforts to improve emergency department and primary care electronic medical record systems have been successful (810). Similar efforts to improve electronic health data collection and influenza-related absenteeism data in schools might yet demonstrate the usefulness of school-based surveillance systems.

[continued - click on title for full document]

CDC: Avian Influenza and Ban on Overnight Poultry Storage in Live Poultry Markets, Hong Kong

Volume 18, Number 8—August 2012


We analyzed ≈12 years of surveillance data on avian influenza in Hong Kong live poultry markets. A ban on keeping live poultry overnight in these markets reduced virus isolation rates by 84% in chickens (p = 0.006) and 100% (p = 0.01) in minor poultry.

[click on title for full document]

Tuesday, July 24, 2012

When contagion strikes, it's Honolulu you should avoid

24 July 2012

When the next outbreak of Sars or Swine flu hits, New York's John F Kennedy airport and Los Angeles's airports will likely be the key spreaders of disease, according to a new study. But while the influence of these super-hubs may not come as much of a surprise, the third most outbreak-friendly airport in the states is far smaller, and far less obvious – Honolulu International.

In a paper published Monday in the journal PLoS One, a team of researchers from MIT outlined a new computer model that predicts how the 40 largest American airports may contribute to the diffusion of contagious disease within the first few days of a potential epidemic.

They looked at which hubs may be key "early spreaders" because knowing where epidemics may begin is key to stemming an outbreak, Marta Gonzalez, professor in the department of civil and environmental engineering at MIT, and one of the contributors to the new model, told the Guardian.

Factors other than sheer volume of travelers may contribute to the spread of disease.

While Honolulu is neither the busiest airport in the US (that would be Atlanta International), nor even among the top 20 biggest hubs (such as Chicago O'Hare and Minneapolis St Paul, both of which featured in the film Contagion), volume is not the key factor in disease spreading. Atlanta's airport, which sees the highest volume of travelers in the US was ranked just eighth in its ability to cause contagion.

Honolulu airport "combines three important features that catalyze contagion spreading", the study reports. Its geographical positioning in the middle of the Pacific Ocean makes it a prime layover between the US west coast and large Asian hubs; it's also "well connected" to other powerful spreader airports, such as LAX; and it sees a high volume of long-range travel; all of which would help to spread a disease outbreak.

To fine-tune their new model, Gonzalez and her team analyzed cellphone data on top of passenger itineraries to determine real-world travel patterns, including layovers and re-routing.

"The spread of a disease is not random, just as human travel patterns are replicable and not random (particularly when taking into account return flights)," Gonzalez said. "We are able to create more accurate models due to our ability to analyze big data."

Though computer models may not predict precisely when or if a new outbreak will hit, they can prepare officials in high-risk areas – such as Hawaii.

"This can improve the measures for containing infection in specific geographic areas and aid public health officials in making decisions about the distribution of vaccinations or treatments in the earliest days of contagion," Gonzalez noted.

"Techniques such as multi-scale computer modelling … can make a contribution to strengthening our societies' adaptiveness, resilience, and sustainability."

2 more Cambodian kids killed by hand, foot, mouth disease over weekend

hat-tip Crofsblog

PHNOM PENH, July 24 (Xinhua) -- Three more Cambodian children were tested positive for Enterovirus 71 (EV-71) over the weekend and two of them were killed by the disease, bringing the death toll to 56 since April, a senior health official said Tuesday.

Ly Sovann, deputy director of the Health Ministry's communicable disease control department, told Xinhua that the two dead children were in Kampong Cham province, some 124 km east of Phnom Penh, and the other one is recovering from the disease at the Kantha Bopha Children's Hospital in Siem Reap province.

Cambodia has been plagued by EV-71, which causes hand, foot and mouth disease (HFMD) since April. The severe form of HFMD has killed at least 56 Cambodian children so far.

The Ministry of Education last week ordered the close of all kindergartens and primary schools across the country, two weeks earlier than the scheduled annual vacation, in fears of the disease.

HFMD virus is contagious and infection spreads from person to person by direct contact with nose or throat discharges, saliva, fluid from blisters or the stool of infected persons, according to the World Health Organization.

