Recombinomics: Emergence of Vaccine and Tamiflu Resistant H1N1

Commentary

Emergence of Vaccine and Tamiflu Resistant H1N1
Recombinomics Commentary 23:15
February 18, 2009

Italian A/(H1N1) isolates show several amino-acid changes in HA (A189T, G185A, S141N), respect to vaccine strain.

The above comments from Italy's weekly influenza report , indicate that the vaccine and Tamiflu resistant H1N1 isolates (A/Parma/23/2009, A/Parma/24/2009, A/Parma/25/2009, A/Parma/26/2009) match recently released US sequences, A/Wisconsin17/2008 and A/Washington/8/2008. The HA sequence for both isolates have the same three changes (A193T, G189A, S145N using H3 numbering). Moreover, the two changes flanking the receptor binding domain, G189A and A193T are in A/Hawaii/19/2008, and A/Mbagathi/7586/2008, as well as the recently released A/Philippines/1159/2008. Moreover, phylogenetic analysis of the NA sequences predict these changes will also be in Japan isolates, Miyagi/35/08, Yamaguchi/26/08, Yamaguchi/27/08, Yamaguchi/28/08. Both Japan and South Korea have had explosions of H1N1 Tamiflu resistant cases, suggesting that the vaccine resistant H1N1 is widespread.

The A193T is in all public H1N1 Tamiflu resistant sequences in the United States and is now also in all public isolates in Spain, and the vast majority if not all isolates in Japan. Although A193T was also linked to the fixing of Adamantane resistance in H1N1 clade 2C as well as Tamiflu resistance in H1N1 clade 2B, it is not in the current vaccine for the northern hemisphere in 2008/2009, and is not vaccine for the southern hemisphere in 2009, nor the northern hemisphere in 2009/2010.
The absence of these important changes in seasonal flu vaccine targets remain a cause for concern.

In Italy, three of the first five H1N1 isolates were from patients who had taken this season's vaccine, suggesting the H1N1 was not only Tamiflu resistant, but also vaccine resistant. Similarly, a report from Taiwan cited vaccine resistance levels at 70% for H1N1, and Japan also reported lower titers for H1N1 isolates when compared to the Bisbane/59 isolate used to represent H1N1 in the current vaccine.

Similarly, both South Korea and Japan reported explosions of cases linked to H1N1 and recently released sequences in the United States have the same three acquisitions reported in Spain. Moreover, recent weekly reports from the CDC do not show a reduction in the levels of H1N1. The vast majority of influenza in the US is influenza A, and the vast majority of influenza A is H1N1, with Tamifu resistance levels approaching 100% (the few sensitive isolates appear to be clade 2C).
Thus, the current approach of using vaccines to chase viral evolution continues to be a cause for concern. The fixing of H274Y in H1N1 seasonal flu raises serious concerns about the potential use of Tamiflu in an H5N1 bird flu pandemic.

Media Links

Dr. Margaret Chan, Director-General of WHO - 124th Assembly

Wednesday, February 18, 2009



Issues surrounding pandemic preparedness took precedence at the 124th assembly (Jan 19-26th in Geneva) of the Executive Board of the World Health Organization. In a report to the assembly, Dr. Margaret Chan, Director-General of WHO, advised:

“Influenza pandemics are historically recurring events. We are wise to prepare….On World Health Day this year, we will be looking at ways to ensure that hospitals and health care facilities survive, structurally and functionally, in times of natural disasters and conflict. This is another part of preparedness.”


Countries were urged to cooperate with each other to solve health care and licensure issues surrounding a pending influenza pandemic. Vaccine-sharing/distribution was encouraged, and expanding the capacities of developing countries for vaccine-production was also addressed.

To see Dr. Margaret Chan’s full report, go to the World Health Organization.
Image Source: USA Today

Study calls for increased research in flu transmission to prepare for pandemic flu outbreak

Feb 18, 2009

Researchers at Rhode Island Hospital have completed a study to better understand the impact of infection control measures during a possible flu pandemic. Their study focused on the likelihood of the transmission of flu from individuals showing no symptoms (asymptomatic) or from individuals who are infected but have not yet exhibited symptoms. The researchers call on the scientific community to better understand the transmission of influenza in order to provide guidelines for effective pandemic flu planning. Their findings are published in the March-April 2009 edition of Public Health Reports.

The study, from Rhode Island Hospital’s department of epidemiology and infection control and the division of infectious diseases, notes that public health measures for controlling outbreaks involve isolation of symptomatic individuals and the quarantine of individuals with whom they have had contact. This intervention is dependent upon early identification of symptoms, and the success of the intervention can be limited by transmission that occurs prior to symptom onset and transmission from asymptomatic infection.

Senior author Leonard Mermel, DO, ScM, medical director of the department of epidemiology and infection control at Rhode Island Hospital, along with Eleni Patrozou, MD, performed a systematic review of literature on viral shedding and disease transmission. The review included animal studies, human studies, inoculation experiments, vaccine and antiviral drug efficacy studies, and observations during outbreaks.

