Wednesday, October 17, 2012
DHHS: Influenza Viruses Containing the Hemagglutinin from Goose/ Guangdong/1/96 Lineage Request for information and comment
[Federal Register Volume 77, Number 201 (Wednesday, October 17, 2012)]
[Proposed Rules]
[Pages 63783-63785]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-25377]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
42 CFR Part 73
[Docket: CDC-2012-0010]
Influenza Viruses Containing the Hemagglutinin from the Goose/
Guangdong/1/96 Lineage
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Request for information and comment.
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SUMMARY: The Centers for Disease Control and Prevention (CDC) within
the Department of Health and Human Services (HHS) announces the opening
of a docket to obtain information and comments from the public to
questions concerning highly pathogenic avian influenza (HPAI) H5N1
viruses that contain a hemagglutinin (HA) from the Goose/Guangdong/1/96
lineage, and their potential to pose a severe threat to public health
and safety. This information will be considered in a determination of
whether such viruses should be listed as HHS select agents, by revising
the HHS Select Agent Regulations (42 CFR Part 73).
DATES: Electronic or written comments should be received on or before
December 17, 2012.
ADDRESSES: You may submit comments identified by Docket Number CDC-
2012-0010, by any of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Division of Select Agents and Toxins, Centers for
Disease Control and Prevention, 1600 Clifton Road NE., Mailstop A-46,
Atlanta, Georgia 30333, Attn: Docket Number: CDC-2012-0010.
Instructions: All submissions received must include the agency name
and docket number (CDC-2012-0010) for this notice. All relevant
comments received will be posted without change to www.regulations.gov,
including any personal information provided. For access to the docket
to read background documents or comments received, go to
www.regulations.gov.
FOR FURTHER INFORMATION CONTACT: Dr. Robbin Weyant, Director, Division
of Select Agents and Toxins, Centers for Disease Control and
Prevention, 1600 Clifton Road NE., Mailstop A-46, Atlanta, Georgia
30333. Telephone: (404) 718-2000.
SUPPLEMENTARY INFORMATION:
I. Background
Since late 2003, the World Health Organization (WHO) has reported
over 600 cases of human infection with highly pathogenic avian
influenza (HPAI) H5N1 viruses with a mortality rate that exceeds 50
percent in hospitalized patients (Ref 1). Current epidemiologic
evidence indicates that, once transmitted into a human host, H5N1
viruses may result in more severe disease in humans than other subtypes
of influenza.
One important factor that can account for some of the increased
pathogenicity is the hemagglutinin (HA) molecule. Cleavage of the HA
molecule by host proteases (chemicals that can break amino acid bonds)
enables influenza viruses to productively infect cells (i.e.,
replicate). For human influenza viruses, replication is restricted to
the respiratory tract. However, HPAI H5N1 viruses contain a polybasic
amino acid sequence in the HA molecule that is not found in human
influenza viruses. This feature allows the molecule to be cleaved by a
wider variety of proteases throughout the body and consequently, HPAI
H5N1 viruses can replicate systemically in avian species.
Extrapulmonary dissemination of HPAI H5N1 virus has been documented
among some fatal human HPAI H5N1 virus infections. The HA molecule
mediates binding of the influenza virus to host cells in the
respiratory tract. Human influenza viruses preferentially bind to
different receptors than avian influenza viruses (Ref 2). While human
influenza virus receptors are more prevalent in the upper respiratory
tract, the receptors that bind avian viruses are present in the lower
respiratory tract of humans. The ability of H5N1 viruses to bind and
infect cells within the lung may contribute to the severity of H5N1
induced viral pneumonia (Ref 3-5). Furthermore, a change from avian- to
human-type receptor-binding specificity, as seen with the pandemic
strains of 1918 (H1N1), 1957 (H2N2),
[[Page 63784]]
and 1968 (H3N2), is thought to be a critical step in the adaptation of
avian influenza viruses to humans and the ability to transmit
efficiently among humans (Ref 6-8). In two recent independent studies
(Ref 9 and Ref 10), investigators have shown that laboratory modified
HPAI H5N1 influenza viruses with certain mutations can be transmitted
via the respiratory route between ferrets. Ferrets are widely
considered to provide the best animal model for exploring these aspects
of influenza virus pathogenicity as they might relate to human
infection (Ref 11).
We recognize that all HPAI H5N1 influenza virus clades found in
humans to date have been derived from the Goose/Guangdong/1/96 lineage,
and the HA molecule enables the virus to infect a host cell. Thus, we
are interested in receiving information and comments on whether the
influenza viruses that contain a hemagglutinin (HA) from the Goose/
Guangdong/1/96 lineage have the potential to pose a severe threat to
public health and safety (Ref 12). Currently, all HPAI H5 subtype
viruses are regulated by the U.S. Department of Agriculture (USDA)
Animal and Plant Health Inspection Service (APHIS) whose oversight
focuses on the threat to animal health and safety. Listing influenza
viruses that contain an HA from the goose/Guangdong/1/96 lineage as an
HHS select agent will ensure that the focus of regulation will also be
on the potential impact of these viruses on human health as well as
agriculture. While USDA sets biosafety measures that may also be more
generally beneficial to public health, its focus with respect to select
agent designation is primarily on risks to agricultural animals, rather
than direct effects on human health. There is precedence (e.g.,
Bacillus anthracis) for including agents that have both human and
agricultural impacts on both the HHS and USDA Select Agent Lists.
Designating HPAI containing an HA from the Goose/Guangdong/1/96 lineage
an HHS select agent, in addition to its status as a USDA select agent,
may help to ensure that HPAI strains that have the greatest potential
for major direct effects on human health will be regulated with a focus
on protection of human health.
The question of whether the influenza viruses that contain an HA
from the Goose/Guangdong/1/96 lineage pose a severe threat to public
health and safety was considered by HHS/CDC's Intragovernmental Select
Agents and Toxins Technical Advisory Committee (ISATTAC). The ISATTAC
is comprised of Federal government scientists from HHS/CDC, the
Biomedical Advanced Research and Development Authority (BARDA) within
the Office of the Assistant Secretary for Preparedness and Response
(HHS/ASPR) in HHS, the National Institutes of Health (HHS/NIH), the
Food and Drug Administration (HHS/FDA), USDA/APHIS, the USDA/
Agricultural Research Service, the USDA/Center for Veterinary
Biologics, the Department of Homeland Security (DHS), and the
Department of Defense (DOD). The criteria used by the ISATTAC in its
review were the degree of pathogenicity, communicability, ease of
dissemination, route of exposure, environmental stability, ease of
production, ability to genetically manipulate or alter, long-term
health effects, acute morbidity, acute mortality, available treatment,
status of host immunity, vulnerability of special populations, and the
burden or impact on the health care system. ISATTAC made the
recommendation that the influenza viruses containing an HA from the
Goose/Guangdong/1/96 lineage do have the potential to pose a severe
threat to public health and safety. In making its recommendation to
HHS/CDC, the ISATTAC considered both the historical data regarding the
Goose/Guangdong/1/96 lineage and data from current in vitro and in vivo
animal studies. The virulence of viruses of this lineage, the data
showing transmissibility of genetically modified H5N1 viruses among
ferrets, together with the fact that the level of immunity in the
general population is low were all considered. Further, in its
recommendation the ISATTAC voiced concern that an influenza pandemic
caused by viruses containing an HA from the Goose/Guangdong/1/96
lineage, could potentially overwhelm the health care system. The
ISATTAC also recognized that the study of the Goose/Guangdong/1/96
lineage-derived viruses could lead to significant public health
benefits for understanding pandemic influenza, improved diagnostics,
and the development of more effective countermeasures. Therefore, the
risks posed by these viruses need to be weighed against any adverse
impact that a regulation will have on legitimate research.
On July 2, 2010, the President signed Executive Order 13546,
``Optimizing the Security of Biological Select Agents and Toxins in the
United States'' that directed the Secretaries of HHS and USDA to
designate a subset of the select agents and toxins list (Tier 1) that
presents the greatest risk of deliberate misuse with the most
significant potential for mass casualties or devastating effects to the
economy, critical infrastructure, or public confidence. The Executive
Order 13546 also established the Federal Experts Security Advisory
Panel (FESAP) to advise the HHS and USDA Secretaries on the designation
of Tier 1 agents and toxins. In December of 2010, the FESAP provided
the HHS and USDA Select Agent regulatory programs with recommendations
on updating the HHS and USDA Select Agent and Toxin lists, including a
subset of agents and toxins recommended for Tier 1 designation.
On October 3, 2011, HHS/CDC published a notice of proposed
rulemaking (76 FR 61206) in which we proposed a list of select agents
and toxins that should be considered Tier 1 select agents and toxins.
The proposed Tier 1 agents and toxins that were based on Executive
Order 13546 and the recommendations from FESAP were scored against 20
criteria by over 60 Subject Matter Experts representing the Federal
life sciences, public health, law enforcement, security, and
intelligence communities. The criteria included:
The relative ease with which a particular select agent or
toxin might be disseminated or transmitted from one human to another or
into the environment where it could produce a deleterious effect upon
human health;
The potential for a high mortality rate;
The potential for a major human health impact;
Select agents or toxins whose misuse might result in
public panic or other social or economic disruption; and
Select agents or toxins whose use might require Federal,
State, and/or local officials to take special action in planning for
major human health disasters.
We proposed that the following agents should be designated as Tier
1 agents: Bacillus anthracis, Botulinum neurotoxin, Botulinum
neurotoxin producing species of Clostridium, Burkholderia mallei, B.
pseudomallei, Francisella tularensis, Marburg virus, Variola major
virus, Variola minor virus, and Yersinia pestis. On the same day, USDA/
APHIS published a companion rule in the Federal Register proposing its
list of select agents and toxins that should be considered Tier 1
select agents and toxins. Although USDA/APHIS regulates HPAI viruses as
select agents, they did not propose to designate HPAI viruses as Tier 1
select agents. Given the above criteria used by the FESAP, we would
welcome comment on whether HPAI H5N1 influenza viruses containing the
HA from the Goose/Guangdong/1/96 lineage should be listed as a Tier 1
select agent. The final determination of whether or not to designate
this particular lineage
[[Page 63785]]
of H5N1 HPAI as Tier 1 would be a collaborative process between HHS and
USDA. HHS and USDA would continue to work closely together whether or
not both HHS and USDA designate these viruses as Tier 1 Select Agents.
II. Establishment of a Docket and Request for Specific Input on Certain
Topics
We are establishing a docket to provide an opportunity for
interested persons to submit comments, research data, and other
information that will better inform us about the risk posed by HPAI
H5N1 influenza viruses containing the HA from the Goose/Guangdong/1/96
lineage to public health and safety. In particular, we welcome comment
on the following questions:
(1) Do HPAI H5N1 influenza viruses containing the HA from the
Goose/Guangdong/1/96 lineage pose a severe threat to public health and
safety?
(2) Are there other influenza strains containing HA from Goose/
Guangdong/1/96 lineage that would also pose a severe threat even if
they were not fully of HPAI H5N1 origin?
(3) Are there any other HPAI H5N1 influenza strains that have been
identified to pose a severe threat to public health and safety?
(4) Should these viruses be regulated as HHS select agents?
(5) If these viruses should be regulated as HHS select agents,
should these viruses be designated as Tier 1 select agents?
(6) Should special precautions (i.e., safety and containment
measures) be considered when working with diagnostic specimens
suspected of containing HPAI H5N1 influenza viruses containing the HA
from the Goose/Guangdong/1/96 lineage (i.e., any precautions versus
none at all, precautions beyond those usual for clinical samples and/or
laboratory microbes, etc.)? and
(7) Should special precautions (i.e., safety and containment
measures) be considered when working with strains of HPAI containing
the HA from the Goose/Guangdong/1/96 lineage that have been shown to be
transmissible between mammals beyond those recommended for non-
mammalian transmissible HPAI (Ref 13 and Ref 14)?
III. References
1. WHO, Cumulative number of confirmed human cases for avian
influenza A(H5N1) reported to WHO, 2003-2011; http://www.who.int/influenza/human_animal_interface/H5N1_cumulative_table_archives/en/index.html.
2. Fukuyama S, Kawaoka Y. The pathogenesis of influenza virus
infections: The contributions of virus and host factors. Curr Opin
Immunol. 2011 Aug;23(4):481-6. Epub 2011 Aug 11.
3. Shinya K, Ebina M, Yamada S, Ono M, Kasai N, Kawaoka Y. Avian
flu: Influenza virus receptors in the human airway. Nature. 2006 Mar
23;440(7083):435-6.
4. Nicholls JM, Chan MC, Chan WY, Wong HK, Cheung CY, Kwong DL, Wong
MP, Chui WH, Poon LL, Tsao SW., Guan Y, Peiris JS. Tropism of avian
influenza A (H5N1) in the upper and lower respiratory tract. Nat
Med. 2007 Feb;13(2):147-9. Epub 2007 Jan 7.
5. Van Riel D, Munster VJ, de Wit E, Rimmelzwaan GF, Fouchier RA,
Osterhaus AD, Kuiken T. H5N1 Virus Attachment to Lower Respiratory
Tract. Science. 2006 Apr 21;312(5772):399. Epub 2006 Mar 23.