Good hygiene practice can prevent HFMD. Presently, there is no specific treatment available for HFMD, it said. Parents should seek medical advice if their children develop high fever, vomiting, lethargy and limb weakness.

Litany of Ex-Ministers Tied to Graft-Tainted Bird Flu Vaccine Plant

hat-tip Crofsblog
July 24, 2012
A graft-ridden project to build an avian influenza vaccine plant implicated three health ministers and one finance minister before former Democratic Party treasurer Muhammad Nazaruddin got involved, an audit has revealed.

According to the report from the Supreme Audit Agency (BPK), the project that began in 2008 and was halted in 2011 was conceived after state pharmaceutical company Bio Farma expressed interest in producing a bird flu vaccine.

In 2006, Bio Farma sent proposals to the World Health Organization and Japanese Embassy for funding.

The Japanese Embassy, through the Japan International Cooperation Agency, rejected the proposal.

Continued - Click on title for full article

Bird Flu Researchers To Meet About Research Moratorium

July 24, 2012
by nell-greenfieldboyce
Top influenza researchers around the world published a statement back in January saying they would temporarily hold off on any work with contagious, lab-altered forms of a particularly worrisome form of bird flu.

The unusual voluntary moratorium was supposed to last only 60 days, but it's been more than six months. And scientists don't agree on what should happen next.

Some scientists and researchers say these mutant bird flu viruses could cause a devastating pandemic if they ever got out of the lab. Others argue that the work is vital to help public health officials get ready for the possible threat of a flu pandemic that might emerge naturally, as bird flu viruses mutate in the wild.

Flu researchers are going to New York next week for the annual conference of the government-funded Centers of Excellence for Influenza Research and Surveillance (CEIRS). Researchers who made the mutant viruses will be there, plus others who signed the voluntary moratorium.
But some flu experts say there are bigger questions here that go beyond what's done in any one country — and that they need to be addressed at an international level.

"The way that I see it is that all the discussions that are ongoing are not really hitting the nail on the head," says Ilaria Capua, an Italian flu researcher at the Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, who signed the moratorium.

In her view, if this kind of work continues to get funded and published in the U.S. and Europe, the technology for making mutant flu viruses will get easier and easier, and more and more labs will want to do it.

"And then we have 100, 200 labs around the world which contain in their freezers influenza viruses of high pathogenicity which are transmissible in humans," says Capua. "Is this what we want?"

She notes that this proliferation could increase the risk of a lab accident, especially if work starts getting done in less stable regions of the world where political turmoil or natural disasters could compromise security.

The World Health Organization is planning to have an open meeting next year that will address some of these issues. In the meantime, that agency has just released some guidelines for appropriate risk-control measures for research with these mutant bird flu viruses.

"Given the potential of these newly developed laboratory-modified H5N1 strains to start a pandemic," the guidance notes, "it is important that facilities that are NOT able to identify and appropriately control the risks associated with these agents REFRAIN from working with them."

continued (click on title for full article)

Guidance for adoption of appropriate risk control measures to conduct safe research on H5N1 transmission

July 2012

Following the Technical Consultation on H5N1 Research Issues held at WHO in February 2012, WHO staff informally consulted a number of relevant scientific bodies and experts from the human health and animal health communities to seek their perspectives related to biosafety and laboratory biosecurity guidance on conditions under which further research should be conducted on the laboratory-modified H5N1 viruses.

Existing frameworks and guidelines were also reviewed, such as: applying the risk group classification presented in the WHO Laboratory biosafety manual, 3 rd edition, 2004, and considering the biorisk management approach provided in CEN CWA 15793:2011 Laboratory biorisk management (CWA 15793).