Mermel says, “Our findings indicate that pre-symptomatic transmission of influenza has been inferred based on the presence of the virus in the upper respiratory tract rather than from the appropriate transmission experiments. This is troubling because our review of the literature does not support significant influenza transmission based on positive nasopharyngeal cultures in the absence of symptoms.”

Their findings also indicate that small-particle aerosols expelled from infected individuals may play a greater role in influenza transmission than previously recognized. The problem, however, is that it remains unclear as to how many of these droplets are generated by asymptomatic or pre-symptomatic individuals.

Mermel adds, “Asymptomatic individuals may shed influenza virus, but studies have not conclusively determined if these individuals effectively transmit influenza to others. Our review of the literature suggests that the role of asymptomatic or pre-symptomatic influenza-infected individuals in disease transmission may have been overestimated in recent articles that have served as the basis for national and international pandemic planning.”

He concludes, “Based on the historical record over the last century, we must be prepared for another pandemic. Our research tells us that a better understanding of transmission dynamics is essential if we are to develop effective influenza pandemic plans.”

###

Founded in 1863, Rhode Island Hospital in Providence, RI, is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, emergency medicine and trauma, neuroscience, orthopedics, pediatrics, radiation oncology and surgery. Rhode Island Hospital ranks among the country’s leading independent hospitals that receive funding from the National Institutes of Health (NIH), with NIH research awards of nearly $27 million annually and nearly $46 million in total. It is home to Hasbro Children’s Hospital, the state’s only facility dedicated to pediatric care. Rhode Island Hospital is a founding member of the Lifespan health system.

Contact: Nancy Cawley
ncawley@lifespan.org
Lifespan

Banda Aceh was stricken by bird flu

on Wednesday, 18 February 2009 13:21 WIB
Puluhan the chicken died suddenly Be on the alert
Banda Aceh - Banda Aceh was again stricken by bird flu after beforehand the same deadly illness the lustre last 2008, this time the illness was known after the death 45 chickens belonging to Ruli in the Merduati Region yesterday in followed with the death 6 chickens belonging to Nur Jannah, the Ruli neighbour in Lr Kemuning, Kecamatan Koetaraja, Pusat of the Banda Aceh City, the next day this morning. Drh Mustafa Kasie Peternakan Kota Banda Aceh in his statement to was on the alert, on Wednesday (18/2) described the death of the chicken in this Kemuning as positive Bird Flu, or avia influenza. The cause of bird flu was the A virus of type influenza that spread between the poultry. Said he this virus was afterwards found also could spread to the other species like the pig, the cat, the dog, the tiger, and humankind. "This just the first time happened in this year, but last year (2008) had the official found 14 points,said Mustafa that was accompanied by Razali SP, Head of Sector Peternakan Kehutanan and the Plantation Kota Banda Aceh. At this time Mustafa words of a team hunted serga bird flu that was named Parsipatory Disease Surverlance Respon (PDSR) destroyed the chicken that died as well as the living chicken belonging to Ruli and Nurjannah, the amount around 35 tails. The A virus of type influenza had several sub-types that were marked by the Hemagglutinin existence (H) and Neuramidase (N). There were 9 H variants and 14 variants of N. Virus bird flu that was contagious at this time was the sub-type H5N1 that had incubation time for 3-5 days. Wild birds and the domestication poultry (the livestock) could become the source of the disseminator H5N1. In South-East Asia most cases of bird flu happened to the transport route or poultry livestock breeding instead of the migration route of wild birds. This virus could spread through air or contact through food, the drink, and the touch. Nevertheless, this virus will die in the high temperature. Because of that meat, the egg, and the animal must be cooked fully to avoid the spread. The cleanliness himself must be also taken care of by washing the hands with the antiseptic. The cleanliness of the body and clothes must be also maintained. The virus could survive in the cold temperature. The foodstuff that was cooled down or frozen could keep the virus. The hands must be washed before and after cooking or touched the raw foodstuff. The poultry better be not maintained in the house or the room of the residence. Livestock breeding must be kept away from housing to reduce the risk of the spread. Not always if tertular the virus will cause was sick. Nevertheless, this could endanger in afterwards the day because of the virus always bermutasi so as to have the potential for the pathogen at one time. Therefore, if being found by the animal or birds that died suddenly the authority side will make the assumption of the existence of bird flu. To prevent the spread, the other animal around the area that berkasus bird flu must be destroyed. The sign of the public who could happen was feverish high, the respiratory complaint and (possibly) the stomach. Replikasi the virus could in the body go fast so as the patient must immediately get medical attention. The medical handling and giving of medicine was carried out by the authorised medical official. The normal medicine was given was penurun hot and anti the virus. Between antivirus that could be used was the kind that hindered replikasi from neuramidase (neuramidase inhibitor), including Oseltamivir (Tamiflu) and Zanamivir. Each one of the antivirus this had the side-effect and must be given in specific time so as to be needed by the doctor's opinion. The flu illness brung the first time attacking Banda Aceh on September 25 2005, at that time thousands of tails of the chicken were destroyed in the Lamdom village, Kecamatan Longbata Kota Banda Aceh.