6. Matrosovich, M., et al. Early alterations of the receptor-binding
properties of H1, H2, and H3 avian influenza virus hemagglutinins
after their introduction into mammals. J Virol 74, 8502-8512 (2000).
7. Stevens, J., et al. Glycan microarray analysis of the
hemagglutinins from modern and pandemic influenza viruses reveals
different receptor specificities. J Mol Biol 355, 1143-1155 (2006).
8. Connor, R.J., Kawaoka, Y., Webster, R.G. & Paulson, J.C. Receptor
specificity in human, avian, and equine H2 and H3 influenza virus
isolates. Virology 205, 17-23 (1994).
9. Masaki Imai,1 Tokiko Watanabe,1, 2 Masato Hatta,1 Subash C. Das,1
Makoto Ozawa,1, 3 Kyoko Shinya,4 Gongxun Zhong,1 Anthony Hanson,1
Hiroaki Katsura,5 Shinji Watanabe,1, 2 Chengjun Li,1 Eiryo
Kawakami,2 Shinya Yamada,5 Maki Kiso,5 Yasuo Suzuki,6 Eileen A.
Maher,1 Gabriele Neumann1 & Yoshihiro Kawaoka. Experimental
adaptation of an influenza H5 HA confers respiratory droplet
transmission to a reassortant H5 HA/H1N1 virus in ferrets. Nature.
2012 May 2;486(7403):420-8.
10. Russell CA, Fonville JM, Brown AE, Burke DF, Smith DL, James SL,
Herfst S, van Boheemen S, Linster M, Schrauwen EJ, Katzelnick L,
Moster[iacute]n A, Kuiken T, Maher E, Neumann G, Osterhaus AD,
Kawaoka Y, Fouchier RA, Smith DJ. The potential for respiratory
droplet-transmissible A/H5N1 influenza virus to evolve in a
mammalian host. Science. 2012 Jun 22; 336(6088):1541-7.
11. Belser JA, Szretter KJ, Katz JM, Tumpey TM. Use of animal models
to understand the pandemic potential of highly pathogenic avian
influenza viruses. Adv Virus Res. 2009;73:55-97.
12. WHO/OIE/FAO H5N1 Evolution Working Group. Continued evolution of
highly pathogenic avian influenza A (H5N1): updated nomenclature.
Influenza Other Respi Viruses. 2012 Jan; 6(1): 1-5. doi: 10.1111/
j.1750-2659.2011.00298.x. Epub 2011 Oct 29.
13. Guidelines for Avian Influenza Viruses (http://www.selectagents.gov/resources/Guidelines%20for%20Avian%20Influenza%20Viruses_2011-11-4.pdf).
14. Biosafety in Microbiological and Biomedical Laboratories (http://www.cdc.gov/biosafety/publications/bmbl5/index.htm).
Dated: October 9, 2012.
Kathleen Sibelius,
Secretary.
[FR Doc. 2012-25377 Filed 10-16-12; 8:45 am]
BILLING CODE 4163-18-P
http://www.gpo.gov/fdsys/pkg/FR-2012-10-17/html/2012-25377.htm
Feds Seek Comments On Bird Flu Safety Fears
Tuesday, 10/16/12 1:38pm
The Department of Health and Human Services posted a call for public comments today requesting information on whether the lab-created bird flu viruses "have the potential to pose a severe threat to public health and safety." The government is also asking whether any special precautions need to be considered when scientists work with these viruses.
The move comes after some have criticized officials for not having enough public discussion about these controversial viruses, which were created in the lab as part of an effort to understand how highly pathogenic H5N1 bird flu viruses out in the wild might mutate and start a pandemic in people.
Continued: http://www.vpr.net/npr/163012771/
Tuesday, October 16, 2012
Indonesia: Health Minister Still Wants Bird Flu Vaccine Project Continues
In addition, Nafsiah also warned that bird flu pandemic could later endanger public
October 16, 2012
Skalanews - Minister of Health, Nafsiah Mboi insisted on running the equipment procurement project bird flu vaccine. He reasoned if not passed, then the project would cost the state. addition, Nafsiah also cautioned that a bird flu pandemic could later endanger the public. If it is not passed, the people could not telindungi [sheltered; protected; shielded; safeguarded]. So the project should be followed up. "Yes it is pity that the assets anyway, so do not be wasteful he will be broken, because it will cost the state a very large," said Nafsiah in the House, Jakarta, Tuesday (16/10). was why the Commission IX Nafsiah asked to consider it. However, Nafsiah not questioned if the Commission IX to form working committees related to the case first. Having studied the situation in depth, he hopes the project was no follow-up. "When the legal process ahead, live alone. Which takes precedence save state assets if it did not proceed because it redundant," he said.
http://skalanews.com/baca/news/8/0/126152/politik/menkes-tetap-ingin-proyek-vaksin-flu-burung-dilanjutkan.html
October 16, 2012
Skalanews - Minister of Health, Nafsiah Mboi insisted on running the equipment procurement project bird flu vaccine. He reasoned if not passed, then the project would cost the state. addition, Nafsiah also cautioned that a bird flu pandemic could later endanger the public. If it is not passed, the people could not telindungi [sheltered; protected; shielded; safeguarded]. So the project should be followed up. "Yes it is pity that the assets anyway, so do not be wasteful he will be broken, because it will cost the state a very large," said Nafsiah in the House, Jakarta, Tuesday (16/10). was why the Commission IX Nafsiah asked to consider it. However, Nafsiah not questioned if the Commission IX to form working committees related to the case first. Having studied the situation in depth, he hopes the project was no follow-up. "When the legal process ahead, live alone. Which takes precedence save state assets if it did not proceed because it redundant," he said.
http://skalanews.com/baca/news/8/0/126152/politik/menkes-tetap-ingin-proyek-vaksin-flu-burung-dilanjutkan.html
ProMED: USA (TEXAS), NO TYPE B OUTBREAK
I previously reported on this, here.
excerpt from that post:
The Texas Department of State Health Services has not confirmed an outbreak of influenza in Laredo, Texas. Routine surveillance did identify some early season influenza B cases in the community. Based on these findings, the local health department sent a health advisory to local healthcare providers reminding them of the importance of influenza prevention, treatment and diagnosis. --
Carol M Davis, MSPH, CPH
Epidemiologist
Emerging and Acute Infectious Disease Branch
Texas Department of State Health Services
Mailcode 1960
Austin, TX 78714-9347 USA
[ProMED-mail post entitled: Influenza (99): USA (TX) type B outbreak, archive number 20121013.1341462, relayed a report on PRWeb that the Texas Department of State Health Services had confirmed an outbreak of influenza B virus infection in Laredo. This information is incorrect. The influenza B cases were identified in the community in early season surveillance only. ProMED-mail apologises for propagating this misinformation and thanks Carol Davis for providing this correction. - Mod.CP]
http://www.promedmail.org/direct.php?id=20121015.1344949
excerpt from that post:
A new medical surveillance system, in development, testing and proving for more than 10 years, has identified an outbreak of influenza type B virus infection in Laredo (Texas), a major port of entry between Mexico and the United States.Date: Mon 15 Oct 2012
The Texas Department of State Health Services has not confirmed an outbreak of influenza in Laredo, Texas. Routine surveillance did identify some early season influenza B cases in the community. Based on these findings, the local health department sent a health advisory to local healthcare providers reminding them of the importance of influenza prevention, treatment and diagnosis. --
Carol M Davis, MSPH, CPH
Epidemiologist
Emerging and Acute Infectious Disease Branch
Texas Department of State Health Services
Mailcode 1960
Austin, TX 78714-9347 USA
[ProMED-mail post entitled: Influenza (99): USA (TX) type B outbreak, archive number 20121013.1341462, relayed a report on PRWeb that the Texas Department of State Health Services had confirmed an outbreak of influenza B virus infection in Laredo. This information is incorrect. The influenza B cases were identified in the community in early season surveillance only. ProMED-mail apologises for propagating this misinformation and thanks Carol Davis for providing this correction. - Mod.CP]
http://www.promedmail.org/direct.php?id=20121015.1344949
Monday, October 15, 2012
Nature: Mixed flu strain in Mizo man
Published online 15 October 2012
Researchers from the National Institute of Cholera and
Enteric Diseases (NICED) in Kolkata have spotted a classical case of
'sporadic reassortment' — mixing of genetic material from swine and
human origin viruses — in an influenza A viral strain with H1N2 subtype.1
The study supports the possibility of 'reassortment events' during
influenza season when infectivity is high and two different subtypes of
the virus circulate together in the same geographical location.
The mixed strain circulated during the swine flu pandemic in 2009-2010 and has been found from a 25-year-old man in Mizoram. The strain has been named A/Eastern India/N-1289/2009.
Influenza A viruses of the H1N2 subtype were isolated previously in India and Japan during 2001–02. They were reassortants of the human H1N1 and H3N2 viruses and distinct from the H1N2 swine influenza viruses. However, repeated attempts to isolate the recombinant virus had failed. The researchers say this could have been due to the 'loss of viability' as the samples came from Mizoram (about 1219 kms from Kolkata) by courier and took more than 48 hrs to reach the NICED lab.
Reassortment is responsible for some major genetic shifts in the history of the influenza virus. The 1957 and 1968 pandemic flu strains were caused by reassortment between an avian virus and a human virus. The 2009 H1N1 swine flu virus has been found to have an unusual mix of swine, avian and human influenza genetic sequences.
After sequencing the full genome, the researchers found the unique reassortment event where the N-1289 virus acquired its hemagglutinin (HA) gene from a 2009 pandemic H1N1 virus with swine origin and the other genes from H3N2-like viruses of human origin.
Co-circulation of both these influenza viruses during 2009 and complete disappearance of seasonal H3N2 and H1N1 strains in 2010 was also observed in eastern India. Such co-circulation is the prime cause of the generation of genetically reassortant viruses, the researchers say.
http://www.nature.com/nindia/2012/121015/full/nindia.2012.154.html
The mixed strain circulated during the swine flu pandemic in 2009-2010 and has been found from a 25-year-old man in Mizoram. The strain has been named A/Eastern India/N-1289/2009.
Influenza A viruses of the H1N2 subtype were isolated previously in India and Japan during 2001–02. They were reassortants of the human H1N1 and H3N2 viruses and distinct from the H1N2 swine influenza viruses. However, repeated attempts to isolate the recombinant virus had failed. The researchers say this could have been due to the 'loss of viability' as the samples came from Mizoram (about 1219 kms from Kolkata) by courier and took more than 48 hrs to reach the NICED lab.
Reassortment is responsible for some major genetic shifts in the history of the influenza virus. The 1957 and 1968 pandemic flu strains were caused by reassortment between an avian virus and a human virus. The 2009 H1N1 swine flu virus has been found to have an unusual mix of swine, avian and human influenza genetic sequences.
After sequencing the full genome, the researchers found the unique reassortment event where the N-1289 virus acquired its hemagglutinin (HA) gene from a 2009 pandemic H1N1 virus with swine origin and the other genes from H3N2-like viruses of human origin.
Co-circulation of both these influenza viruses during 2009 and complete disappearance of seasonal H3N2 and H1N1 strains in 2010 was also observed in eastern India. Such co-circulation is the prime cause of the generation of genetically reassortant viruses, the researchers say.
-
References
- Mukherjee, T. R. et al. Full genomic analysis of an influenza A (H1N2) virus identified during 2009 pandemic in Eastern India: evidence of reassortment event between cocirculating A(H1N1)pdm09 and A/Brisbane/10/2007-like H3N2 strains. Virol. J. doi: 10.1186/1743-422X-9-233 (2012)
The Armageddon virus
Why experts fear a disease that leaps from animals to humans could devastate mankind in the next five years
- Warning comes after man died from a Sars-like virus that had previously only been seen in bats
- Earlier this month a man from Glasgow died from a tick-borne disease that is widespread in domestic and wild animals in Africa and Asia
One leading British virologist, Professor John Oxford at Queen Mary Hospital, University of London, and a world authority on epidemics, warns that we must expect an animal-originated pandemic to hit the world within the next five years, with potentially cataclysmic effects on the human race.
Such a contagion, he believes, will be a new strain of super-flu, a highly infectious virus that may originate in some far-flung backwater of Asia or Africa, and be contracted by one person from a wild animal or domestic beast, such as a chicken or pig.
[I looked up the Profile of Professor John Oxford: http://ec.europa.eu/research/profiles/index_en.cfm?p=1_oxford]
Full article: http://www.dailymail.co.uk/sciencetech/article-2217774/The-Armageddon-virus-Why-experts-fear-disease-leaps-animals-humans-devastate-mankind-years.html?openGraphAuthor=%2Fhome%2Fsearch.html%3Fs%3D%26authornamef%3DJohn%2BNaish
Nepal: Bird flu confirmed in Bode farm
2012-10-15
BHAKTAPUR: At least 1,200 chickens have died of bird flu at a poultry farm in Bode-3 of Madhyapur Thimi in Bhaktapur till Monday noon.
The Animal Health Directorate collected samples of dead chickens from the farm after its owner, Om Bahadur Khadka, reported death of chickens.
