FAO: Flashback: US increases funding to combat influenza and emerging disease threats

	US increases funding to combat influenza and emerging disease threats
	Continued partnership will strengthen countries' preparedness, surveillance and response

October 2012
Excerpt:

Funding will also go to regional coordination to combat avian influenza and to support surveillance and prevention in Cambodia, Lao PDR, Nepal and Myanmar, which are threatened by the disease's continuing persistence in neighbouring countries. 

These countries continue to have sporadic outbreaks, indicating the H5N1 virus continues to circulate in poultry and remains a threat to poultry production, human health and the livelihoods of millions of vulnerable farmers who depend on poultry raising for their basic food needs and a means of making a living.

"The US Government has been key in generating international support to combat avian influenza and to reduce the chances for a human pandemic by assisting FAO and others to address the threat in animals before it spills over into humans. Such support for basic prevention measures is rare, yet most sensible and cost effective," said FAO Chief Veterinary Officer Juan Lubroth.

Emerging pandemic threats

Thanks in large part to the USAID-FAO partnership, since avian influenza grew to proportions of a global crisis between 2004 and 2006, the scientific community has gained a deeper understanding of what drives disease emergence and thus the measures to take to prevent disease. 

Due to the speed with which animal-origin pathogens such as H5N1, severe acute respiratory syndrome (SARS) in 2002-2003 and the H1N1 influenza pandemic in 2009, caused by a virus that had combined elements of avian, swine and human origin, USAID launched its "Emerging Pandemic Threats (EPT) programme.

Through EPT's "Identify" component, support is funnelled to countries to strengthen the capacities of national and regional laboratory networks to diagnose and characterize different types of influenza virus threats. 

This continues to be especially important in Southeast Asia, where new virus strains continue to emerge, which can eventually develop into a direct threat for human health and perpetuate poultry losses. In addition, as viruses adapt, poultry vaccines against H5N1 can lose their effectiveness, leaving domestic poultry vulnerable to disease.

http://www.fao.org/news/story/en/item/163271/icode/

FAO: World risks new bird flu surge if countries drop their guard

29 January 2013, Rome - The world risks a repeat of the disastrous 2006 bird flu outbreaks unless surveillance and control of this and other dangerous animal diseases is strengthened globally, FAO warns.

"The continuing international economic downturn means less money is available for prevention of H5N1 bird flu and other threats of animal origin.  This is not only true for international organizations but also countries themselves," says FAO Chief Veterinary Officer Juan Lubroth.  "Even though everyone knows that prevention is better than cure, I am worried because in the current climate governments are unable to keep up their guard."

Continued strict vigilance is required, however, given that large reservoirs of the H5N1 virus still exist in some countries in Asia and the Middle East, in which the disease has become endemic. Without adequate controls, it could easily spread globally as it did at its peak in 2006, when  63 countries were affected. 

Investing makes sense

Investing more in prevention makes economic sense given the huge toll inflicted by a full-scale pandemic. Between 2003 and 2011 the disease killed or forced the culling of more than 400 million domestic chickens and ducks and caused an estimated $20 billion of economic damage.

Like several animal diseases, H5N1 can also be transmitted to humans. Between 2003 and 2011, it infected over 500 people and killed more than 300, according to the World Health Organization.  

"I see inaction in the face of very real threats to the health of animals and people," Lubroth says.

This is all the more regrettable as it has been shown that appropriate measures can completely eliminate H5N1 from the poultry sector and thus protect human health and welfare. Domestic poultry are now virus-free in most of the 63 countries infected in 2006, including Turkey, Hong Kong, Thailand and Nigeria. And, after many years of hard work and international financial commitment, substantial headway is finally being made against bird flu in Indonesia.

Growing threat

Another growing threat is Peste des Petits Ruminants, or PPR, a highly contagious disease that can decimate flocks of sheep and goats. "It is currently expanding in sub-Saharan Africa - causing havoc in the Democratic Republic of Congo among other countries - and is just starting to spill over into southern Africa," Lubroth says. "The damage could well be huge".