Banda Aceh was stricken by bird flu

of Hundreds Of poultries died Suddenly Governor's Regulation Banten Barren
on Thursday, February 19 2009 01:12 WIB Serang, Kompas -

Hundreds Of poultries belonging to the resident in three subdistricts in the Serang City, Banten, died suddenly. Moreover, after dripping several samples of the carcass were concluded, some poultries died because of being infected by the bird flu virus. The death of the poultry suddenly that one of them happened in the Kemanisan Village, Kecamatan Curug, Kota Serang, Banten. On Wednesday afternoon (18/2), a chicken belonging to Habudin, the resident of the Waru Kidul Village, died suddenly. Moreover, the other resident named Imron has lost 12 chickens in the period less than one week. ”Terakhir this morning died one, the number that died already 12 ekor,” he said. The same condition was experienced by several other residents in the Waru Kidul Village. From the data that was assembled by the Service of Pertanian Kota Serang it was known, already 120 chickens belonging to the resident in the village died suddenly. Results of the test that was carried out by the official of the Control of Bird Flu in the Service of Pertanian Serang it was known, the chicken belonging to the resident died suddenly because of being infected by bird flu. ”Hari on last Monday we the test of one of the samples of the chicken carcass. Positive results so as to be able to be concluded, the death of the poultry was in this village caused by the flu virus burung,” said Danang Turniatmadji from the team of the control of Service bird flu of Pertanian Kota Serang. The bird flu virus was also found to the chicken that died suddenly in the Sukajaya Village, Curug. At least 24 chickens belonging to the resident of the Gowok Masjid Village it was reported died suddenly because terjangkit bird flu. The poultry belonging to Munir, the resident of the Pasir Huni Village, Desa Pancalaksana, of Curug, also died suddenly. However, he did not know the cause of the death because of not yet having the inspection. ”Bulan then three chickens that died, two yesterday were one. Suddenly fell and died, enggak knew because of him. But indeed his beak went out busa,” the words of the building worker. Apart from the Curug Subdistrict, the death of the poultry suddenly also happened in the Kalodran Village and Kepuren, Kecamatan Walantaka. At least 140 chickens belonging to the resident there died because of being suspected of being affected by bird flu. ”Kami said suspect because of not having the poultry carcass that could we tes,” said Danang. So also dozens of ducks belonging to villagers Trumbu and the Luhur Paddy-field, Kecamatan Kasemen. However, the official still could not carry out the test because of the duck keburu was sold to the market. Pergub barren In fact, Banten Queen Atut Chosiyah Governor has passed Governor's Regulation (Pergub) the Control of Bird Flu. However, Pergub Nomor 1 2007 that was barren because still often was violated by the resident. Was based on observation, still many residents who left the chicken wandering around the house. In fact, pergub arranged, the chicken must be maintained in the pen. Moreover, still many chickens that were carried by using the basket were open although in fact was banned pergub. Now to deal with spread him the bird flu virus, the Service of Pertanian Serang has given the liquid disinfektan to the resident. Moreover, they also carried out counselling concerning the control method at the same time the handling of the affected poultry bird flu. Therefore, was hoped the bird flu virus will not spread to humankind.

Officials say animal vaccination figures a sham

February 18, 2009 12:43:21 Vietnam (GMT+07)

Some veterinarians have over-reported the number of livestock and poultry they have vaccinated, casting doubt on official immunization figures, an animal health official said Tuesday. The figure veterinary agencies in some provinces had reported - that 40- 60 percent of poultry and cattle had already been vaccinated – was not accurate, Hoang Van Nam, the Deputy Head of the Department of Animal Health under the Ministry of Agriculture and Rural Development told reporters on the sideline of a meeting on preventing animal diseases in Hanoi Tuesday that was organized by the ministry. Nam said some veterinarians over stated the number of immunizations to claim vaccination fees. According to Bui Quang Anh, head of the ministry’s Bureau of Animal Health, in 2008 the ministry imported 250 million vaccine shots to distribute to provinces but 100 million of them are still left in storage. Anh said most provinces still have very low percentages of cattle and poultry vaccinated against diseases. In central Ha Tinh Province, 60 percent of cattle have been reported to be vaccinated against foot-and-mouth disease, and 30 percent of pigs vaccinated against cholera. In Thanh Hoa, the number of vaccinated cattle is estimated at around 50 percent. According to Anh, at least 80 percent of flocks of poultry and cattle need to be vaccinated to effectively prevent diseases. Many locals don’t understand the importance of vaccinating the animals, he said. Problems related to animal diseases are more complex in the northern region than in southern Mekong Delta because of weather conditions and the practice of keeping free-range cattle. To prevent the spread of animal diseases, local relevant agencies should intensify vaccinations, raise public awareness, isolate and eliminate outbreaks of the diseases, and encourage people to keep their livestock fenced, Nam said. Since early this year, bird flu has hit 31 communes of 16 districts in the nine provinces of Thanh Hoa, Thai Nguyen, Ca Mau, Soc Trang, Nghe An, Hau Giang, Quang Ninh, Bac Ninh and Quang Tri, affecting over 30,000 fowl, including about 11,500 chickens and 21,000 ducks, according to the department. In Bac Lieu, bird flu has infected 600 ducks, its Department of Animal Health said Tuesday. On Sunday, the province’s Phuoc Long District Bureau of Animal Health destroyed all 600 ducks owned by Tran Sa Na in Vinh Loc Village, Vinh Phu Dong Commune, the provincial department’s Director Lam Chi Thong said. The department collected samples which later tested positive for the A H5N1 bird flu virus, Thong said. As the avian influenza virus has already spread in the neighboring provinces of Ca Mau, Soc Trang and Hau Giang, Bac Lieu Province will take urgent measures against the epidemic, he said. Meanwhile, foot-and-mouth disease has hit 1,027 cattle in 38 communes of 11 districts in the five provinces of Long An, Kon Tum, Hoa Binh, Son La, Quang Binh and Quang Nam.