Khadka’s poultry farm used to inhabit 2,000 fowls.
It has been confirmed only today that the fowls had died of bird flu.
With confirmation of bird flu, the Animal Health Directorate has declared the area a crisis zone for 90 days and intensified surveillance for the deadly flu strain.
Khadka's farm first recorded fowl deaths on October 11.
BHAKTAPUR: At least 1,200 chickens have died of bird flu at a poultry farm in Bode-3 of Madhyapur Thimi in Bhaktapur till Monday noon.
The Animal Health Directorate collected samples of dead chickens from the farm after its owner, Om Bahadur Khadka, reported death of chickens.
Khadka’s poultry farm used to inhabit 2,000 fowls.
It has been confirmed only today that the fowls had died of bird flu.
With confirmation of bird flu, the Animal Health Directorate has declared the area a crisis zone for 90 days and intensified surveillance for the deadly flu strain.
Khadka's farm first recorded fowl deaths on October 11.
Nepal: #H5N1 Bird Flu Suspected at Poultry Farm
2012-10-15
BODE: Authorities in Bhaktapur’s Bode have culled more than 1500 chickens following a suspected outbreak of bird flu, health officials said.
The outbreak of avian influenza initially killed 500 chickens out of 2000 at the poultry farm of a local Om Khadka.
A meeting of health officials is underway at Bhaktapur to confirm whether the reported case is of bird flu.
BODE: Authorities in Bhaktapur’s Bode have culled more than 1500 chickens following a suspected outbreak of bird flu, health officials said.
The outbreak of avian influenza initially killed 500 chickens out of 2000 at the poultry farm of a local Om Khadka.
A meeting of health officials is underway at Bhaktapur to confirm whether the reported case is of bird flu.
Sunday, October 14, 2012
FAB’ENTECH launches a Phase I clinical trial in Singapore for its new product against H5N1 Avian Influenza
[Red editing is mine]
October 12, 2012
LYON, France--()--Fab’entech, a French biopharmaceutical company specialized in developing specific polyclonal immunoglobulins against emerging infectious diseases announces that the company is launching its first clinical trial in humans for its product against the H5N1 Avian Influenza virus. If promising results from animal testing are confirmed, these immunoglobulins may provide a new specific approach for the treatment of subjects infected by or exposed to the H5N1 virus.
"The phase 1 clinical trial represents an important milestone in providing a potential innovative solution to combat H5N1 virus infections in humans," said founder and CEO of Fab’entech, Dr. Bertrand Lépine, MD. "The clinical trial will take place in Singapore, located in the Asia-Pacific region where the risk of propagation of H5N1 virus is one of the highest in the world. The injection of specific anti-H5N1 polyclonal immunoglobulins is likely to provide immediate protection for people who have been infected with or exposed to the virus."
The good safety profile and the efficacy of this product have been extensively documented in animal studies conducted in collaboration with the INSERM Jean Mérieux BSL-4 Laboratory of Lyon (France). The clinical trial in Singapore will involve 16 healthy adult volunteers who will be monitored for 5 weeks. It will be a double blinded, placebo controlled study, performed in strict compliance with Good Clinical Practices (GCP).
About Avian Influenza H5N1
Avian influenza is an infectious disease caused by the A(H5N1) strain of the influenza virus, which occurs primarily in birds (particularly wild water birds, but sometimes also poultry). Historically, human infections with avian influenza viruses have been extremely rare but certain H5N1 strains can cause serious infections in humans with a mortality rate that can reach 60-80% in some regions, particularly in Asia.
According to World Health Organisation (WHO), 608 human cases have been reported since 2003, including 30 human cases in the first half of 2012. The scientific community estimates that an H5N1 influenza pandemic remains a real threat, particularly if the H5N1 virus were to mutate and become transmissible between humans.
http://www.businesswire.com/news/home/20121012005805/en/FAB%E2%80%99ENTECH-launches-Phase-clinical-trial-Singapore-product
October 12, 2012
Specific anti-H5N1 polyclonal immunoglobulins developed by
Fab’entech raise the prospect of a new approach to the treatment of H5N1
Avian Influenza in humans
LYON, France--()--Fab’entech, a French biopharmaceutical company specialized in developing specific polyclonal immunoglobulins against emerging infectious diseases announces that the company is launching its first clinical trial in humans for its product against the H5N1 Avian Influenza virus. If promising results from animal testing are confirmed, these immunoglobulins may provide a new specific approach for the treatment of subjects infected by or exposed to the H5N1 virus.
“The phase 1 clinical trial represents an important milestone in providing a potential innovative solution to combat H5N1 virus infections in humans”This approach is based on passive immunotherapy which consists in injecting patients with specific antibodies (immunoglobulins) capable of recognizing, targeting and neutralizing the virus. Based on an already validated and well-established production process at industrial scale, Fab’entech is able to provide highly purified immunoglobulins to neutralize the virus.
"The phase 1 clinical trial represents an important milestone in providing a potential innovative solution to combat H5N1 virus infections in humans," said founder and CEO of Fab’entech, Dr. Bertrand Lépine, MD. "The clinical trial will take place in Singapore, located in the Asia-Pacific region where the risk of propagation of H5N1 virus is one of the highest in the world. The injection of specific anti-H5N1 polyclonal immunoglobulins is likely to provide immediate protection for people who have been infected with or exposed to the virus."
The good safety profile and the efficacy of this product have been extensively documented in animal studies conducted in collaboration with the INSERM Jean Mérieux BSL-4 Laboratory of Lyon (France). The clinical trial in Singapore will involve 16 healthy adult volunteers who will be monitored for 5 weeks. It will be a double blinded, placebo controlled study, performed in strict compliance with Good Clinical Practices (GCP).
About Avian Influenza H5N1
Avian influenza is an infectious disease caused by the A(H5N1) strain of the influenza virus, which occurs primarily in birds (particularly wild water birds, but sometimes also poultry). Historically, human infections with avian influenza viruses have been extremely rare but certain H5N1 strains can cause serious infections in humans with a mortality rate that can reach 60-80% in some regions, particularly in Asia.
According to World Health Organisation (WHO), 608 human cases have been reported since 2003, including 30 human cases in the first half of 2012. The scientific community estimates that an H5N1 influenza pandemic remains a real threat, particularly if the H5N1 virus were to mutate and become transmissible between humans.
http://www.businesswire.com/news/home/20121012005805/en/FAB%E2%80%99ENTECH-launches-Phase-clinical-trial-Singapore-product
Texas State Department of Health (TSDH) confirms a Laredo influenza outbreak in Texas -- 6 times higher than 2011
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Sat 13 Oct 2012
TSDH confirms Laredo flu outbreak
The Texas State Department of Health (TSDH) confirms a Laredo influenza outbreak in Texas -- 6 times higher than 2011 -- in contrast to the absence of flu activity elsewhere in the United States. Laredo Health and school officials are alerting families and recommending immediate action.
A new medical surveillance system, in development, testing and proving for more than 10 years, has identified an outbreak of influenza type B virus infection in Laredo (Texas), a major port of entry between Mexico and the United States. The Texas State Department of Health Services in Austin has confirmed the outbreak, with cases running 6 times higher than at this time in the 2011 influenza season in Laredo. The outbreak is in sharp contrast to a recent report of sparse influenza activity in the United States by the national Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, which is now conducting further confirmatory testing.
[This report contrasts with recent surveillance reports of influenza virus activity in the rest of the northern hemisphere. The most recent WHO Epidemiological Analysis reports that: "Influenza transmission in all reporting countries in the temperate regions of the northern hemisphere is still minimal, that is, at inter-seasonal levels. In the United States of America, one additional laboratory-confirmed human case of influenza A(H3N2)v infection was reported since the last update, but no on-going human-to-human transmission has been identified. More information can be found at: http://www.cdc.gov/flu/swineflu/variant.htm.
Throughout Europe, 23 countries reported data but influenza activity is still at inter-seasonal levels. During the 1st week of the 2012-2013 influenza season, there was no evidence of significant influenza activity in Europe according to the European Centre for Disease Prevention and Control (ECDC).
During weeks 38 to 39, influenza activity remained low throughout most parts of the world. Influenza A(H3N2) viruses remained the predominant circulating virus subtype globally, followed by influenza B and A(H1N1)pdm viruses. However, in Central and South America, influenza B was the predominant circulating virus in the region. It may be that the outbreak in Laredo, an entry port between Mexico and the United States, represent spill-over from Central and South America (see: http://www.who.int/influenza/gisrs_laboratory/updates/summaryreport/en/ )
http://www.promedmail.org/direct.php?id=20121013.1341462
International Society for Infectious Diseases
http://www.isid.org
Date: Sat 13 Oct 2012
TSDH confirms Laredo flu outbreak
The Texas State Department of Health (TSDH) confirms a Laredo influenza outbreak in Texas -- 6 times higher than 2011 -- in contrast to the absence of flu activity elsewhere in the United States. Laredo Health and school officials are alerting families and recommending immediate action.
A new medical surveillance system, in development, testing and proving for more than 10 years, has identified an outbreak of influenza type B virus infection in Laredo (Texas), a major port of entry between Mexico and the United States. The Texas State Department of Health Services in Austin has confirmed the outbreak, with cases running 6 times higher than at this time in the 2011 influenza season in Laredo. The outbreak is in sharp contrast to a recent report of sparse influenza activity in the United States by the national Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, which is now conducting further confirmatory testing.
[This report contrasts with recent surveillance reports of influenza virus activity in the rest of the northern hemisphere. The most recent WHO Epidemiological Analysis reports that: "Influenza transmission in all reporting countries in the temperate regions of the northern hemisphere is still minimal, that is, at inter-seasonal levels. In the United States of America, one additional laboratory-confirmed human case of influenza A(H3N2)v infection was reported since the last update, but no on-going human-to-human transmission has been identified. More information can be found at: http://www.cdc.gov/flu/swineflu/variant.htm.
Throughout Europe, 23 countries reported data but influenza activity is still at inter-seasonal levels. During the 1st week of the 2012-2013 influenza season, there was no evidence of significant influenza activity in Europe according to the European Centre for Disease Prevention and Control (ECDC).
During weeks 38 to 39, influenza activity remained low throughout most parts of the world. Influenza A(H3N2) viruses remained the predominant circulating virus subtype globally, followed by influenza B and A(H1N1)pdm viruses. However, in Central and South America, influenza B was the predominant circulating virus in the region. It may be that the outbreak in Laredo, an entry port between Mexico and the United States, represent spill-over from Central and South America (see: http://www.who.int/influenza/gisrs_laboratory/updates/summaryreport/en/ )
http://www.promedmail.org/direct.php?id=20121013.1341462
Saturday, October 13, 2012
Pub Med: H5N1 highly pathogenic avian influenza virus isolated from conjunctiva of a whooper swan with neurological signs
Arch Virol. 2012 Oct 10. [Epub ahead of print]
Affiliation
Research Center for Animal Hygiene and Food Safety,
Obihiro University of Agriculture and Veterinary Medicine, 2-11 Inada,
Obihiro, Hokkaido, 080-8555, Japan.
Abstract
An H5N1 highly pathogenic avian influenza virus
was isolated from conjunctiva of a whooper swan with neurological signs,
which was captured during the latest H5N1 HPAI outbreak in Japan. The
conjunctival swab contained a larger amount of the virus in comparison
with the tracheal swab. This is the first report on H5N1 virus isolation
from the conjunctiva of a wild bird, and the result may suggest the
conjunctival swab to be a critical sample for H5N1 HPAIV detection in
waterfowl. Phylogenetic analysis of the HA gene indicated that the virus
falls into H5N1 clade 2.3.2.1.
PMID
23053526 [PubMed - as supplied by publisher]
[Editing is mine]
Saudi Arabia: Pilgrims’ health satisfactory: MoH
October 12, 2012
RIYADH — The recently detected coronavirus does not pose any threat to the health of pilgrims, Dr. Ziad Memish, Deputy Health Minister for Public Health, announced here Friday. “The virus is not yet a threat to the pilgrims. The health of pilgrims who have arrived as of today (Friday) is satisfactory, and no epidemic or any worrying disease has been detected,” he said.
Dr. Memish said that the ministry is strictly screening all pilgrims at its 16 air, sea, and land ports of entry. It is also monitoring pilgrims compliance with Haj health instructions in their home countries and checking whether the appropriate vaccines have been taken. “Since the ports of entry are the front lines of defense against any passage of infectious diseases, the health authorities at these places have been provided with well-trained healthcare personnel, equipped with the latest devices to detect any symptoms of disease in pilgrims,” he said.
http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20121013139430
RIYADH — The recently detected coronavirus does not pose any threat to the health of pilgrims, Dr. Ziad Memish, Deputy Health Minister for Public Health, announced here Friday. “The virus is not yet a threat to the pilgrims. The health of pilgrims who have arrived as of today (Friday) is satisfactory, and no epidemic or any worrying disease has been detected,” he said.