"The irony is that a perfectly good vaccine exists for PPR, but few people are using it," he adds.  Along with tight finances, lack of political will, and poor planning and coordination are other reasons why PPR and other animal diseases are often allowed to spread.

Investing in prevention means improving hygiene practices, market and border controls, and health security in farms and markets. It includes equipping laboratories and training staff to diagnose and respond to disease outbreaks, and in organizing efficient extension services to serve farmers' needs.

Despite tight budgets, international organizations should also try to do more through concerted action. "We need to come together to find ways to ensure the safety of the global food chain," Lubroth urges. 

"The costs - and the dangers - of not acting are just too high."  
  
http://www.fao.org/news/story/en/item/168885/icode/

Cambodia: Poultry From Same Lot Likely Infected; Increased Trading for Chinese New Year

1/29/13
Excerpt:

The three infections in two weeks compares starkly with 2012, when just three people were diagnosed with avian influenza in the entire year, down from eight cases in 2011. All three cases in 2012 led to the death of the patient.

The WHO, the Ministry of Health and animal health experts from the Ministry of Agriculture are currently trying to find a link between the three latest cases, said the WHO’s Sonny Krishnan.

It was likely that the avian influenza originated from the same group of poultry, but spread over three provinces due to increased trading in chickens before the forthcoming Chinese New Year on February 8, Mr. Krishnan said.

“What happens is that people get poultry from surrounding villages and if they can’t sell it, it’s transferred somewhere else,” he said.

“So Chinese New Year is a probable reason why the cases are so spread out.”

Cambodia: #H5N1 Avian Influenza Human Cases List

As you can see from this map, Kampot Province is directly below Kampong Speu.  The 9 yo is from Kampot.

Kampong Speu​

Date 1/27/13

Name:  35(M)
From:  Trapeang Sla village, Preah Nipean commune,  Kong Pisey district, Kampong Speu
Onset:  1/13
Adm:  Treated by private practioner
Adm:  1/21
Hospital:  Khmer-Soviet Friendship Hosp. Phnom Penh, sym's fever, dyspnea
DOD:   1/21
Notes:  Prepared sick chicken for food prior to being sick.
Confirmation:  1/23/13 - Positive

Takeo

Date:  1/27/13

Name:  15(F)
From:  Snao village, Prey Kabass district, Takeo Province
Onset:  1/11/13
Adm:  Treated by private practioner.
Hospital:  Kantha Bopha
Adm:  1/17/13 sym's fever & shortness of breath.
DOD:  1/21/13
Notes:  Previous dead poultry in village.  Prepared sick chicken for food prior to being sick.
Confirmed:  1/22/13 - Positive

Name:  5 yo female
From:  Angk Krasang Village, Prey Lvea commune, Prey Kabass district, Takeo Province.
Onset:  1/25
Adm:  local private practitioner
Adm:  1/31 with fever, cough & dyspnoea
Hospital:  Kantha Bopha Hospital
Confirmed:  Positive, diagnosed on 2/7
DOD:  2/7
Notes:  recent deaths of poultry in village. 

Phnom Penh

Date:  1/27/13

Name:  8 month male
From:  Chrey Korng Village, Sangkat Chorm Chao, Khan Por Sen Chey, Phnom Penh
Onset:  1/8/13Hospital:  National Pediatric Hosp.
Adm:  1/9 sym's fever, cough, runny nose, vomiting.
Notes:  Samples sent on 1/11.  History of contact with poultry.
DOD:  survived and recovered
Confirmed:  1/22/13 - positive

Kampong Speu

Date 1/28/13
Name:  17 month girl
From:  Kong Pisei district, Prey Nhat commune, Kampong Speu
Onset:  1/13, fever, runny nose, vomiting
Adm:  private practitioner
Adm:  1/17 fever, cough, somnolence & dyspnoea 
Hospital: Kantha Bopha Phnom PenhNotes:  Recent poultry death in village.  Contact with poultry.
DOD:  1/28
Confirmed:  Positive 1/26