Hold a view diametrically opposite pandemic minutes!

Wednesday, 18/02/2009, 16:23

TPO - Between the HPAI are Bùng the back and spread to many provinces across the country, is now in Hanoi capital and the trade of poultry slaughter still occur as detached hề not have.

Slaughter live poultry market in Ha Vy.
Trade, slaughter poultry in Hanoi:

"Deaf not fear guns"

A furnace operation in mobile market Me Tri Ha

.
Not her own Chi, many people in Ha Vy is indifferent meat poultry without using any forms of protection time. "At first I also have to wear the page pluck chickens, ducks but later found it too cumbersome to wear no more. How is death, four years pluck lease with the "virus in singing" What I go to the first, "she professional poultry rent in Ha Vy confirmed.

Market in the Ha Vy (Thuong Tin), which provides the largest poultry to Hanoi and neighboring provinces, the business still live poultry place vibrant though H5N1 pandemic are at risk of Bùng.

Quarantine: 100 baby seal ... only 1 child

Chi Chi, a transport of poultry from sale of Ha Vy Ha Dong market in stolid "Dịch not about to Ha Vy. If you have flu, before we die!".

It is so complete, Lan - a small trade fair in Nghia Tan - candid answer with: "The years we eat, drink, sleep with influenza have star".

According to surveys by journalists first, the amount of household goods business in the market Cuc, temporary markets in Hanoi are taken from Dong Anh, Soc Son district of Ha Tay and especially old from Bac Ninh - where are have HPAI recurrence. They transport live poultry in a cage with a bit loaded with pineapple motorbike to Hanoi.

The trade and slaughter of poultry at markets Cuc, temporary market or foreign markets to be released almost up. Here, the manager "only to check in early am or pm" - in a market in Lo Duc Cuc said. But also in the market, for opening, Hoang Mai market, ... status of the poultry business in sales and goods through quarantine not still happen. At the market, most of the shops selling poultry are not marked on the quarantine of poultry.

Tons of chicken products sold in the center business the southern most are not marked quarantine.
No sign of disease, even your car is only 100 a seal is quarantined as allowed. This situation is common place in the Dong Mai night market. "Just a quarantine and a certificate for the car, but the seal is an how Xue, Lan - a business for influenza.

In the center business the south (of Mai night market), every day has to be tons of chicken meat for sale and most are not marked quarantine. When customers need to ask chickens "dấu quarantine", a sales application was: "In no country can join the chicken is. I sell only the delicious chicken, chicken East England, Bac Ninh "please" here, not every ship land, rest assured that every purchase. "

Hoang Mai market in time, has at least 5 people carrying poultry meat from Ha Vy available on sale with cheap unexpected: 30 thousand VND / kg for chicken industry, sugarcane chicken is 35-40 thousand VND / kg, meat 35-40 thousand VND / kg.

Next to a selling frozen chickens is not marked on the price kì very "comfortable": chicken industry 30 thousand dong / kg, 40 thousand chickens of sugarcane / kg. She offered to sell chickens, "Everyday I did not sell here, need to do first quarantine. Not succulent chicken every day after to find me. Many people have to put my chicken on tableful.

The type of chicken this cheap, he Toan (Ha Vy market), said: "sugarcane chickens, chicken meat industry or thousand sold cheap to be injected more serious need for water, the meat and molt in NAT. Poultry price is the only Major, dead chickens. Normal-thousand meat or chicken to touch just tacky plastic and cost is much higher. "

Avian influenza spread rapidly in Bac Lieu, Ca Mau

19/02/2009 0:20 19/02/2009 0:20

Phong To bring poultry destroys village in Vinh Loc, Vinh Phu Dong commune, H. Phuoc Long -

18.2 pm, Bac Lieu People's Committee meeting on emergency prevention, control HPAI is tends to spread rapidly in the province.

. According to intelligence Lam, Department Director Department Veterinary Bac Lieu province, to the 18.2 days, the 3,185 birds of 14 households in 4 village, 2 communes of Phuoc Long district, including Vinh Loc, Phuoc 3 A, Tan America (Vinh Phu Dong commune) and village Long Duc (Phuoc Long town) infected, dead and destroyed. Catheter warning, the avian influenza outbreaks in the forecast is to continue to spread rapidly to many other localities, the disease control very difficult by the wide area, not chit rivers.