Dr. Memish said that the ministry is strictly screening all pilgrims at its 16 air, sea, and land ports of entry. It is also monitoring pilgrims compliance with Haj health instructions in their home countries and checking whether the appropriate vaccines have been taken. “Since the ports of entry are the front lines of defense against any passage of infectious diseases, the health authorities at these places have been provided with well-trained healthcare personnel, equipped with the latest devices to detect any symptoms of disease in pilgrims,” he said.
http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20121013139430
Friday, October 12, 2012
Influenza (98): human-animal interface, WHO
Published Date: 2012-10-11
Date: Mon 1 Oct 2012
Source: WHO, Programmes and Projects [edited]
http://www.who.int/influenza/human_animal_interface/HAI_Risk_Assessment/en/index.html
A. Human infection with avian influenza A(H5N1) virus and associated animal health events:
-----------------------------------------------------
From 2003 through 1 Oct 2012, 608 laboratory-confirmed human cases with avian influenza A(H5N1) virus infection have been officially reported to WHO from 15 countries, of which 359 died. Since January 2012, 30 human cases of influenza A(H5N1) virus infection have been reported to WHO. Since the last update [10 Sep 2012], no new laboratory-confirmed human cases with influenza A(H5N1) virus infection have been reported to WHO. Public health risk assessment for avian influenza A(H5N1) viruses: The public health risk for the virus remains unchanged.
B. Human infection with other non-human influenza viruses
---------------------------------------------------------
A(H3N2) variant virus infection
-------------------------------
The United States of America (USA) reported few additional human cases of influenza A(H3N2)v, and no additional deaths. The large majority of cases have been associated with swine exposure, though instances of likely human-to-human transmission have been identified. No sustained human-to-human transmission has been reported.
Limited serological studies [1-4] indicate that adults may have some pre-existing immunity to this virus but children do not. Seasonal vaccines do not provide cross protection against A (H3N2)v infection. WHO has identified several candidate vaccine viruses specific for A(H3N2)v that could be used to produce an (H3N2)v vaccine if needed [5].
Overall public health risk assessment for influenza A(H3N2)v viruses:
Further human cases and small clusters may be expected as this virus is circulating in the swine population in the USA and people may continue to be exposed, especially through the autumn. Close monitoring of the situation is warranted as schools have started again and changing weather conditions may favor influenza transmission.
A(H1N1) variant virus infections
--------------------------------
As a result of enhanced surveillance around the agricultural fairs, a case of human infection with H1N1 variant influenza virus was detected and reported from the USA [6]. The case occurred in August 2012 in a previously healthy woman. She was not hospitalized and recovered from her illness. The person had direct contact with swine at a State Fair. No further cases were identified. This is the 2nd case of infection with this H1N1v virus in the USA; the previous case occurred in 2011.
Canada also reported a case of human infection with influenza A(H1N1)v in an adult male with underlying risk factors. He developed symptoms at the end of August [2012] and was hospitalized with pneumonia in September. He had occupational exposure to swine. No additional cases have been reported.
The influenza A(H1N1)v viruses isolated from patients in the USA and Canada have an haemagglutinin similar to human seasonal influenza viruses circulating very recently in people, which might suggest some existing population immunity except in young children. Current seasonal vaccines would provide cross protection against these viruses. Available data indicates that the virus would be susceptible to antivirals (neuraminidase inhibitors; oseltamivir and zanamivir).
Overall public health risk assessment for influenza A(H1N1)v viruses:
Further human cases and small clusters of human infection with these viruses may be expected as they are circulating in swine populations. No human-to-human transmission with this virus has been reported. It is expected that the human populations are largely protected by existing immunity except for young children and by the seasonal influenza vaccine.
Because influenza viruses evolve constantly and change characteristics and behavior unpredictably, WHO continues to stress the importance of global monitoring of variant influenza viruses and recommends to all Member States to strengthen routine surveillance activities.
All human infections with non-human influenza viruses as such are reportable to WHO under IHR (2005). More information on influenza at the human-animal interface is available from WHO (http://www.who.int/influenza/human_animal_interface/en/); additional information on influenza in animals is available from OIE (http://www.oie.int/animal-health-in-the-world/web-portal-on-avian-influenza/) and FAO (http://www.fao.org/avianflu/en/index.html), and OFFLU (http://www.offlu.net).
References
----------
1. CDC. Antibodies cross-reactive to influenza A(H3N2) variant virus and impact of 2010-11 seasonal influenza vaccine on cross-reactive antibodies -- United States. MMWR 2012; 61(14): 237-41; [available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6114a1.htm].
2. Skowronski, et al. Cross-reactive antibody to swine influenza A(H3N2)subtype virus in children and adults before and after immunisation with 2010/11 trivalent inactivated influenza vaccine in Canada, August to November 2010. Euro Surveillance 2012; 17(4); available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20066.
3. Waalen et al. Age-dependent prevalence of antibodies cross-reactive to the influenza A(H3N2) variant virus in sera collected in Norway in 2011; Euro Surveillance 2012; 17(19); available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20170.
4. Danuta Skowronski, et al. Cross-reactive and vaccine-induced antibody to emerging swine influenza A(H3N2)v, JID 2012; available at http://jid.oxfordjournals.org/content/early/2012/08/07/infdis.jis500.full.pdf+html.
5. WHO. Candidate vaccine viruses for variant influenza A(H3N2); available at http://www.who.int/influenza/vaccines/virus/candidates_reagents/variant_a_h3n2/en/index.html.
6. CDC. H1N2 variant virus detected in Minnesota; available at http://www.cdc.gov/flu/spotlights/h1n2v-cases-mn.htm.
Relevant links
--------------
- WHO table: cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO: http://www.who.int/influenza/human_animal_interface/EN_GIP_LatestCumulativeNumberH5N1cases.pdf
- WHO table: H5N1 avian influenza: timeline of major events http://www.who.int/influenza/human_animal_interface/avian_influenza/H5N1_avian_influenza_update.pdf
- WHO archive: avian influenza situation updates: http://www.who.int/influenza/human_animal_interface/avian_influenza/archive/en/index.html
- World Organisation of Animal Health (OIE) webpage: web portal on avian influenza: http://www.oie.int/animal-health-in-the-world/web-portal-on-avian-influenza/
- Food and Agriculture Organization of the UN (FAO) webpage: avian influenza: http://www.fao.org/avianflu/en/index.html
- Updated unified nomenclature system for the highly pathogenic H5N1 avian influenza viruses: http://www.who.int/influenza/gisrs_laboratory/h5n1_nomenclature/en/index.html
--
communicated by:
ProMED-mail rapporteur Marianne Hopp
[This document includes an epidemiological curve of avian influenza H5N1 cases in humans by country and month of onset, and a useful map of avian influenza H5N1 cases in humans for 2012. Readers are recommended to view these illustrations, which can be accessed, via the source URL above. - Mod.CP]
[all editing is mine]
http://www.promedmail.org/direct.php?id=20121011.1337739
Date: Mon 1 Oct 2012
Source: WHO, Programmes and Projects [edited]
http://www.who.int/influenza/human_animal_interface/HAI_Risk_Assessment/en/index.html
A. Human infection with avian influenza A(H5N1) virus and associated animal health events:
-----------------------------------------------------
From 2003 through 1 Oct 2012, 608 laboratory-confirmed human cases with avian influenza A(H5N1) virus infection have been officially reported to WHO from 15 countries, of which 359 died. Since January 2012, 30 human cases of influenza A(H5N1) virus infection have been reported to WHO. Since the last update [10 Sep 2012], no new laboratory-confirmed human cases with influenza A(H5N1) virus infection have been reported to WHO. Public health risk assessment for avian influenza A(H5N1) viruses: The public health risk for the virus remains unchanged.
B. Human infection with other non-human influenza viruses
---------------------------------------------------------
A(H3N2) variant virus infection
-------------------------------
The United States of America (USA) reported few additional human cases of influenza A(H3N2)v, and no additional deaths. The large majority of cases have been associated with swine exposure, though instances of likely human-to-human transmission have been identified. No sustained human-to-human transmission has been reported.
Limited serological studies [1-4] indicate that adults may have some pre-existing immunity to this virus but children do not. Seasonal vaccines do not provide cross protection against A (H3N2)v infection. WHO has identified several candidate vaccine viruses specific for A(H3N2)v that could be used to produce an (H3N2)v vaccine if needed [5].
Overall public health risk assessment for influenza A(H3N2)v viruses:
Further human cases and small clusters may be expected as this virus is circulating in the swine population in the USA and people may continue to be exposed, especially through the autumn. Close monitoring of the situation is warranted as schools have started again and changing weather conditions may favor influenza transmission.
A(H1N1) variant virus infections
--------------------------------
As a result of enhanced surveillance around the agricultural fairs, a case of human infection with H1N1 variant influenza virus was detected and reported from the USA [6]. The case occurred in August 2012 in a previously healthy woman. She was not hospitalized and recovered from her illness. The person had direct contact with swine at a State Fair. No further cases were identified. This is the 2nd case of infection with this H1N1v virus in the USA; the previous case occurred in 2011.
Canada also reported a case of human infection with influenza A(H1N1)v in an adult male with underlying risk factors. He developed symptoms at the end of August [2012] and was hospitalized with pneumonia in September. He had occupational exposure to swine. No additional cases have been reported.
The influenza A(H1N1)v viruses isolated from patients in the USA and Canada have an haemagglutinin similar to human seasonal influenza viruses circulating very recently in people, which might suggest some existing population immunity except in young children. Current seasonal vaccines would provide cross protection against these viruses. Available data indicates that the virus would be susceptible to antivirals (neuraminidase inhibitors; oseltamivir and zanamivir).
Overall public health risk assessment for influenza A(H1N1)v viruses:
Further human cases and small clusters of human infection with these viruses may be expected as they are circulating in swine populations. No human-to-human transmission with this virus has been reported. It is expected that the human populations are largely protected by existing immunity except for young children and by the seasonal influenza vaccine.
Because influenza viruses evolve constantly and change characteristics and behavior unpredictably, WHO continues to stress the importance of global monitoring of variant influenza viruses and recommends to all Member States to strengthen routine surveillance activities.
All human infections with non-human influenza viruses as such are reportable to WHO under IHR (2005). More information on influenza at the human-animal interface is available from WHO (http://www.who.int/influenza/human_animal_interface/en/); additional information on influenza in animals is available from OIE (http://www.oie.int/animal-health-in-the-world/web-portal-on-avian-influenza/) and FAO (http://www.fao.org/avianflu/en/index.html), and OFFLU (http://www.offlu.net).
References
----------
1. CDC. Antibodies cross-reactive to influenza A(H3N2) variant virus and impact of 2010-11 seasonal influenza vaccine on cross-reactive antibodies -- United States. MMWR 2012; 61(14): 237-41; [available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6114a1.htm].
2. Skowronski, et al. Cross-reactive antibody to swine influenza A(H3N2)subtype virus in children and adults before and after immunisation with 2010/11 trivalent inactivated influenza vaccine in Canada, August to November 2010. Euro Surveillance 2012; 17(4); available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20066.
3. Waalen et al. Age-dependent prevalence of antibodies cross-reactive to the influenza A(H3N2) variant virus in sera collected in Norway in 2011; Euro Surveillance 2012; 17(19); available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20170.
4. Danuta Skowronski, et al. Cross-reactive and vaccine-induced antibody to emerging swine influenza A(H3N2)v, JID 2012; available at http://jid.oxfordjournals.org/content/early/2012/08/07/infdis.jis500.full.pdf+html.
5. WHO. Candidate vaccine viruses for variant influenza A(H3N2); available at http://www.who.int/influenza/vaccines/virus/candidates_reagents/variant_a_h3n2/en/index.html.
6. CDC. H1N2 variant virus detected in Minnesota; available at http://www.cdc.gov/flu/spotlights/h1n2v-cases-mn.htm.
Relevant links
--------------
- WHO table: cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO: http://www.who.int/influenza/human_animal_interface/EN_GIP_LatestCumulativeNumberH5N1cases.pdf
- WHO table: H5N1 avian influenza: timeline of major events http://www.who.int/influenza/human_animal_interface/avian_influenza/H5N1_avian_influenza_update.pdf
- WHO archive: avian influenza situation updates: http://www.who.int/influenza/human_animal_interface/avian_influenza/archive/en/index.html
- World Organisation of Animal Health (OIE) webpage: web portal on avian influenza: http://www.oie.int/animal-health-in-the-world/web-portal-on-avian-influenza/
- Food and Agriculture Organization of the UN (FAO) webpage: avian influenza: http://www.fao.org/avianflu/en/index.html
- Updated unified nomenclature system for the highly pathogenic H5N1 avian influenza viruses: http://www.who.int/influenza/gisrs_laboratory/h5n1_nomenclature/en/index.html
--
communicated by:
ProMED-mail rapporteur Marianne Hopp
[This document includes an epidemiological curve of avian influenza H5N1 cases in humans by country and month of onset, and a useful map of avian influenza H5N1 cases in humans for 2012. Readers are recommended to view these illustrations, which can be accessed, via the source URL above. - Mod.CP]
[all editing is mine]
http://www.promedmail.org/direct.php?id=20121011.1337739
HEALTH HAZARDS - SAUDI ARABIA: UPDATED HAJJ PILGRIMS TRAVEL ADVICE
Published Date: 2012-10-11 17:24:30
This year [2012] the Hajj will take place during [24-29 Oct 2012]. Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo, cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. Current guidelines foresee mandatory vaccination with quadrivalent meningococcal vaccine for all pilgrims and yellow fever and poliomyelitis vaccine for pilgrims from high-risk countries. Influenza vaccine is strongly recommended.