Kampot Province

Date 1/29/13

Name:  9 yo girl
From:  Thmei village, Thmei commune, Toeuk Chhou district, Kampot Province
Onset:  1/19, fever, cough
Adm:  Initially treated by a private practitioner
Adm:  1/27
Hospital:  Kantha Bopha with fever, cough, somnolence and dyspnoea
DOD:  1/28
Notes:   Poultry dead around village.
Confirmed:  Positive - 1/28

Cambodia: Two New Bird Flu Deaths

1/29/13

PHNOM PENH: Two Cambodian girls have died from bird flu, health authorities said Tuesday, raising the toll from the deadly infection in the kingdom to four so far this year.

The victims, a 17-month-old girl and a nine-year-old girl, from the southern provinces of Kampot and Kampong Speu, died Monday in hospital, the World Health Organization said in a joint statement with the Cambodian health ministry.

Tests on the girls, whose villages had recorded recent deaths among poultry, confirmed they had contracted the H5N1 strain of avian influenza, the statement added.

Last week Cambodia said two people -- a 15-year-old girl and a 35-year-old man, had died from the H5N1 strain contracted while preparing infected chicken.

Continued  here

Cambodia: MOH Update - Fourth & Fifth New Human Cases of Avian Influenza H5N1

1/29/13
Today we received another Press Release from the Ministry of Health of Cambodia and the World Health Organization.  Two more cases have been confirmed positive for H5N1 virus.

The fourth case, I have already posted on.  A 17-month girl, from Prey Nheat village, Prey Nheat Commune, Kong Pisey district in Kampong Speu Province.
Onset:  1/13, fever, cough, runny nose, vomiting
Adm:  Initially treated by a private practitioner
Adm:  1/17
Hospital:  Kantha Bopha with fever, cough, somnolence & dyspnoea
DOD:  1/28
Notes:  Poultry dead around village, contact with sick poultry
Confirmed:  Positive - 1/26

The fifth case:
Name:  9 yo girl
From:  Thmei village, Thmei commune, Toeuk Chhou district, Kampot Province
Onset:  1/19, fever, cough
Adm:  Initially treated by a private practitioner
Adm:  1/27
Hospital:  Kantha Bopha with fever, cough, somnolence and dyspnoea
DOD:  1/28
Notes:   Poultry dead around village.
Confirmed:  Positive - 1/28

For the full Press Release click  here

Cambodia: Update on 4th Human Case #H5N1

[The 35yo male that died, was also from Kong Pisei district.  He was from Preah Nipean commune.]

Excerpts:
An official on the Ministry of Health’s human influenza hotline and a commune chief said yesterday a two-year-old girl from Kampong Speu was diagnosed with H5N1 on Saturday after being admitted to Kantha Bopha hospital in Phnom Penh, where a 15-year-old girl died of the virus last Monday.

Due to less-rigorous monitoring of the disease in other hospitals, the cases seen in Kantha Bopha hospital were likely just the “tip of the iceberg”, said Dr Philippe Buchy, head of the virology unit at the Institut Pasteur du Cambodge, the medical research centre that tested the recent cases. 

Local health officials had buried the burned birds outside the village, sprayed the village and distributed medicine to eradicate the virus, he said.

Officials in Kong Pisei district’s Prey Nhat commune, in Kampong Speu province, the home of the two-year-old confirmed on Saturday to be the fourth case of the year, were pushing similar measures, according to commune chief Chan Sun.

Sun said a lot of poultry in the commune tended to get sick during the dry season, and officials had told villagers not to cook or touch sick or dead birds.  

“They have to burn and bury the dead poultry,” he said. “We have also prohibited poultry buyers who usually come into the commune from buying chickens in the commune for a while until we are sure everything is safe.”

More than 40 chickens at the infected toddler’s house had fallen sick and died, and, as with the other three cases this month, health officials suspect contact with poultry had caused her to become ill.