Bac Lieu, the province has more than 900,000 children of poultry, including ducks run of 44,000 and nearly 100,000 new breeding birds are not vaccinated to thoroughly ... Bê Hoang Pham, Vice President permanent Bac Lieu People's Committee guided the local industry functions implemented several emergency measures to control disease spread; enhanced vaccination, insecticide spraying all communes where outbreaks occur, including for. And established the core team working on the 24/24 hours online to closely control the transport, sale and breeding of ducks running import province. Tuyere proposal should immediately destroys the infected flocks of ducks do not need to have test results.

Tại In Ca Mau province, HPAI events also very complicated.

18.2 days, Pham Van Song, Head of Agriculture and Rural Development U Minh district, said, flocks of ducks of 21 xiem Mr. Ngo Thanh Hai, khom 1, U Minh town died before, to positive results with the influenza virus A H5N1. Recently, Ca Mau City more ducks out of her 710 Lu Thi sure, Hamlet 4, An Xuyen commune positive for influenza virus A H5N1. As of 18.2, Ca Mau province, HPAI outbreaks have occurred in 7 communes and towns with 4,400 children of 25 poultry raising households infected must destroyed.

Vietnam: One More Province

Thứ Tư, 18/02/2009, 11:25
Disease of cattle and poultry at risk of Bùng

(ANTD) - Department of Animal Health said, beginning in 2009 to present, HPAI was found in 31 communes belonging to 16 districts in 10 provinces across the country: Thanh Hoa, Thai Nguyen, Ca Mau, Soc Trang, Nghe An, Hau Giang, Quang Ninh, Bac Ninh, Quang Tri and Bac Lieu to total poultry died and forced to close all 33,000 children.

Yesterday 17-2, HPAI has been detected in ducks out about 30 days age of 1 farms in Vinh Loc Village, Vinh Phu Dong commune, Phuoc Long district, Bac Lieu, the death of 30 children 607 out the duck. To control the disease are increasingly complex, MARD has immediate meetings with "hot" with the local Northern bàn measures resolved.

Mr Bui Quang Anh - Department of Animal Health Department Director commented: "In addition to causes such as control of the liquid to climb, not planned livestock development, there is another important reason is that other provinces do not perform vaccination seriously. "

In 2008, MARD have about 250 million doses of avian influenza vaccine for distribution to other provinces, but the report of new local run out about 50%, left more than 100 million doses are still ... store inventory. With events such as today, Department of Animal Health warning, risk occurs in a batch of large areas nationwide, especially in two areas the Red River Delta and the Mekong Delta is very high.

In addition, a LMLM are also headache for authorities. Less than 2 months, LMLM outbreaks occurred in 38 communes in 11 districts, of 5 provinces: Long An, Kon Tum, Hoa Binh, Son La and Quang Binh as 1,027 buffaloes, cows infected. It is said that 3 / 5 provinces is due to project poverty, livestock development cause. According to Bui Quang Anh, the MARD has completed from instructions for the same project, will be issued in next time.

According to the draft circulars, in the process of project implementation, organizations related to conduct in accordance with the law on the same program, animal quarantine, suggest additional components for animal of livestock development, providing the same. Handling of violations to terminate status as distribute spreading disease as the last time.

Patients infected with H5N1 in Quang Ninh critical

23:02 '17/02/2009 (GMT +7)

17 / 2, from General Hospital in Quang Ninh Province for, although the health, the doctor's Hospital in Quang Ninh Province and the Institute for infectious diseases and tropical countries of dedicated treatment, but health of patients does Mui Ly The evolution trend of bad.

- After more than half a month of treatment at General Hospital in Quang Ninh Province, the health of patients Mui Tai Ly, 23 years old, An Quang commune, Dam Ha district more critical.

Bệnh nhân Lý Tài Múi đang được chăm sóc tại Bệnh viện Đa khoa Quảng Ninh. Ảnh: Báo QN

Patients Ly Mui Medical care is in General Hospital in Quang Ninh. Photo: Newspapers QN

At patients with heart failure level, and carry out heart film as congestion of the transmission system leading heart; men liver failure, kidney failure ... At this time, patients are being filtered blood continuously running artificial kidney.

This is a patient infected with influenza A/H5N1 first in 2009, transferred to treatment at General Hospital in Quang Ninh Province on 3 / 2 states in high fever, blood pressure dropped, respiratory failure severity.

In Quang Ninh, 17 / 2, continue to detect HPAI in chickens out of 13 households 1 in Ha Khanh ward, Ha Long city. Dịch has 5 children sick and 4 children died. Animal Health Department has conducted the destruction of the birds above.

Currently, there are 8 provinces including Ca Mau, Soc Trang, Nghe An, Hau Giang, Quang Ninh, Quang Tri, Bac Ninh and Bac Lieu have HPAI not last 21 days.