Based on this, the following considerations are proposed:

  • Facilities wishing to work with the laboratory-modified H5N1 should critically evaluate the considerable personal and institutional responsibilities inherent in manipulating influenza viruses with pandemic potential that are not presently circulating in nature.
  • Only laboratories that meet the appropriate biosafety level AND show conformity to available biorisk management standards (e.g. CWA 15793) should consider working with these laboratory-modified H5N1 strains, in close collaboration and communication with relevant national authorities, and under strict national oversight.
  • Relevant national authorities should identify, approve and oversee the laboratories which might work on this material.
  • Biosafety and laboratory biosecurity considerations should be taken into account in reviews of research findings scheduled for publication.
  • Final responsibility for the identification and implementation of appropriate risk assessment, mitigation, and containment measures for work with laboratory-modified H5N1 strains lies with individual countries and facilities. Accordingly, measures may vary from country to country, and decisions should be taken in light of currently available knowledge, context, and applicable national requirements.
  • Given the potential of these newly developed laboratory-modified H5N1 strains to start a pandemic, it is important that facilities that are NOT able to identify and appropriately control the risks associated with these agents REFRAIN from working with them.

This guidance may be updated in light of new information and experience.

Sunday, July 22, 2012

New Zealand: H3N2 Strain Deadly This Year

The best protection against an influenza strain which is reaching epidemic levels in New Zealand is the vaccine, but even that is not 100 per cent effective, a virologist warns.

The H3N2 strand of the influenza virus, which causes hallucinations and crippling nausea, has left about 12 people fighting for their lives.

Experts believe New Zealand could face an epidemic as big as swine flu.

A special isolation ward has been set up at Christchurch Hospital, and now public health officials are warning the virus is spreading north.

Canterbury Health virologist Lance Jennings said the severe strain of the flu was causing havoc in Canterbury.

"With H3N2 ... we tend to see more severe outcomes in terms of hospital admissions, admissions to intensive care and death,'' Dr Jennings said.

Waitemata and Counties Manukau have the highest number of flu sufferers nationwide, but there has yet to be a rise in flu patients hospitalised in those districts.

Dr Jennings said this year's flu vaccine had the H3N2, H1N1 and influenza B virus in it.

"As far as we're aware at the present time, the H3N2 virus, that's affecting Canterbury at the moment, is similar to the antigens which are included in the current influenza vaccine.

"And similarly with the H1N1 and the B viruses largely in the North Island, as well as the H3N2, they're similar to the antigens in the influenza vaccine.''

However, influenza vaccines were not perfect, he said, and protected only about 90 per cent of healthy adults.

"That means among healthy [vaccinated] adults, at least 10 per cent will get infected with influenza.''

Dr Jennings recommended those who do get the flu to stay home, rather than going into work and infecting colleagues.

''[And] if they're concerned about their condition then phone their GP, don't rush into the practice, or to the emergency department, phone them and seek advice.''

The last time the country had a significant H3N2 outbreak was about 2006, he said.

Northern Hemisphere countries also had an outbreak of the virus during their latest winter, Dr Jennings said.

Tim Jelleyman, acting chief medical officer at Waitemata, said he expected the number of flu cases in the district to increase.

Canterbury medical officer Alistair Humphrey said a special ward had been set up at Christchurch Hospital to cater for up to 60 patients affected by the epidemic at any given moment. About seven patients had been admitted to intensive care, he said.

"It's certainly putting pressure on the whole health system. I work clinically as a GP in a 24-hour surgery ... My shifts have been absolutely full-on every time I'm there. It's putting pressure on GPs, on the emergency departments, on hospitals. Doctors and nurses are starting to get ill.''

The epidemic is expected to spread across the country in coming weeks, expedited by the return to school after the winter break.

Vaccination is free until July 31 for pregnant women, people aged 65 or older, and anyone with ongoing medical conditions.

National Influenza Specialist Group spokeswoman Brenda Saunders said almost 960,000 doses of the flu vaccination had been distributed so far this season - 28,000 fewer than the same time last year.

Public Health Surveillance's national report shows a steep increase in flu cases last week, almost double the number at the same time last year.

Humphrey said: "This year we are up [on flu cases] pretty much as high as we were during the swine flu epidemic. It's a serious illness. It's not something that should be ignored.''

What is H3N2
* H3N2 is an A-type virus.
* It descended from a virus that originated as a pandemic in Hong Kong in 1968.
* Canterbury Health virologist Dr Lance Jennings says H3N2 circulates through a population until the level of immunity has built up.
* Symptoms include hallucinations, crippling fevers and nausea.
* Once there is resilience in the population, H3N2 mutates so that it is more infective.