“Health officials went to the girl’s and her neighbours’ houses this morning to spray and distribute medicines, and they tested some poultry,” Sun said. 

Cambodia: 4 Human Cases #H5N1 In One Month

PHNOM PENH — Two Cambodians have already died from bird flu in 2013, making a worrying start to the year.

Now a two-year-old Cambodian girl is in a serious condition in Phnom Penh after being hospitalized with the H5N1 virus, also known as avian, or bird, flu.

Sonny Inbaraj Krishnan, the communications officer for the World Health Organization in Phnom Penh, says the development has health professionals concerned.

“This is the fourth case this month of human influenza H5N1," Krishnan said. "Last year we had three cases, so within one month in the new year we've got four cases, and we're quite concerned about that.”
-snip-
Over the weekend officials culled and burned more than 4,000 chickens and ducks in the village that was home to the 15-year-old victim.  
-snip-
“Well our specific worry is that this H5N1 virus could undergo what we call a recombination and then re-assortment with another influenza virus," he explained, "and that could give rise to a new virus that is transmittable between humans - so that’s our main concern.”

Cambodia is a predominantly agricultural nation, and every village has its chickens and ducks. Health ministry staff are monitoring those who came into contact with the patients who were infected, and teams from the agriculture ministry are testing poultry in the affected villages and destroying sick birds.

http://www.voanews.com/content/new-bird-flu-case-raises-fears-in-cambodia/1592100.html 
 

Cambodia Ministry of Health Statement on 1/25/13

 This is a Press release dated 1/25/13. 

Joint Press Release Between The Ministry of Health Kingdom of Cambodia and the World Health Organization (WHO).

The Statement goes on to say the first case was an 8 month old from Chrey Korng Village, Sangkat Chorm Chao, Khan Por Sen Chey, Phnom Penh.  He developed symptoms on 1/8, was brought to the hospital on 1/9, samples were sent on 1/11, with results on 1/22. 

The 2nd case, a 15 year old female was from Snao Village, Snao Commune, Prey Kabass district in Takeo Province.  She becameill on 1/11, was initially treated by a private practitioner, and admitted to hospital on the 1th.  She died on the 21st.

The 3rd case was a 35 year old man from Trapeang Sla village, Preah Nipean commune, Kong Pisey district, Kampong Speu province.  He has his first symptoms on 1/13, was hospitalized on 1/21.  Being treated by a private practitioner beforehand.  He died shortly after the samples were taken, which was on 1/21/13.

There is a campaign underway to educate the public on avian influenza.  They are also checking close contacts, any epidemiological linkage among the three cases.

The whole statement can be found here.

Cambodia: 4th #H5N1 Confirmed Human Death

Photo: Mary Kozlovski/IRIN

Preparing poultry at Phnom Penh's Orussey market

PHNOM PENH, 28 January 2013 (IRIN) - Health authorities in Cambodia will bolster public awareness campaigns on H5N1 avian influenza after four people became infected in January, resulting in two fatalities.

“Ongoing public awareness campaigns need to be reinforced through TV and radio,” Sok Touch, director of Cambodia’s Communicable Disease Control Department (CDC), told IRIN on 28 January, calling on people to be vigilant. “We’re planning on doing this immediately as there is no room for complacency.”

The four cases of H5N1 avian influenza, commonly known as bird flu, are the first confirmed in Cambodia this year. There were three recorded cases (all fatal) in 2012.

Since 2005, 24 people have been infected resulting in 21 deaths, according to WHO, with over half of the infections in children under 14.

According to a joint statement from the Ministry of Health and World Health Organization (WHO) on 25 January, an eight-month-old boy from the capital Phnom Penh recovered after being infected with bird flu, while a 15-year-old girl from southwestern Takeo Province and a 35-year-old man from southwestern Kampong Speu Province died after contracting the virus.

The CDC said the boy had contact with chickens at a market, but the girl from Takeo and the man from Kampong Speu both fell ill after cooking dead chickens gathered from their villages.