Monkey Business from the CDC

Too bad the CDC cannot take the time to inform travellers or anyone else, of the current H5N1 situation in China, SE Asia or Egypt. They love to talk about Yellow Fever though. 8 Cases of Bird Flu in China and too many to mention in Indonesia, not to mention fresh cases in Vietnam and Egypt, would lead one to think, a small mention would be considered for travellers from the USA.

AnnouncementYellow Fever in South America and the Caribbean—Evolving Situation

This information is current as of today, February 18, 2009 at 18:05

Updated: February 17, 2009

Since the end of 2007, reports of yellow fever among both humans and monkeys in parts of South America have been increasing. In Brazil, Argentina, and Paraguay, risk areas for yellow fever expanded during 2008. As seen through recent reports of yellow fever among humans and monkeys in southern Brazil and northern Argentina, the spread of yellow fever virus appears to be continuing in 2009. Other countries in the region have recently reported an increase in yellow fever activity, including cases among monkeys in Venezuela and on the island of Trinidad in the twin island republic of Trinidad and Tobago. It is important that travelers and clinicians are aware that the yellow fever risk in South America is evolving, and as the risk areas change, current locations where yellow fever vaccine is recommended may also change.

As the situation unfolds, specific travel notices can be found on the CDC Travelers’ Health Travel Notices web page. Current notices include:

• In the News: Trinidad and Tobago (February 17, 2009)
• In the News: Updated Yellow Fever Vaccination Recommendations for Brazil (January 9, 2009)

You can also check the recommendations for the country you are visiting at the by-country listing of yellow fever vaccine recommendations and requirements.

Additional Information

For more information about the emerging yellow fever situation in South America and the Caribbean, see the following resources.

Pan American Health Organization (PAHO) Updates:

• Yellow Fever Situation in the Americas (February 10, 2009) PDF version
• Update: Situation of Yellow Fever in the Americas (January 30, 2009)
• Epidemiological Alert: Increase in Circulation of Jungle Yellow Fever Virus in the Americas (January 27, 2009)

• Page last updated: February 17, 2009

ProMED: AVIAN INFLUENZA, HUMAN (37): VIET NAM, WHO

[Vietnam has not reported any outbreaks in Ninh Binh. OIE does not have any reports of outbreaks in Ninh Binh. I wonder where he was exposed? OIE link is here: http://www.oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm]

Archive Number
20090218.0671
Published Date
18-FEB-2009
Subject
PRO/AH/EDR> Avian influenza, human (37): Viet Nam, WHO
AVIAN INFLUENZA, HUMAN (37): VIET NAM, WHO
******************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Wed 18 Feb 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) disease
outbreak news [edited]



Avian influenza situation in Viet Nam - WHO update 2
----------------------------------------------------
The Ministry of Health in Viet Nam has reported a new confirmed case
of human infection with the H5N1 avian influenza virus. The case has
been confirmed at the National Institute of Hygiene and Epidemiology (NIHE).

The case is a 32-year old man from Kim Son district, Ninh Binh
province. He developed symptoms on 5 Feb 2009 and was hospitalized on
13 Feb 2009. He is currently in a serious condition. The case is
known to have had recent contact with sick poultry prior to the onset
of his illness.

Further investigations are currently underway. Control measures have
been implemented and close contacts are being identified and monitored.

Of the 109 cases confirmed to date in Viet Nam, 52 have been fatal.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

FLU, NOT MENINGITIS, KILLED GIRL

February 18, 2009
Posted: 1:33 am
February 18, 2009

A 10-year-old Long Island girl whose mysterious death sparked a meningitis scare at her elementary school actually died from the flu, health officials said yesterday.

The fifth-grader at Northside Elementary in Levittown, not identified by officials, died early Saturday morning at a local hospital after falling sick just a few hours earlier.

"It happened so quickly," the girl's grieving mother Theresa Barbaro said on Monday. "There was no explanation."

The school sent out an e-mail alert the next day to parents and posted a message on its Web site suggesting that the girl may have died from viral meningitis.

But the Nassau County Department of Health said yesterday that the "presumptive cause of death in the 10-year-old Levittown student" was "influenza A," the more serious form of the disease.

Barbaro blasted her daughter's school for setting off a meningitis scare before her child's cause of death was determined.

WHO: Recommended composition of influenza virus vaccines for use in the 2009-2010 northern hemisphere influenza season

It is recommended that vaccines for use in the 2009-2010 influenza season (northern hemisphere winter) contain the following:

— an A/Brisbane/59/2007 (H1N1)-like virus;^*
— an A/Brisbane/10/2007 (H3N2)-like virus;^**
— a B/Brisbane/60/2008-like virus.^#

^* A/Brisbane/59/2007 is a current vaccine virus; A/South Dakota/6/2007 (an A/Brisbane/59/2007-like virus) is a current vaccine virus used in live attenuated vaccines.
^** A/Brisbane/10/2007 and A/Uruguay/716/2007 (an A/Brisbane/10/2007-like virus) are current vaccine viruses.
^# B/Brisbane/33/2008 is a B/Brisbane/60/2008-like virus.