The annual Hajj is one of the greatest assemblies of humankind on earth. Each year, 3 million Muslims attend the Hajj in Mecca, Saudi Arabia. Of these, 1.8 million non-Saudi Arabians usually come from overseas countries, and 89 per cent (1.6 millions) of them arrive by air [1]. Pilgrims come from more than 180 countries worldwide, and about 45 000 pilgrims each year arrive to Saudi Arabia from the European Union [2].
Preventive measures during the Hajj:
Saudi Arabia provides free health care to all pilgrims during the Hajj. For the 2012 Hajj, which will take place on [24-29 Oct 2012], the country has prepared 25 hospitals, 4427 beds including 500 critical care beds and 550 emergency care beds. In addition, there are 141 health care centres in the vicinity of the Hajj area with 20 000 specialised health care workers. The planning for the Hajj relies on the coordinated efforts of 24 supervisory committees [2]. The Hajj preventive medicine committee oversees all public health and preventative matters during the Hajj. A large number of public health officers regulate ports of entry for all pilgrims to ensure compliance with the requirements of the Saudi Arabian Ministry of Health. Public health teams are located in various areas of the Hajj, including 21 mobile teams. At each of the 18 hubs at King Abdulaziz International Airport Hajj terminal in Jeddah, 2 clinical examination rooms and a large holding area are dedicated to assess arriving pilgrims, check their immunisation status, and administer the recommended prophylactic medicines [2]. The public health teams and teams at the ports of entry report back to the command centre on 9 communicable diseases using electronic and manual surveillance systems. These diseases are influenza, influenza-like illness, meningococcal disease, food poisoning, viral haemorrhagic fevers, yellow fever, cholera, poliomyelitis, and plague [2].
Pre- and post-Hajj travel advice:
The Hajj is a unique event with possible impact on international public health. Health care practitioners around the world must be attentive to the potential risks of disease transmission during the Hajj. They must recommend appropriate strategies for the prevention and control of communicable diseases before, during, and after the completion of the Hajj. The current international collaboration in planning vaccination campaigns, developing visa quotas, arranging rapid repatriation, and managing health hazards at the Hajj are crucial steps in this process. The Saudi Arabian Ministry of Health publishes the Hajj requirements for each Hajj season. This year's [2012] Hajj recommendations have recently been published [3].
Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo (DRC), cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. We present here the changes and additions made in the recommendations for these diseases. For completeness, we also summarise the existing recommendations [3,4].
Meningococcal disease
The risk of the occurrence of meningococcal outbreaks is a real concern during the Hajj seasons. This risk is related to the high carriage rates, with one study from Mecca reporting carriage rate as high as 80 per cent [5]. Due to the previous occurrence of meningococcal outbreaks, the bivalent A and C meningococcal vaccine became a requirement for the attendance of the Hajj in 1986. Two large outbreaks caused by meningococcal serogroup W135 in 2000 and 2001 [6-8] resulted in an extension of the previous requirement to include serogroups Y and W135, and the quadrivalent (A, C, Y, W135) meningococcal polysaccharide vaccine was included as a requirement for a Hajj visa in May 2001 [9]. In addition, visitors arriving from countries in the African meningitis belt receive chemoprophylaxis with ciprofloxacin tablets (500 mg) at the port of entry to lower the rate of meningococcal carriage. It is estimated that about 400 000 to 460 000 pilgrims receive the recommended doses at the port of entry in Saudi Arabia. Compliance with meningococcal vaccination among arriving international pilgrims exceeded 97 per cent in 2011 [1].
Yellow fever
In accordance with the International Health Regulations 2005, all travellers arriving from countries identified by the World Health Organization (WHO) as areas at risk of yellow fever must present a valid yellow fever vaccination certificate showing that the person was vaccinated at least 10 days previously and not more than 10 years before arrival at the border. In the absence of such a certificate, the individual will be placed under strict surveillance for 6 days from the date of vaccination or the last date of potential exposure to infection, whichever is earlier. Health offices at entry points will be responsible for notifying the appropriate director general of health affairs in the region or governorate about the temporary place of residence of the visitor. Aircraft, ships, and other means of transportation arriving from countries affected by yellow fever are requested to submit a certificate indicating that it applied disinfection in accordance with methods recommended by WHO.
Risks of respiratory tract infections
Acute upper respiratory tract infections (URTIs) are the most common disease during Hajj. There are many factors promoting the spread of respiratory pathogens, including close contact among pilgrims, shared sleeping tents, and dense air pollution [2]. The pathogens causing URTIs among pilgrims are respiratory syncytial virus (RSV), parainfluenza virus, influenza virus and adenovirus [10]. The rates of different types of respiratory virus infections are as follows: influenza (9.8 per cent), parainfluenza (7.4 per cent), adenovirus (5.4 per cent) and RSV (1.4 per cent) [11]. Because of overcrowding and the fact that many Muslims come from countries where tuberculosis (TB) is endemic, pulmonary tuberculosis was a leading cause of hospitalisation in patients with community-acquired pneumonia [12]. The estimated risk of tuberculosis acquisition during the Hajj is thought to be around 10 per cent, based on the use of pre-visit and post-visit QuantiFERON TB assay test [13]. In another community-based survey of the epidemiology of tuberculosis in Saudi Arabia, positive tests using purified tuberculin antigens were more frequent in Saudi Arabians living in the Holy cities hosting pilgrims compared to other cities in Saudi Arabia [14]. The development of strategies to reduce the transmission of TB during the Hajj is a challenge for which no evidence-based approved measures are available to date. The Saudi Arabian Ministry of Health continues to recommend wearing face masks in crowded places and changing them frequently to minimise transmission of respiratory infections. Controlling tuberculosis transmission in mass gatherings is an area that needs urgent research studies. [14].
Novel coronavirus infection
Of particular interest is the recent report of 2 cases of acute respiratory failure associated with a novel coronavirus. Both patients were previously healthy adults. The cases occurred a few months before the 2012 Muslim Hajj season. The 1st case of infection with the novel coronavirus was identified in a Saudi Arabian national, who died in June 2012 [15,16]. The 2nd case was a patient from Qatar who was transferred to a hospital in London, United Kingdom in early September 2012 [17]. Available data to date do not support human-to-human transmission of this novel coronavirus, and zoonotic transmission is highly suspected. In the 2nd case of this novel coronavirus infection, none of the 64 close contacts developed severe disease, 13 of them (20 percent) reported mild respiratory symptoms, and the novel coronavirus was not detected in 10 symptomatic contacts who were tested [17].
WHO does not recommend any travel restrictions to or from Saudi Arabia. The current case definitions from WHO [18] and from the Saudi Arabian Ministry of Health can be found on the WHO website (http://www.who.int/csr/disease/coronavirus_infections/case_definition/en/index.html) and in Table 1, respectively. The practice of good hand hygiene and cough etiquette was associated with less respiratory illness among United States travellers to the 2009 Hajj [19]. It is recommended that pilgrims continue to practice proper hand hygiene, protective behaviours and cough etiquette to further decrease the occurrence of respiratory diseases. [see Table 1. Severe respiratory disease associated with novel coronavirus: case definition by the Saudi Arabian Ministry of Health at above given URL link.]
Foodborne diseases and cholera
Diarrhoeal illnesses during mass gathering including Hajj are a potential health hazard. Many factors may contribute to this problem including: inadequate standards of food hygiene, shortage of water, the presence asymptomatic carriers of pathogenic bacteria, and the preparation of large numbers of meals poorly stored by pilgrims. There are only few studies describing the incidence and aetiology of traveller's diarrhoea during the Hajj. In one study, diarrhoea was the 3rd most common cause (6.7 per cent) of hospitalisation [20]. Another study describes an outbreak of diarrhoeal illness in a small number of soldiers during the Hajj season [21]. As a precautionary measure, the Saudi Arabian Ministry of Health strongly enforces that pilgrims are not allowed to bring fresh food into Saudi Arabia. Only properly canned or sealed food or food stored in containers with easy access for inspection is allowed in small quantities, sufficient for one person for the duration of their trip.
Cholera is another risk during the Hajj, especially in light of the continued occurrence of outbreaks in different countries. As of 20 Sep 2012, a total of 19 283 cases, including 276 (1.4 per cent) deaths have been reported in the ongoing cholera outbreak in Sierra Leone since the beginning of the year [2012] [22]. The highest numbers of cases occurred in the western area of the country, where the capital city of Freetown is located. In addition, the WHO reported a sharp increase in the number of cholera cases in July [2012] in the DRC and many other countries [23]. The Ministry of Health of Saudi Arabia has updated its public health staff at all ports of entry for pilgrims, to be observant of all pilgrims coming from areas where cholera has been reported by WHO, and to maintain a high level of vigilance for any signs and symptoms of diarrhoea, and to continue surveillance at their camps and initiate quarantine and contact tracing once a case is suspected. Emphasis is being placed on early detection of cases and timely provision of treatment at all Hajj premises, once pilgrims have passed the ports of entry while incubating the disease.
Poliomyelitis
Poliomyelitis is still predominant in certain countries around the world. The attendance of visitors from these countries to the Hajj may pose a health risk for other visitors. All travellers arriving from polio-endemic countries and re-established transmission countries, namely Afghanistan, Angola, Chad, the DRC, Nigeria and Pakistan, regardless of age and vaccination status, should receive one dose of oral poliovirus vaccine (OPV). Proof of OPV vaccination at least 6 weeks prior departure is required to apply for entry visa for Saudi Arabia. These travellers will also receive one dose of OPV at border points on arrival in Saudi Arabia. The same requirements are valid for travellers from recently endemic countries at high risk of reimportation of poliovirus, i.e. India (Table 2).
Polio cases secondary to wild poliovirus importation or to circulating vaccine-derived poliovirus in the past 12 months have been reported in the following countries: China, Central African Republic, Cote d'Ivoire, Kenya, Mali, Niger, Somalia and Yemen [4]. All visitors aged under 15 years travelling to Saudi Arabia from these countries should be vaccinated against poliomyelitis with the OPV or inactivated poliovirus vaccine (IPV). Proof of OPV or IPV vaccination 6 weeks prior to application is required for entry visa. Irrespective of previous immunisation history, all visitors under 15 years arriving in Saudi Arabia will also receive one dose of OPV at border points (Table 2).
Table 2. Saudi Arabian health requirements and recommendations for entry visas for the Hajj seasons in 2012
Ebola outbreaks
Two large outbreaks of Ebola have been reported by the Ministries of Health of Uganda and the DRC. In Uganda, a total of 24 probable and confirmed cases were reported during the outbreak. Eleven of these 24 cases have been laboratory-confirmed by the Uganda Virus Research Institute in Entebbe. A total of 17 deaths were reported in this outbreak. The last confirmed case was admitted on [3 Aug 2012] and discharged from hospital on [24 Aug 2012] [24,25]. This is twice the maximum incubation period (21 days) for Ebola proposed by the WHO during Ebola outbreak response operations. In the DRC, 46 cases (14 laboratory-confirmed, 32 probable) of Ebola haemorrhagic fever were reported until [15 Sep 2012]. Of these, 19 have been fatal (6 confirmed, 13 probable). The cases occurred in 2 health zones of Isiro and Viadana in Haut-Uele district in Province Orientale. In addition, 26 suspected cases have been reported and are being investigated.
The 2 Ebola outbreaks are not epidemiologically linked and have been caused by 2 different Ebola subtypes: Ebola subtype Sudan in Uganda, and Ebola subtype Bundibugyo in DRC. To avoid global spread of the disease, the Saudi Arabian Ministry of Health decided to exclude pilgrims from these 2 countries for this Hajj season. This restriction is based on the careful review and deliberation of the national committee on communicable disease prevention who felt that it cannot be excluded that new cases may emerge, and on the fact that the risk of disease transmission is thought to be high with potential catastrophic consequences if occurring during the Hajj, as the disease has a high mortality rate, and no therapeutic interventions are available.
[Reported by: J A Al-Tawfiq /1, Z A Memish /2
1. Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi Arabia
2. Public Health Directorate, Ministry of Health, Riyadh, Director WHO Collaborating Center for Mass Gathering Medicine, Professor, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia]
References follow: http://www.promedmail.org/direct.php?id=20121011.1338172
This year [2012] the Hajj will take place during [24-29 Oct 2012]. Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo, cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. Current guidelines foresee mandatory vaccination with quadrivalent meningococcal vaccine for all pilgrims and yellow fever and poliomyelitis vaccine for pilgrims from high-risk countries. Influenza vaccine is strongly recommended.
The annual Hajj is one of the greatest assemblies of humankind on earth. Each year, 3 million Muslims attend the Hajj in Mecca, Saudi Arabia. Of these, 1.8 million non-Saudi Arabians usually come from overseas countries, and 89 per cent (1.6 millions) of them arrive by air [1]. Pilgrims come from more than 180 countries worldwide, and about 45 000 pilgrims each year arrive to Saudi Arabia from the European Union [2].