A fourth case, also in Kampong Speu, was confirmed by the Ministry of Health on 27 January, when a 17-month-old girl tested positive for H5N1.
“We are working closely with the Ministry of Health to enhance surveillance of H5N1,” said Sonny Krishnan, communications officer with WHO in Phnom Penh, adding that WHO did not know yet if there was a link between the cases of the girl and 35-year-old man.

“We just did a map of the two communes and they’re not far from each other, so there could be an indication of a movement of poultry," Krishnan said.

Philippe Buchy, head of virology at the Pasteur Institute in Phnom Penh, said the best way to avoid further infections was to contain infected poultry, which is complicated in Cambodia.

“The country is large, there is not the surveillance required; a lot of resources [that are needed]... are not available to monitor clearly the poultry deaths everywhere, especially in a country where most of the production is backyard,” he said.

An earlier report by the UN Food and Agriculture Organization (FAO) indicated that chickens are kept by 90-95 percent of rural households, providing an important source of protein and livelihoods for millions.

According to WHO, since 2003, there have been 613 laboratory confirmed cases of H5N1 with 362 related deaths worldwide.

mk/ds/cb

Egypt: "Agricultural production" Shura demanding Ptfl veterinary supervision on poultry farms & cattle

Arabic Translation:
1/28/13

Committee called the Shura Council's agricultural production, to activate the implementation of Ministerial Decree No. 58 of 1982 on the conditions for the establishment of farms raising cattle and poultry, to ensure full veterinary supervision on these farms and to ensure early warning before any crisis of epidemic proportions. 

This came during a committee meeting today under the chairmanship of Mr. sad, to discuss a proposal submitted by the desire MP Dr. Yasser Hammoud on veterinary supervision on the farm. 

MP in the proposal need to ensure the safety of bio-farms and healthy food access safe for the citizens. 
He noted that the government had halted work this decision when he was Dr. Youssef Wali, minister of agriculture in 1985, which led to the spread of the plague among cattle, while veterinary supervision limit. 

He explained that when the bird flu appeared in 2006 caused the lack of veterinary supervision and quarantine enough in the presence of 300 epicenter of the disease, which is causing losses estimated in the billions on Egypt's economy. 

For his part, Dr. Osama Salim chief of veterinary services, the importance of increasing awareness of the importance of veterinary supervision under the reform of the system of veterinary in the entire farm. 

In turn, noted Dr. Khalid Mansour, head of the Livestock Development, Ministry of Agriculture, it does not have to download more of its energy farms Belzamh veterinary supervision costs.

Notes from the Field: Emergence of New Norovirus Strain GII.4 Sydney — United States, 2012

[You can find Informational links on the Norovirus along the right side-bar of the blog]