For more information

Recommended composition of influenza virus vaccines for use in the 2009-2010 influenza season [pdf 44kb]

South Korea bird flu outbreak killed more than 20,000 buried only free-range chicken

New Tang Dynasty TV www.ntdtv.com 2009-2-18 19:37


【New Tang Dynasty February 18, 2009讯】 (Central News Agency, Seoul, JIANG Yuan-zhen Mar on the 18th), South Jeolla Province in South Korea Suncheon, Goseong, three Boseong to keeping free-range chicken farms, one after another outbreak of low pathogenic H5 avian flu, epidemic prevention authorities immediately culled and buried more than 22,000 free-range chicken only. To prevent the spread of the epidemic has entered a state of emergency.

South Korea, "Joint Press News Agency," reported today that the South Korean Ministry of Agriculture, Forestry and Fisheries Food and is located in southwestern Korea Jeollanam-do (Province) revealed that the National Veterinary Research and Quarantine Service for the Abelian Shuntian, solid three Toki City, and Po and other cities The three chicken farms in the samples examined, confirmed are low pathogenic H5 avian influenza.

Ministry of Agriculture, Forestry and Fisheries of food sources said that the confirmation of avian influenza antibodies in individuals infected with avian flu, is a fight against the avian flu virus and the formation of an immune body, not because the bird flu virus into the chicken in vivo and lead to their死亡.


Reported that so far, although they are free-range chicken farms did not appear dead, but their excretion was detected in a low pathogenic avian influenza antibodies. In order to prevent the spread of the epidemic on the three farms more than 22,000 free-range chicken for only culled and buried.

In December last year, South Jeolla Province to the migratory birds rest - Hampyeong County Dadong droppings of migratory birds in the pond, were found to have low pathogenic avian influenza virus; in November last year in Hampyeong, and Po Naju city market to sell the ducks droppings found a low pathogenic avian influenza virus antibodies; in October last year in the Tung Wah Group of the Great Wall gun face, Hampyeong-gun Dorasan Crescent side of face and duck rearing farms, also occurred in the low pathogenic avian influenza.

South Jeolla Province said over the past Administration of low-pathogenic avian flu has not taken measures culled and buried, but in order to prevent the spread of the epidemic, this year decided to kill and bury.

新唐人电视台http://www.ntdtv.com/xtr/gb/2009/02/18/a259019.html
New Tang Dynasty TV http://www.ntdtv.com/xtr/gb/2009/02/18/a259019.html

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hat-tip Muscade

INFURU entered a period of two infected birds in Hong Kong stage =

(09/02/18 07:42)




Teru's Tiyou Hiroshi chief of the Hong Kong Bird Watching, collected from a large crow butterfly mint嶼山collected in large cay and Hitoshi Azuma, in common with the occult and garbage and dead birds found in埔heron, Aoi Because of avian influenza in Hong Kong has already entered a period of two and the stage of infection (large AD)

AD [Japan] Hong Kong University on February 18 this year, dead birds were collected from the coast and the west gate and嶼山屯H5N1 was detected in a large series of bird-flu virus. Feb. 15, police said Mamoru Osamu more natural to fish farming, Hitoshi Azuma cay's 12 confirmed detection of the virus in dead butterflies were collected in peppermint. Birds, bird flu expert from Hong Kong are The second phase and has entered a stage of infection, the Chinese authorities and the prosecution of the negligent supervision, a strong possibility that the hidden information of the infected birds INFURU he said.

Teru's Tiyou Hiroshi chief of the Hong Kong Bird Watching, collected from a large crow butterfly mint嶼山collected in large cay and Hitoshi Azuma, in common with the occult and garbage and dead birds found in埔heron, Aoi Because of avian influenza in Hong Kong has already shown that the two means that the stage into the stage of infection.

* Infection from poultry to wild birds

Mr. Zhang, the infection status of the time, "ie, after finding the carcasses of poultry infected with bird INFURU along the coast, from the outbreak of the infection in birds, H5N1 is the virus from infected poultry to wild birds it is clear that. "

Currently, in Hong Kong and found a total of 40 carcasses of poultry birds, 12 birds in the H5N1 virus was detected in bird-INFURU. Mr. Zhang, from these cases, it is INFURU birds can also be transmitted through the channel, said Chinese authorities could not find the problem that caused a great deal of investigation. Mr. Zhang said, "These dead and washed away to be dumped into the sea and islands. This possibility, we will pay attention in the last year, prosecutors from the failure to specifically monitor the coast, caused problems it, "he said.

* Chinese authorities bird INFURU or concealed information

Mr. Zhang is in China, already this year eight cases have occurred in full-infected bird. However, despite the outbreak of bird flu in poultry was. Thus, the government was neglecting the test questions呈SHITA cover up the circumstances that forced INFURU birds. In addition, "for people in China, died of illness in poultry should not be eating, and whether or how to handle television, has not introduced any. Meanwhile, in Hong Kong is strictly for people's attention the call. continent should learn from Hong Kong. "

* Infected birds found in densely populated, high-risk

Mr. Chang, as an example屍骸heron found in埔Aoi, a little before, the heron is possible when eating infected food at the coast and the continent can not be ruled out. In addition, some cases of infected birds were discovered recently, and found that in densely-populated city, and the high risk of large residential area.