H1N1 claims 2nd life in 15 days in Mumbai

MUMBAI: A 56-year-old Ambivli man died of H1N1 on Thursday , making it the second death due to the virus in the Mumbai Metropolitan Region in a fortnight . The death of Satish Sutar, who is suspected to have been infected during a recent visit to Pune, has increased the state's toll to 29 in three months, the highest in the country so far.

Sutar had been down with cold since July 1 but ignored it. Only when his condition worsened did he approach doctors. In fact, he was not diagnosed or treated for swine flu till a day before his death.

Superbug Summer Books: ZOOBIQUITY

In the summer of 1997, I was a newspaper reporter covering the Centers for Disease Control and Prevention, and I heard from a contact at the CDC that a team was headed to Hong Kong to check out an odd case. A 3-year-old boy had died of flu. That was sad, but not notable enough on its own to send premier disease detectives rocketing around the world. What was extraordinary about the boy’s death was its cause: a strain of flu known as H5N1 that had never been seen in humans before, though it was common in birds and had recently killed 4,500 chickens on a Hong Kong farm. By the end of that year, 17 other Hong Kong residents would become infected, five others would die, and to shut down the epidemic, Hong Kong would slaughter every chicken in the territory, 1.4 million of them.

That worked, for a while. But in 2003, H5N1 appeared again. Since then, it has sickened 607 people around the world, killing more than half of them. It has done something else too. H5N1 and the 2009 H1N1 “swine flu” — a much larger epidemic whose toll of illness and death was recently revised sharply upward — introduced to many people the idea that diseases could jump from animals to humans, and be much more dangerous to their new human hosts than to the animals they came from.

Diseases that jump in that manner are called “zoonoses,” and because their effect can be so dramatic, they are the subject of major international tracking projects, not to mention cultural fascination. (For just one example, watch last year’s movie Contagion.) But a new book, “Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing” (Knopf) argues that by viewing animals only as a source of infection, we miss a rich range of illnesses that we have in common with other species and that could broaden our understanding of what affects our health and theirs.

“Zoobiquity” has two authors, UCLA cardiology professor Dr. Barbara Natterson-Horowitz and journalist Kathryn Bowers. For the third installment of Superbug Summer Books, I talked to Dr. Natterson-Horowitz by phone and edited and condensed our chat.

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Mumbai: Sale of vaccine shoots up as swine flu cases rise sharply

July 23, 2012
The spurt in swine flu cases and the two deaths in July have boosted the sale of vaccines that provide immunity against the H1N1 virus by more than 50%, said druggists. On Sunday, 10 more cases of swine flu were reported taking the total number to 151 since January. Till June 30, the city had recorded 58 cases; the rest of the 93 cases have been reported in the past three weeks.

“The demand is high. The sale of the trivalent influenza vaccine, which immunises a person against H3N2, H1N1 and influenza B virus, has nearly doubled. In June, we sold around 1,000 vaccines, but this month we have sold 1,500 in three weeks,” said Anil Rajguru, manager, Med-orbit, a Mulund-based wholesaler of medicines and vaccines. “Of these, 400 vaccines were ordered by doctors and hospitals.”

Shop owners said pharmaceutical companies have launched trivalent vaccines in July itself instead of in the winter months. “Paediatricians give children the vaccine so that they develop immunity against flu and H1N1,” said Dr Haresh Shah, chief executive officer, Ishita Pharma, another wholesaler.

Doctors said diagnostic swab testing has also increased. Health officials said more people test positive as the virus is air-borne. “We recommend vaccination for high-risk groups such as elderly, small children and those with chronic ailments,” said Dr Om Shrivastav, infectious diseases expert and member of the state advisory committee for swine flu.

“There are no government guidelines regarding vaccinations. While doctors and paramedical staff should get vaccinated, otherwise, only those with compromised immunity, diabetics, tuberculosis and pregnant women, should get vaccinated,” said Dr Pradip Awate, state epidemiologist, directorate of health services.