Preventive measures during the Hajj:
Saudi Arabia provides free health care to all pilgrims during the Hajj. For the 2012 Hajj, which will take place on [24-29 Oct 2012], the country has prepared 25 hospitals, 4427 beds including 500 critical care beds and 550 emergency care beds. In addition, there are 141 health care centres in the vicinity of the Hajj area with 20 000 specialised health care workers. The planning for the Hajj relies on the coordinated efforts of 24 supervisory committees [2]. The Hajj preventive medicine committee oversees all public health and preventative matters during the Hajj. A large number of public health officers regulate ports of entry for all pilgrims to ensure compliance with the requirements of the Saudi Arabian Ministry of Health. Public health teams are located in various areas of the Hajj, including 21 mobile teams. At each of the 18 hubs at King Abdulaziz International Airport Hajj terminal in Jeddah, 2 clinical examination rooms and a large holding area are dedicated to assess arriving pilgrims, check their immunisation status, and administer the recommended prophylactic medicines [2]. The public health teams and teams at the ports of entry report back to the command centre on 9 communicable diseases using electronic and manual surveillance systems. These diseases are influenza, influenza-like illness, meningococcal disease, food poisoning, viral haemorrhagic fevers, yellow fever, cholera, poliomyelitis, and plague [2].
Pre- and post-Hajj travel advice:
The Hajj is a unique event with possible impact on international public health. Health care practitioners around the world must be attentive to the potential risks of disease transmission during the Hajj. They must recommend appropriate strategies for the prevention and control of communicable diseases before, during, and after the completion of the Hajj. The current international collaboration in planning vaccination campaigns, developing visa quotas, arranging rapid repatriation, and managing health hazards at the Hajj are crucial steps in this process. The Saudi Arabian Ministry of Health publishes the Hajj requirements for each Hajj season. This year's [2012] Hajj recommendations have recently been published [3].
Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo (DRC), cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. We present here the changes and additions made in the recommendations for these diseases. For completeness, we also summarise the existing recommendations [3,4].
Meningococcal disease
The risk of the occurrence of meningococcal outbreaks is a real concern during the Hajj seasons. This risk is related to the high carriage rates, with one study from Mecca reporting carriage rate as high as 80 per cent [5]. Due to the previous occurrence of meningococcal outbreaks, the bivalent A and C meningococcal vaccine became a requirement for the attendance of the Hajj in 1986. Two large outbreaks caused by meningococcal serogroup W135 in 2000 and 2001 [6-8] resulted in an extension of the previous requirement to include serogroups Y and W135, and the quadrivalent (A, C, Y, W135) meningococcal polysaccharide vaccine was included as a requirement for a Hajj visa in May 2001 [9]. In addition, visitors arriving from countries in the African meningitis belt receive chemoprophylaxis with ciprofloxacin tablets (500 mg) at the port of entry to lower the rate of meningococcal carriage. It is estimated that about 400 000 to 460 000 pilgrims receive the recommended doses at the port of entry in Saudi Arabia. Compliance with meningococcal vaccination among arriving international pilgrims exceeded 97 per cent in 2011 [1].
Yellow fever
In accordance with the International Health Regulations 2005, all travellers arriving from countries identified by the World Health Organization (WHO) as areas at risk of yellow fever must present a valid yellow fever vaccination certificate showing that the person was vaccinated at least 10 days previously and not more than 10 years before arrival at the border. In the absence of such a certificate, the individual will be placed under strict surveillance for 6 days from the date of vaccination or the last date of potential exposure to infection, whichever is earlier. Health offices at entry points will be responsible for notifying the appropriate director general of health affairs in the region or governorate about the temporary place of residence of the visitor. Aircraft, ships, and other means of transportation arriving from countries affected by yellow fever are requested to submit a certificate indicating that it applied disinfection in accordance with methods recommended by WHO.
Risks of respiratory tract infections
Acute upper respiratory tract infections (URTIs) are the most common disease during Hajj. There are many factors promoting the spread of respiratory pathogens, including close contact among pilgrims, shared sleeping tents, and dense air pollution [2]. The pathogens causing URTIs among pilgrims are respiratory syncytial virus (RSV), parainfluenza virus, influenza virus and adenovirus [10]. The rates of different types of respiratory virus infections are as follows: influenza (9.8 per cent), parainfluenza (7.4 per cent), adenovirus (5.4 per cent) and RSV (1.4 per cent) [11]. Because of overcrowding and the fact that many Muslims come from countries where tuberculosis (TB) is endemic, pulmonary tuberculosis was a leading cause of hospitalisation in patients with community-acquired pneumonia [12]. The estimated risk of tuberculosis acquisition during the Hajj is thought to be around 10 per cent, based on the use of pre-visit and post-visit QuantiFERON TB assay test [13]. In another community-based survey of the epidemiology of tuberculosis in Saudi Arabia, positive tests using purified tuberculin antigens were more frequent in Saudi Arabians living in the Holy cities hosting pilgrims compared to other cities in Saudi Arabia [14]. The development of strategies to reduce the transmission of TB during the Hajj is a challenge for which no evidence-based approved measures are available to date. The Saudi Arabian Ministry of Health continues to recommend wearing face masks in crowded places and changing them frequently to minimise transmission of respiratory infections. Controlling tuberculosis transmission in mass gatherings is an area that needs urgent research studies. [14].
Novel coronavirus infection
Of particular interest is the recent report of 2 cases of acute respiratory failure associated with a novel coronavirus. Both patients were previously healthy adults. The cases occurred a few months before the 2012 Muslim Hajj season. The 1st case of infection with the novel coronavirus was identified in a Saudi Arabian national, who died in June 2012 [15,16]. The 2nd case was a patient from Qatar who was transferred to a hospital in London, United Kingdom in early September 2012 [17]. Available data to date do not support human-to-human transmission of this novel coronavirus, and zoonotic transmission is highly suspected. In the 2nd case of this novel coronavirus infection, none of the 64 close contacts developed severe disease, 13 of them (20 percent) reported mild respiratory symptoms, and the novel coronavirus was not detected in 10 symptomatic contacts who were tested [17].
WHO does not recommend any travel restrictions to or from Saudi Arabia. The current case definitions from WHO [18] and from the Saudi Arabian Ministry of Health can be found on the WHO website (http://www.who.int/csr/disease/coronavirus_infections/case_definition/en/index.html) and in Table 1, respectively. The practice of good hand hygiene and cough etiquette was associated with less respiratory illness among United States travellers to the 2009 Hajj [19]. It is recommended that pilgrims continue to practice proper hand hygiene, protective behaviours and cough etiquette to further decrease the occurrence of respiratory diseases. [see Table 1. Severe respiratory disease associated with novel coronavirus: case definition by the Saudi Arabian Ministry of Health at above given URL link.]
Foodborne diseases and cholera
Diarrhoeal illnesses during mass gathering including Hajj are a potential health hazard. Many factors may contribute to this problem including: inadequate standards of food hygiene, shortage of water, the presence asymptomatic carriers of pathogenic bacteria, and the preparation of large numbers of meals poorly stored by pilgrims. There are only few studies describing the incidence and aetiology of traveller's diarrhoea during the Hajj. In one study, diarrhoea was the 3rd most common cause (6.7 per cent) of hospitalisation [20]. Another study describes an outbreak of diarrhoeal illness in a small number of soldiers during the Hajj season [21]. As a precautionary measure, the Saudi Arabian Ministry of Health strongly enforces that pilgrims are not allowed to bring fresh food into Saudi Arabia. Only properly canned or sealed food or food stored in containers with easy access for inspection is allowed in small quantities, sufficient for one person for the duration of their trip.
Cholera is another risk during the Hajj, especially in light of the continued occurrence of outbreaks in different countries. As of 20 Sep 2012, a total of 19 283 cases, including 276 (1.4 per cent) deaths have been reported in the ongoing cholera outbreak in Sierra Leone since the beginning of the year [2012] [22]. The highest numbers of cases occurred in the western area of the country, where the capital city of Freetown is located. In addition, the WHO reported a sharp increase in the number of cholera cases in July [2012] in the DRC and many other countries [23]. The Ministry of Health of Saudi Arabia has updated its public health staff at all ports of entry for pilgrims, to be observant of all pilgrims coming from areas where cholera has been reported by WHO, and to maintain a high level of vigilance for any signs and symptoms of diarrhoea, and to continue surveillance at their camps and initiate quarantine and contact tracing once a case is suspected. Emphasis is being placed on early detection of cases and timely provision of treatment at all Hajj premises, once pilgrims have passed the ports of entry while incubating the disease.
Poliomyelitis
Poliomyelitis is still predominant in certain countries around the world. The attendance of visitors from these countries to the Hajj may pose a health risk for other visitors. All travellers arriving from polio-endemic countries and re-established transmission countries, namely Afghanistan, Angola, Chad, the DRC, Nigeria and Pakistan, regardless of age and vaccination status, should receive one dose of oral poliovirus vaccine (OPV). Proof of OPV vaccination at least 6 weeks prior departure is required to apply for entry visa for Saudi Arabia. These travellers will also receive one dose of OPV at border points on arrival in Saudi Arabia. The same requirements are valid for travellers from recently endemic countries at high risk of reimportation of poliovirus, i.e. India (Table 2).
Polio cases secondary to wild poliovirus importation or to circulating vaccine-derived poliovirus in the past 12 months have been reported in the following countries: China, Central African Republic, Cote d'Ivoire, Kenya, Mali, Niger, Somalia and Yemen [4]. All visitors aged under 15 years travelling to Saudi Arabia from these countries should be vaccinated against poliomyelitis with the OPV or inactivated poliovirus vaccine (IPV). Proof of OPV or IPV vaccination 6 weeks prior to application is required for entry visa. Irrespective of previous immunisation history, all visitors under 15 years arriving in Saudi Arabia will also receive one dose of OPV at border points (Table 2).
Table 2. Saudi Arabian health requirements and recommendations for entry visas for the Hajj seasons in 2012
Ebola outbreaks
Two large outbreaks of Ebola have been reported by the Ministries of Health of Uganda and the DRC. In Uganda, a total of 24 probable and confirmed cases were reported during the outbreak. Eleven of these 24 cases have been laboratory-confirmed by the Uganda Virus Research Institute in Entebbe. A total of 17 deaths were reported in this outbreak. The last confirmed case was admitted on [3 Aug 2012] and discharged from hospital on [24 Aug 2012] [24,25]. This is twice the maximum incubation period (21 days) for Ebola proposed by the WHO during Ebola outbreak response operations. In the DRC, 46 cases (14 laboratory-confirmed, 32 probable) of Ebola haemorrhagic fever were reported until [15 Sep 2012]. Of these, 19 have been fatal (6 confirmed, 13 probable). The cases occurred in 2 health zones of Isiro and Viadana in Haut-Uele district in Province Orientale. In addition, 26 suspected cases have been reported and are being investigated.
The 2 Ebola outbreaks are not epidemiologically linked and have been caused by 2 different Ebola subtypes: Ebola subtype Sudan in Uganda, and Ebola subtype Bundibugyo in DRC. To avoid global spread of the disease, the Saudi Arabian Ministry of Health decided to exclude pilgrims from these 2 countries for this Hajj season. This restriction is based on the careful review and deliberation of the national committee on communicable disease prevention who felt that it cannot be excluded that new cases may emerge, and on the fact that the risk of disease transmission is thought to be high with potential catastrophic consequences if occurring during the Hajj, as the disease has a high mortality rate, and no therapeutic interventions are available.
[Reported by: J A Al-Tawfiq /1, Z A Memish /2
1. Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi Arabia
2. Public Health Directorate, Ministry of Health, Riyadh, Director WHO Collaborating Center for Mass Gathering Medicine, Professor, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia]
References follow: http://www.promedmail.org/direct.php?id=20121011.1338172
Disaster & Prepardness Response: WHO’s hospital safety index and emergency checklist rolled out in Europe
12-10-2012
WHO has developed tools, including the index and checklist, helping health authorities to improve hospitals and health systems’ ability to prepare for emergencies and remain resilient during and after disasters.
Assessments using the hospital safety index were made in 9 countries in the WHO European Region. These include training national experts to assess priority hospitals and identifying the most effective mitigation measures for emergencies.
Several countries, including the Republic of Moldova, have integrated the application of the hospital safety index into the processes for accrediting hospitals, or planning new ones, as in Georgia. In Tajikistan, recommendations on structural and other improvements, developed with the Ministry of Health, were used to mobilize donor funding for priority mitigation measures and retrofitting vulnerable facilities. Hospital emergency plans were developed, updated and tested through exercises and drills in Poland and in the Ukraine, and complemented by training of health professionals in emergency management.
To date, more than 140 hospital assessment reports have been produced. Countries shared their experience at a global expert meeting in Istanbul, Turkey in March 2012 and several national and regional meetings.
The WHO tools assess hospitals’ vulnerabilities, promote low-cost/high-impact mitigation measures and strengthen emergency preparedness to ensure that hospitals keep functioning during all emergencies.