Mr. Zhang is also the risk of bird watching in Hashi Yone埔no data were presented with an infected person to a full-bird to bird watching. Experts will have to contact the local birds and bird feces directly shown to be relatively safe.

(Siqin forest reporter, editor靜over translation)

Bird flu hits 9 Vietnam's provinces

[Up to 9. Still do not see the Province that the confirmed case came from....Ninh Binh]

HANOI, Feb. 18 (Xinhua) -- Bird flu is plaguing in nine provinces in Vietnam with a newly-reported coastal province Khanh Hoa was also found the virus, according to Department of Animal Health under Ministry of Agriculture and Rural Development on Wednesday.

In Khanh Hoa province of south central Vietnam, bird flu has killed 27 fowls raised at a local farm, said the department, Vietnam watchdog of bird flu.

Samples of dead ducks found in the province tested positive to the H5N1 virus, said the department.

So far this year, nine provinces of Vietnam nationwide have been hit by avian flu, including four provinces in Mekong Delta, namely Ca Mau, Soc Trang, Hau Giang and Bac Lieu, two northern provinces of Bac Ninh and Quang Ninh, two central provinces of Nghe An and Quang Tri, and the newly-confirmed southern Khanh Hoa, said the department.

Sleman: Bird Flu Outbreak Threatens DIY

Previously reported here: http://pandemicinformationnews.blogspot.com/2009/02/indo-bird-flu-struck-sleman.html

[google translated]
Wednesday, 18 Feb 2009

JOGJA - Pergantian rainy season to the summer or during this period that the increase in the number of flu outbreaks in birds DIY. The air temperature does not menentunya lead to the emergence of the virus Avian influenza (AI) that attack poultry.

"Climate change in the period from January to April will affect the health because of environmental birds play a role in the growth of bird flu virus," said Chairman of the Bird Flu Penanggulangan RSUP dr dr Sardjito Sumardi SpPD (KP) to the journalist in the local hospital, Tuesday (17 / 2).

Mewabahnya back this disease, according to Sumardi can be seen from the cases of dozens of dead chickens in Sleman expressed positive ternjangkit AI virus some time ago. The owner of a dead chicken that even needs to be checked to RSUP dr Sardjito.
Although in the end fell ill expressed negative bird flu, but they were experiencing signs of bird flu fell ill, such as fever, flu and nyerti swallow and was stated suspect bird flu. "But after the test in the laboratory and hospital Sardjito Jakarta to finally expressed their negative bird flu and can go home," he explained.

Therefore Sumardi DIY community can hope to maintain the health environment. For the AI vaccine is currently used for effective new treat bird flu disease in poultry.
While in humans, the vaccine is still in experimental stage. So that the vaccine is not yet known whether it can effectively dimafaatkan to treat human flu virus that infected birds. "Yes indeed, if for poultry, the vaccine is effective for granted but can not be manusi," augment him. (Ptu)

3 questionable statements for you..

There sure are a lot of stories telling us dont worry, yet they seem very contradictory..some even seem to be outright lies..






China bird flu not pandemic, but be prepared: UN
Beijing, February 18, 2009
A recent string of bird flu infections in humans in China posed no pandemic risk as the cases were unrelated, but authorities need to remain alert, UN experts said on Wednesday.

1."The strain we see now is not a pandemic threat," Hans Troedsson, the World Health Organisation's (WHO) representative in China, told journalists.

Troedsson spoke at a press conference in the wake of eight human cases of infection with the deadly H5N1 strain of bird flu reported in China so far this year. Five of those infected died from the disease.

Though the number of cases was up from three in China for all of 2008, Troedsson said the numbers remained too low for great concern, especially as they came during winter months when the virus temporarily gains strength.

2."The eight cases do not really represent anything.... What it only says is that we have a number of cases occurring during a period when we could expect that there should be cases," he said.

With the latest deaths, 25 of the 38 people infected with the H5N1 virus in China since the disease re-emerged in 2003 have succumbed to the illness, adding to fears of an eventual pandemic.

A pandemic, or a global outbreak of a fatal disease, usually occurs every 25-30 years, Troedsson said.

"What is important is that governments make preparedness plans," he said.

Troedsson also noted that human-to-human transmission, which would signal the virus had mutated to a form easily
transmissible between people, had yet to be seen.

According to the WHO, there have been 407 cases of human bird flu and 254 deaths in 15 countries since the strain re-emerged in 2003, with most occurring in Vietnam and Indonesia.

3. All recorded human infections of avian influenza are believed to have been directly transmitted from either diseased or dead birds, he said.

Still, much remains to be learned about the virus and governments should remain vigilant, said Vincent Martin, an avian flu expert with the UN Food and Agricultural Organisation.

"The virus is entrenched .. you cannot deny that there is infection," Martin said at the same briefing.

"What we are lacking today is a complete and full understanding of the epidemiology of the disease."