January 25, 2013 / 62(03);55-55


Noroviruses are the leading cause of epidemic gastroenteritis, including foodborne outbreaks, in the United States (1). Hospitalization and mortality associated with norovirus infection occur most frequently among elderly persons, young children, and immunocompromised patients. Noroviruses belong to the family Caliciviridae and can be grouped into five genogroups (GI through GV), which are further divided into at least 34 genotypes. Human disease primarily is caused by GI and GII noroviruses, with most outbreaks caused by GII.4 strains (1). During the past decade, new GII.4 strains have emerged every 2–3 years, replacing previously predominant GII.4 strains. Emergence of these new norovirus strains has often, but not always, led to increased outbreak activity. For example, the previously dominant GII.4 New Orleans strain was not associated with increased norovirus outbreak activity in the United States (2). CDC collects information on norovirus strains associated with outbreaks in the United States through an electronic laboratory surveillance network called CaliciNet (3). This report documents the recent emergence of a new GII.4 strain, GII.4 Sydney, which caused most (53%) of the norovirus outbreaks reported through CaliciNet during September–December 2012. Continued surveillance will enable further assessment of the public health implications and significance of this new strain.
In March 2012, a new GII.4 norovirus strain was identified in Australia. Named GII.4 Sydney, this emergent strain has since caused acute gastroenteritis outbreaks in multiple countries (4). In the United Kingdom, an early onset of the 2012 winter norovirus season was reported in association with emergence of GII.4 Sydney as the dominant strain implicated in outbreaks.* In the United States, GII.4 Sydney has spread rapidly nationwide, causing an increasing number of outbreaks. During September–December 2012, a total of 141 (53%) of the 266 norovirus outbreaks reported to CaliciNet were caused by GII.4 Sydney. The other outbreaks were caused by 10 different GI and GII genotypes, including GII.4 New Orleans. A statistically significant increase in the proportion of outbreaks caused by GII.4 Sydney was noted: four (19%) of 21 outbreaks in September 2012; 22 (46%) of 48 in October 2012; 70 (58%) of 120 in November 2012; and 45 (58%) of 77 in December 2012† (chi-square test for trend; p<0.01). Most (72 [51%]) of these GII.4 Sydney outbreaks resulted from direct person-to-person transmission; 29 (20%) were foodborne, one (1%) was waterborne, and the transmission mode was unknown in 39 (28%) of the outbreaks. Long-term–care facilities and restaurants were the most frequently reported settings, accounting for 91 (65%) and 18 (13%) of the GII.4 Sydney outbreaks, respectively. During the three previous winters, the peak in reported norovirus outbreaks occurred in January; therefore, at present, it is too early to make an assessment of the relative magnitude of the current season.
GII.4 noroviruses remain the predominant cause of norovirus outbreaks, and the GII.4 Sydney strain appears to have replaced the previously predominant strain, GII.4 New Orleans. Compared with other norovirus genotypes, GII.4 noroviruses have been associated with increased rates of hospitalizations and deaths during outbreaks (5). Health-care providers and public health practitioners should remain vigilant to the potential for increased norovirus activity in the ongoing season related to the emergent GII.4 Sydney strain. Continued surveillance for norovirus outbreaks through CaliciNet and additional data on clinical and epidemiologic features of outbreaks collected through the National Outbreak Reporting System (NORS)§ will enable further assessment of the public health implications of the new GII.4 Sydney strain, including any association with increased severity or level of activity in the ongoing 2012–13 winter norovirus season. Proper hand hygiene, environmental disinfection, and isolation of ill persons remain the mainstays of norovirus prevention and control (1).

Reported by

Leslie Barclay, Mary Wikswo, MPH, Nicole Gregoricus, MSPH, Jan Vinjé, PhD, Ben Lopman, PhD, Umesh Parashar, MBBS, Aron Hall, DVM, Div of Viral Diseases, National Center for Immunization and Respiratory Diseases; Eyal Leshem, MD, EIS officer, CDC. Corresponding contributor: Eyal Leshem, eleshem@cdc.gov, 404-639-7251.

References

1. CDC. Updated norovirus outbreak management and disease prevention guidelines. MMWR 2011;60(No. RR-3).
2. Yen C, Wikswo ME, Lopman BA, Vinje J, Parashar UD, Hall AJ. Impact of an emergent norovirus variant in 2009 on norovirus outbreak activity in the United States. Clin Infect Dis 2011;53:568–71.
3. Vega E, Barclay L, Gregoricus N, Williams K, Lee D, Vinje J. Novel surveillance network for norovirus gastroenteritis outbreaks, United States. Emerg Infect Dis 2011;17:1389–95.
4. van Beek J, Ambert-Balay K, Botteldoorn N, et al. Indications for worldwide increased norovirus activity associated with emergence of a new variant of genotype II.4, late 2012. Euro Surveill 2013;18(1).
5. Desai R, Hembree CD, Handel A, et al. Severe outcomes are associated with genogroup 2 genotype 4 norovirus outbreaks: a systematic literature review. Clin Infect Dis 2012;55:189–93.

* Additional information available at http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2013PressReleases/130109Norovirusnewstrain.

† Data for 2012 are incomplete.

§ Additional information available at http://www.cdc.gov/nors. 

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6203a4.htm