13 October 2012 is the International Day for Disaster Reduction.
When hospitals fail, communities are left without critical health services, including basic emergency care. Keeping hospitals safe from natural or human-made threats goes beyond the mere protection of buildings and physical structures. It requires protecting and ensuring the preparedness of the health workforce, and preserving supply lines to keep facilities operational.
http://www.euro.who.int/en/what-we-do/health-topics/emergencies/disaster-preparedness-and-response/news/news/2012/10/whos-hospital-safety-index-and-emergency-checklist-rolled-out-in-europe
WHO has developed tools, including the index and checklist, helping health authorities to improve hospitals and health systems’ ability to prepare for emergencies and remain resilient during and after disasters.
Assessments using the hospital safety index were made in 9 countries in the WHO European Region. These include training national experts to assess priority hospitals and identifying the most effective mitigation measures for emergencies.
Several countries, including the Republic of Moldova, have integrated the application of the hospital safety index into the processes for accrediting hospitals, or planning new ones, as in Georgia. In Tajikistan, recommendations on structural and other improvements, developed with the Ministry of Health, were used to mobilize donor funding for priority mitigation measures and retrofitting vulnerable facilities. Hospital emergency plans were developed, updated and tested through exercises and drills in Poland and in the Ukraine, and complemented by training of health professionals in emergency management.
To date, more than 140 hospital assessment reports have been produced. Countries shared their experience at a global expert meeting in Istanbul, Turkey in March 2012 and several national and regional meetings.
The WHO tools assess hospitals’ vulnerabilities, promote low-cost/high-impact mitigation measures and strengthen emergency preparedness to ensure that hospitals keep functioning during all emergencies.
13 October 2012 is the International Day for Disaster Reduction.
Need for health services to remain functional in disasters and emergencies
Health services need to keep functioning during and after crises and disasters, when they are needed most. Making sure that hospitals and health facilities are safe and prepared for emergencies is a key priority to ensure community resilience and protect the health of vulnerable groups. Vulnerable groups, particularly women and girls, are often among those most affected in communities hit by disasters.When hospitals fail, communities are left without critical health services, including basic emergency care. Keeping hospitals safe from natural or human-made threats goes beyond the mere protection of buildings and physical structures. It requires protecting and ensuring the preparedness of the health workforce, and preserving supply lines to keep facilities operational.
http://www.euro.who.int/en/what-we-do/health-topics/emergencies/disaster-preparedness-and-response/news/news/2012/10/whos-hospital-safety-index-and-emergency-checklist-rolled-out-in-europe
Chhattisgarh sounds alert as swine flu claims five lives
October 11, 2012
Click on map to enlarge:
Raipur : The Chhattisgarh government Thursday sounded a high alert after swine flu claimed five lives in the state within less than a fortnight, a health department official here said.
"In less than 15 days, five deaths in the state have been confirmed to swine flu. Dozens of people, including two government doctors in Raipur, are suffering from the disease," a directorate of health services official said.
The state government has instructed hospitals across all the 27 districts to distribute Tamiflu, a drug against H1N1 virus that causes swine flu, free of cost.
The government has also asked people to rush to the nearest hospital in case they detect symptoms of the disease, which include high fever, cough, sore throat, body ache, chills and fatigue that can be extreme. http://twocircles.net/2012oct11/chhattisgarh_sounds_alert_swine_flu_claims_five_lives.html
Raipur : The Chhattisgarh government Thursday sounded a high alert after swine flu claimed five lives in the state within less than a fortnight, a health department official here said.
"In less than 15 days, five deaths in the state have been confirmed to swine flu. Dozens of people, including two government doctors in Raipur, are suffering from the disease," a directorate of health services official said.
The state government has instructed hospitals across all the 27 districts to distribute Tamiflu, a drug against H1N1 virus that causes swine flu, free of cost.
The government has also asked people to rush to the nearest hospital in case they detect symptoms of the disease, which include high fever, cough, sore throat, body ache, chills and fatigue that can be extreme. http://twocircles.net/2012oct11/chhattisgarh_sounds_alert_swine_flu_claims_five_lives.html
Singapore: False Tweet on Hospital with Coronavirus Patient
It appears the reason this case made the news is because of the false tweet sent out.
The WHO has declared no new cases since September 22, 2012.
Woman tests negative for SARS-related bug
By Claire Huang | Posted: 12 October 2012
SINGAPORE: A woman suspected of being infected with a variant of the influenza bug that caused the SARS epidemic in 2002 does not have the infection.
While she was initially suspected to be infected with the novel coronavirus, the Singapore General Hospital (SGH) said laboratory tests have confirmed that she does not have the infection.
She was admitted to SGH after arriving in Singapore from Kuwait, with a two-hour transit in Qatar.
The hospital said her illness was linked to influenza A or H1N1 infection, which is one of the circulating seasonal influenza strains.
It added that the patient has a history of chronic disease and as such, would be at a higher risk.
A false tweet was circulated online at about 4pm on Thursday telling netizens to stay away from SGH because it has a patient who has the novel coronavirus.
-snip-
http://www.channelnewsasia.com/stories/singaporelocalnews/view/1230965/1/.html
The WHO has declared no new cases since September 22, 2012.
Novel coronavirus infection - update
10 October 2012 - No new cases of infection with the novel coronavirus have been reported since 22 September 2012. So far, after careful follow-up of close contacts of the two confirmed cases, and a heightened state of global surveillance , there is no evidence of human-to-human transmission of the virus.
The governments of Saudi Arabia, Qatar and the United Kingdom, are continuing their work to gain a better understanding of the disease and the likely source of infection. WHO is supporting the national authorities in their ongoing investigation, and has deployed experts to Saudi Arabia and Qatar as part of an international team. These and future epidemiological and scientific studies will lead to a better understanding of the novel coronavirus.
WHO continues to work with the ministries of health and other international partners to coordinate actions for timely detection, rapid diagnosis and case management of infection caused by the novel coronavirus, should the need arise.
Based on this overall situation, WHO encourages Member States to continue with their routine surveillance to ensure early detection and rapid response to all potential public health threats. WHO will continue to coordinate routine surveillance efforts internationally.
This event was rapidly detected by the international public health community, and notified to WHO under the International Health Regulations (2005). It demonstrates the value of having the appropriate systems and processes in place for early detection, risk assessment and dissemination of information in order to implement appropriate response.
http://www.who.int/csr/don/2012_10_10/en/index.html
Thursday, October 11, 2012
Germs and money: Where and when will the next pandemic emerge?
Oct 13th 2012
ON OCTOBER 2nd a British traveller, flying home to Glasgow from Afghanistan, began to feel ill. Within hours he was diagnosed with Crimean-Congo Haemorrhagic Fever, a virus nasty enough for him to be put onto a military transport aircraft for transfer to an isolation hospital in London. Less than 24 hours later he was dead.
This outbreak, on top of another death last month in Saudi Arabia from a previously unknown virus, a cousin of the Severe Acute Respiratory Syndrome (SARS), has set global health agencies on edge. Ten years ago the deaths of a couple of travellers from foreign parts might not have been news at all. But the fright of the SARS outbreak in 2003 has left a lasting impression, and scientists and public-health officials now tend to see any putative disease threat through its lens.
Continued: http://www.economist.com/node/21564529
ON OCTOBER 2nd a British traveller, flying home to Glasgow from Afghanistan, began to feel ill. Within hours he was diagnosed with Crimean-Congo Haemorrhagic Fever, a virus nasty enough for him to be put onto a military transport aircraft for transfer to an isolation hospital in London. Less than 24 hours later he was dead.
This outbreak, on top of another death last month in Saudi Arabia from a previously unknown virus, a cousin of the Severe Acute Respiratory Syndrome (SARS), has set global health agencies on edge. Ten years ago the deaths of a couple of travellers from foreign parts might not have been news at all. But the fright of the SARS outbreak in 2003 has left a lasting impression, and scientists and public-health officials now tend to see any putative disease threat through its lens.
Continued: http://www.economist.com/node/21564529
Vietnam: Received 20,000 equipment protection help prevent disease outbreaks
On 10/10, Vietnam has received 20,000 of labor protection equipment to help vets in new bird flu outbreak may occur and other emerging diseases, by the International Development (USAID) awarded, at the request of the Ministry of Agriculture and Rural Development of Vietnam.
The personal protective equipment consisting of 50,000 masks, 80,000 and 30,000 hooded jacket gloves for protection, worth about $ 200,000, was transferred to the provinces in the risk of the highest bird flu outbreak, or in need urgent protective equipment, to prevent human exposure to highly pathogenic H5N1 avian influenza virus.
The protective equipment will help protect the veterinary staff and others involved in the prevention of and response to the H5N1 virus, or other pandemic risk in medical facilities and in communities in Vietnam
The protective equipment will help protect the veterinary staff and others involved in the prevention of and response to the H5N1 virus, or other pandemic risk in medical facilities and in communities in Vietnam
Wednesday, October 10, 2012
Human bocavirus Infections found in Shenzhen
Published Date: 2012-10-09 16:45:16
Entry-exit Inspection and Quarantine Bureau warns the mass travelers to take personal protection measures following the consecutive detection of 4 human Human bocavirus cases at Shenzhen Port.
A baby was taken to a medical inspection room for further temperature monitoring, body examination and epidemic investigation after it was found that its temperature had exceeded normal value through infrared thermal imaging temperature monitoring by personnel from Shenzhen Entry-exit Inspection and Quarantine Bureau at Shenzhen Port. The baby, less than one year old, was from Hong Kong. Its armpit temperature was 37.6 centigrade and it had obvious canker in mouth. After throat swab inspection, the baby was diagnosed as a case of human bocavirus infection, the 4th in Shenzhen within one month. The other 3 cases were respectively found from Huanggang Port and Shenzhen Bay Port.
As a new virus that closely relates to human's acute respiratory infection, bocavirus, through airborne transmission, makes children from 6 months to 3 years old vulnerable to pneumonia, bronchitis, bronchopneumonia and other diseases, with main clinical symptoms of cough, fever, gasping, diarrhoea, and so on. Autumn is high occurrence season for the virus. The virus is not easy to be distinguished [symptomatically] from other respiratory virus infection and has caused great attention of many scholars and experts.
Shenzhen Entry-exit Inspection and Quarantine Bureau warns that travellers should take care of their personal hygiene and avoid going to the public areas with high dense crowds. The children should also be taken good care of. Travellers should make immediate report to an inspection and quarantine department and take hospitalization if finding any above mentioned symptoms before entering Shenzhen.
[byline: Connie and Elaine]
-- communicated by: ProMED-mail from HealthMap alerts
[Although it is clear that influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus are important causes of pneumonia, the role of rhinoviruses and some of the newly described viruses, including human coronaviruses and human bocavirus, is harder to determine.
Human bocavirus is a small single-stranded DNA-containing virus classified in the family _Parvoviridae_. It is one of the many respiratory pathogens affecting infants and young children. 4 species of human bocavirus (HBoV) have been recently discovered and classified in the Bocavirus genus (family Parvoviridae, subfamily Parvovirinae). Although detected both in respiratory and stool samples worldwide, HBoV1 is predominantly a respiratory pathogen, whereas HBoV2, HBoV3, and HBoV4 have been found mainly in stool.
A variety of signs and symptoms have been described in patients with HBoV infection including rhinitis, pharyngitis, cough, dyspnea, wheezing, pneumonia, acute otitis media, fever, nausea, vomiting, and diarrhea. Many of these potential manifestations have not been systematically explored, and they have been questioned because of high HBoV co-infection rates in symptomatic subjects and high HBoV detection rates in asymptomatic subjects. However, evidence is mounting to show that HBoV1 is an important cause of lower respiratory tract illness. The best currently available diagnostic approaches are quantitative PCR and serology. [See: T Jartti, et al. Rev Med Virol. 2012 Jan;22(1):46-64).
The name bocavirus is derived from bovine and canine, referring to the 2 known hosts for other members of this genus; the bovine parvovirus which infects cattle, and the minute virus of canines which infects dogs.[7] Parvoviruses (Latin: small viruses) have a 5 kilobase long single-stranded DNA, and they use some of their host's replication proteins to copy their DNA. - Mod.CP
http://www.promedmail.org/
Entry-exit Inspection and Quarantine Bureau warns the mass travelers to take personal protection measures following the consecutive detection of 4 human Human bocavirus cases at Shenzhen Port.
A baby was taken to a medical inspection room for further temperature monitoring, body examination and epidemic investigation after it was found that its temperature had exceeded normal value through infrared thermal imaging temperature monitoring by personnel from Shenzhen Entry-exit Inspection and Quarantine Bureau at Shenzhen Port. The baby, less than one year old, was from Hong Kong. Its armpit temperature was 37.6 centigrade and it had obvious canker in mouth. After throat swab inspection, the baby was diagnosed as a case of human bocavirus infection, the 4th in Shenzhen within one month. The other 3 cases were respectively found from Huanggang Port and Shenzhen Bay Port.
As a new virus that closely relates to human's acute respiratory infection, bocavirus, through airborne transmission, makes children from 6 months to 3 years old vulnerable to pneumonia, bronchitis, bronchopneumonia and other diseases, with main clinical symptoms of cough, fever, gasping, diarrhoea, and so on. Autumn is high occurrence season for the virus. The virus is not easy to be distinguished [symptomatically] from other respiratory virus infection and has caused great attention of many scholars and experts.
Shenzhen Entry-exit Inspection and Quarantine Bureau warns that travellers should take care of their personal hygiene and avoid going to the public areas with high dense crowds. The children should also be taken good care of. Travellers should make immediate report to an inspection and quarantine department and take hospitalization if finding any above mentioned symptoms before entering Shenzhen.
[byline: Connie and Elaine]
-- communicated by: ProMED-mail from HealthMap alerts
[Although it is clear that influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus are important causes of pneumonia, the role of rhinoviruses and some of the newly described viruses, including human coronaviruses and human bocavirus, is harder to determine.
Human bocavirus is a small single-stranded DNA-containing virus classified in the family _Parvoviridae_. It is one of the many respiratory pathogens affecting infants and young children. 4 species of human bocavirus (HBoV) have been recently discovered and classified in the Bocavirus genus (family Parvoviridae, subfamily Parvovirinae). Although detected both in respiratory and stool samples worldwide, HBoV1 is predominantly a respiratory pathogen, whereas HBoV2, HBoV3, and HBoV4 have been found mainly in stool.
A variety of signs and symptoms have been described in patients with HBoV infection including rhinitis, pharyngitis, cough, dyspnea, wheezing, pneumonia, acute otitis media, fever, nausea, vomiting, and diarrhea. Many of these potential manifestations have not been systematically explored, and they have been questioned because of high HBoV co-infection rates in symptomatic subjects and high HBoV detection rates in asymptomatic subjects. However, evidence is mounting to show that HBoV1 is an important cause of lower respiratory tract illness. The best currently available diagnostic approaches are quantitative PCR and serology. [See: T Jartti, et al. Rev Med Virol. 2012 Jan;22(1):46-64).
The name bocavirus is derived from bovine and canine, referring to the 2 known hosts for other members of this genus; the bovine parvovirus which infects cattle, and the minute virus of canines which infects dogs.[7] Parvoviruses (Latin: small viruses) have a 5 kilobase long single-stranded DNA, and they use some of their host's replication proteins to copy their DNA. - Mod.CP
http://www.promedmail.org/
Cruise ship with meningitis outbreak docks in Spain
10/10/12
MADRID, Oct. 9 (Xinhua) -- The cruise-ship Orchesta arrived in the Spanish port of Valencia on Tuesday after four cases of bacterial meningitis had been reported among members of its crew.
The ship, which has 2,800 passengers onboard arrived after sailing from the Italian port of Liverno.
The four infected crew members, two of whom are said to be in a serious condition, are in hospital, while the passengers and remaining crew have all been prescribed antibiotics as a precautionary measure.
The company MSC, which runs the ship has assured passengers that there is no risk to their health given that those infected were not in contact with passengers and added that nobody else has shown any symptoms of the potentially fatal disease.
"No passaneger and no member of the crew has shown and symptoms of meningitis," said the statement published by MSC.
The Orchestra is now expected to continue with its itinerary, calling in at Ibiza, Tuniz, Catalia and Naples.
The warning of the disease was raised around mid-day on Monday, while the majority of the holidaymakers onboard were visiting Livorno
MADRID, Oct. 9 (Xinhua) -- The cruise-ship Orchesta arrived in the Spanish port of Valencia on Tuesday after four cases of bacterial meningitis had been reported among members of its crew.
The ship, which has 2,800 passengers onboard arrived after sailing from the Italian port of Liverno.
The four infected crew members, two of whom are said to be in a serious condition, are in hospital, while the passengers and remaining crew have all been prescribed antibiotics as a precautionary measure.
The company MSC, which runs the ship has assured passengers that there is no risk to their health given that those infected were not in contact with passengers and added that nobody else has shown any symptoms of the potentially fatal disease.
"No passaneger and no member of the crew has shown and symptoms of meningitis," said the statement published by MSC.
The Orchestra is now expected to continue with its itinerary, calling in at Ibiza, Tuniz, Catalia and Naples.
The warning of the disease was raised around mid-day on Monday, while the majority of the holidaymakers onboard were visiting Livorno
Tuesday, October 9, 2012
Vietnam: Smuggling chickens raging, the vaccine is disabled
[There have not been any human infections recently in Vietnam, and the vaccine is not working...so it is not easy to contract the H5N1 Avian Influenza]
Translation:
October 8, 2012
Translation:
October 8, 2012
Chicken illegally carrying dangerous new strain are local mass influx.
It is worrying that this new virus has appeared and spread rapidly in China since the beginning of the year and we are using the vaccine does not work against them. According to Prof. Dr. Nguyen Tran Hien, Director of the Institute of Hygiene and Epidemiology, with the former group, the injectable flu vaccine for poultry only meet 75% of the variation H5N1 virus in poultry, in the absence of disease vaccine increase the risk of the virus to mutate to spread from person to person. Meanwhile, according to the Department of Animal Health, the country also seven provinces with avian bird deaths, the destruction of more than 180,000 children.
However, the Deputy Director of Animal Husbandry Department Nguyen Thanh Son fear, new branches virus can source from chicken cull China, especially chickens smuggled into Vietnam in recent years. Meanwhile, the Deputy Minister of Agriculture and Rural Development Diep Kinh Tan said: "The disease situation is complicated in the North or Central. 2 months ago, there was a new virus (group C) in China, causing the bird flu with the potential to cause very high death and are at risk of entry into Vietnam. "
Chicken spill massive smuggling into the country through the province of Quang Ninh
While new avian influenza virus with high-risk infectious and high mortality rates are raging, state smuggled poultry (the main cause of spreading dangerous strain) has not been controlled.
Smuggled chickens contain pathogenic strains with stronger, higher ability to infect humans and cause death rate is also higher. This information is the Animal Health Department (MARD) warned at the beginning of the year.
Vaccines disabled with the new strain of bird flu
Talking to us, Acting Director of Animal Health, Hoang Van Nam said the new H5N1 virus appears, but still belongs to the old branch, but had differences with both groups A and B viruses cause disease in Vietnam in 2011. According to Prof. Dr. Long Thanh, director of the Central Veterinary Diagnostic Center, but appear from July, but this group of viruses has spread rapidly and over a wide range from the north into Central. According to experts, the virus is able to cause bird flu continues to spread in the future and this strain highly lethal than the old strain.
Saudi Arabia: Video - Hunting Migratory Birds Prohibited For Fear Avian Influenza
October 10, 2012
Sky News Arabic:
Represents the hunting of migratory birds to the Saudis love did not prevent him laws enacted by the Kingdom banned for fear of transmission of avian influenza infection.
http://www.skynewsarabia.com/web/video/49600/%D8%B5%D9%8A%D8%AF-%D8%A7%D9%84%D8%B7%D9%8A%D9%88%D8%B1-%D8%A7%D9%84%D9%85%D9%87%D8%A7%D8%AC%D8%B1%D8%A9-%D8%A7%D9%84%D8%B3%D8%B9%D9%88%D8%AF%D9%8A%D8%A9
Sky News Arabic:
Represents the hunting of migratory birds to the Saudis love did not prevent him laws enacted by the Kingdom banned for fear of transmission of avian influenza infection.
http://www.skynewsarabia.com/web/video/49600/%D8%B5%D9%8A%D8%AF-%D8%A7%D9%84%D8%B7%D9%8A%D9%88%D8%B1-%D8%A7%D9%84%D9%85%D9%87%D8%A7%D8%AC%D8%B1%D8%A9-%D8%A7%D9%84%D8%B3%D8%B9%D9%88%D8%AF%D9%8A%D8%A9
Indonesia: Video in Indonesia: Flu burung teror warga Bandung
http://video.sindonews.com/view/337/flu-burung-teror-warga-bandung
Indonesia: Tia Lestari (8) Update
[I don't recall reading about severe lung disease or pneumonia...]
From the previous article:
10 October 2012 JAKARTA - The Hasan Sadikin Hospital (RSHS) Bandung ensure the death of the patient Tia Lestari, 8, Bojongsoang origin, Bandung regency is not due to bird flu. Tim Bird Flu Handling RSHS Dr Sri Sudhawati confirmed, the patient died due to pneumonia or severe lung disease. "The patient is not suffering from bird flu, he suffered from severe pneumonia. Because before he had contact with poultry that died suddenly," he said when met at RSHS, yesterday.
This is known as in any patient who experienced severe respiratory distress or pneumonia, the procedure is always performed. As reported previously, Tia allegedly died of bird flu. While the 15 chickens that died suddenly around the victim's house and her aunt, was examined Department of Animal Husbandry and Fisheries (Disnakkan) Bandung regency.
Chief Medical Officer (PHO) Bandung regency Ahmad asserted Kustijadi RSHS result of information, the cause of death of the victim is not bird flu," he said yesterday. Although begitun officers Disnakan Bandung District Health Office and also perform related steps anticipation of bird flu.
From the previous article:
The patient became ill on 28 September with intermittent complaints of body heat. "But the family just delivering drugs from the stall. Recent on Tuesday (2/10) brought Lia to the hospital and was subsequently referred to RSHS and while in the ER was vomiting and bloody bowel movements. Lia died the next day, Wednesday (3/10) at 15.00 pm, "he said.
10 October 2012 JAKARTA - The Hasan Sadikin Hospital (RSHS) Bandung ensure the death of the patient Tia Lestari, 8, Bojongsoang origin, Bandung regency is not due to bird flu. Tim Bird Flu Handling RSHS Dr Sri Sudhawati confirmed, the patient died due to pneumonia or severe lung disease. "The patient is not suffering from bird flu, he suffered from severe pneumonia. Because before he had contact with poultry that died suddenly," he said when met at RSHS, yesterday.
This is known as in any patient who experienced severe respiratory distress or pneumonia, the procedure is always performed. As reported previously, Tia allegedly died of bird flu. While the 15 chickens that died suddenly around the victim's house and her aunt, was examined Department of Animal Husbandry and Fisheries (Disnakkan) Bandung regency.
Chief Medical Officer (PHO) Bandung regency Ahmad asserted Kustijadi RSHS result of information, the cause of death of the victim is not bird flu," he said yesterday. Although begitun officers Disnakan Bandung District Health Office and also perform related steps anticipation of bird flu.
Indonesia: Bandung to conduct surveillance after Tia Lia (8) Death
October 9, 2012
Health Office (PHO) Bandung District will conduct disease surveillance for two weeks, in the District Bojongsoang, related to the finding of a chicken H5N1 virus, or bird flu.
Head of DHO Bandung, Kustijadi Achmad said it appealed to the public to immediately see if a fever or flu disease to the nearest health center.
"If there are people who had a fever around the District Bojongsoang, please see a health center. Later when a high fever that does not go away, will be referred to the hospital," he said when met at Soreang Tribune, Tuesday (10/09/2012).
He added, in addition to the medical officer at the health center, five officers on standby for surveillance of health office at any time to the field if there are reports of bird flu. The observation was carried out for two weeks, starting on Monday (10/08/2012).
Indonesia: Little Tia (8) That Died, Had Poultry with #H5N1
[Little Tia (8) from Tia Lia Lestari (8) of Kampung Ciganitri RT 04/04 Village District Cipagalo that enjoyed playing with the poultry at his Aunt's house, posted here, died of dengue hemorrhagic fever, as I posted here. As it ends up, those poultry were infected with the H5N1 Avian Influenza virus.]
CIPAGALO - DVO Bandung find the chickens tested positive for the virus H5NI in RW 04, Cipagalo Village, District Bojongsoang. Certainty of the existence of the bird flu virus after a quick test on chicken carcasses.
"Mother's pet chicken Oneng positive bird flu.'s Just the tail of the five, the one positive tail yesterday (Monday, Red) died suddenly," said Iman Rahman, officer Paramedics DVO Bandung, Tuesday (9/10 / 2012).
Therefore, Iman said it did not want to risk too much by directly spraying disinfectant into poultry cages citizens. Not just a chicken coop, a few corners of houses are often used where chickens were also sprayed.
The plan the agency will also conduct a mass depopulation of poultry in the region, yesterday. But the plan was canceled because officials and residents can not collect all the fowl in the village.
"Chicken pet citizens were outside the cage, scatter some where looking for food," said Faith.
Depopulation of chickens owned by residents, said Faith, it is important to prevent the spread of bird flus.
Because, in addition to found a single positive chickens infected, from the record it, says Iman, already there are 50 chicken residents who died in the last two weeks. Death of the chickens is not currently indicated as could spread bird flu in the region.
"We are still awaiting the results of lab tests, if convicted of the sample is positive, then the massive depopulation of poultry in these immediate causes lie within the indicated endemic," he said.
-snip-
Euis also confirmed a chicken that died suddenly in Cipagalo positive bird flu.
"Yeah, one positive chickens from bird flu rapid tests that we do. But still tested in the lab first. Region is not endemic bird flu, may not find another similar case afterwards. This is the first case this year. Earlier report of 14 District Bandung, all negative bird flu, "he said.
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