Vietnam: Complacency Spreading Bird Flu

 

# 2853

 

 

In 2004 and 2005, when Vietnam was known as the world's most bird flu affected nation, that nation began serious containment and eradication programs.

 

As a measure of their success, Vietnam went through all of 2006 and the first half of 2007 without reporting a single human case.  Even reports in poultry were rare.

 

It seemed, at least for a time, that through a combination of public education, disinfection of poultry farms, and a rigorous vaccination program that Vietnam had beaten back the virus. 

 

Unfortunately, in the past 18 months, bird flu has re-emerged in Vietnam, resulting in at least 16 human infections.

 

According to the Deputy Prime Minister, Nguyen Sinh Hung, public education about the dangers of the virus are either not filtering through to the public, or are simply disbelieved.

 

Worse, agencies whose job it is to vaccinate poultry appear to have inflated the number of birds inoculated in order to reap more profits.

 

The following are excerpts from a much longer article that appears in today's Thanh Nien News.    Follow the link to read it in its entirety.

 

 

 

 

Deputy PM lambasts lax bird flu control

 

 

 

 

 

 

 

 

A street vendor sells duck noodle on a Hanoi street last Friday.

 

Deputy Prime Minister Nguyen Sinh Hung rebuked authorities for failing to control and prevent bird flu this week as the virus and other animal diseases spread to several new localities.

 

Though local governments have improved disease control since bird flu first hit Vietnam in 2003, they have not focused on containing outbreaks, according to a statement Hung issued after chairing an online conference on bird flu prevention Thursday.

 

Hung said only half of the country’s inoculation target had been met.

 

The Health Ministry has said it is still storing some 100 million of the 250 million vaccine shots it imported last year.

 

At another meeting last week, the ministry’s Department of Animal Health said several veterinary agencies’ reports that some provinces had vaccinated 40- 60 percent of their poultry and cattle were inaccurate.

 

Some agencies had overstated the number of immunizations to collect vaccination fees from the government, the department said.

 

<snip>

 

Hung argued that bird flu awareness campaigns had yielded few positive results.

 

Health officials said citizens have yet to realize the seriousness of the problem and are not taking proper precautionary measures.

<snip>

 

Chicken and poultry products are still being sold in large quantities in many bird-flu-affected provinces despite local bans. Many sellers have said they did not care about the diseases and many don’t understand the virus is dangerous to humans.

 

(Continue . . .)

UK: Doctors May Work Outside Their Normal Practice In a Pandemic

 

# 2852

 

 

The UK, with most of their medical care delivered through the NHS (National Health Service), has an advantage over the United States when it comes to devising pandemic plans for doctors.  

 

They can promulgate rules and regulations, and just about everyone in the medical profession will receive, and have to abide by them. 

 

Here in the United States, most doctors are independent contractors who run their own businesses.  What little pandemic information they've received has come from professional journals.

 

In early January of this year, GP's in the UK were issued official pandemic guidance, and were told they must create individual pandemic plans for their surgeries (offices).

 

The UK pandemic plan for General Practitioners, emphasizes that during a pandemic, the public should not rush to their GP if they have the flu. 

 

GP's will not stock or dispense antivirals during a pandemic.  Access to antivirals will come from calling a National Pandemic Flu Line service.

 

Still, it is expected that the burden on doctors will be enormous during a pandemic.

 

 

Today, in anticipation that many doctors will be `out with the flu' during a pandemic, new guidelines have been issued that relax rules on doctors practicing outside of their specialties, and other `good medical practices'.

 

Non-working or retired doctors will be asked to return to service during a pandemic, and `Appraisal, performance review and attending educational events would be put on hold.'

 

 

This report from HealthCare Republic.

 

Doctors to work outside normal practice in flu pandemic

 

02-Mar-09

Doctors can work outside their normal field of practice during a flu pandemic, new GMC guidance states.

 

The pandemic guidance comes into force once the Chief Medical Officer announces a UK Level 3 alert, meaning there is a new virus outbreak after sustained human-to-human transmission.

In a pandemic the GMC ‘strongly encourages’ retired and non-working doctors to go back to work if asked. The council would have powers to rapidly re-register retired doctors.

 

During the pandemic, the right to work outside one’s normal field of practice would also apply to doctors treating patients with conditions other than flu, Pandemic Influenza: Good Medical Practice – Responsibilities of doctors in a national pandemic says.

Appraisal, performance review and attending educational events would be put on hold.

(Continue . ..)

 

 

The revised GMP (Good Medical Practices) document is available HERE as a 24 page pdf file.

Various Reports Out Of Indonesia

 

# 2851

 

 

While Depkes, the Indonesian Ministry of Health, remains largely silent on bird flu issues, local media continues to report about suspect human bird flu cases, and poultry die offs, with regularity.

 

The official stance of the Indonesian government is not to confirm human cases at the time that they occur, but rather to issue cumulative numbers every couple of months.  

 

For this reason, the `official count' issued by Indonesia- and reported by the World Health Organization- remains at 141 cases with 115 fatalities. 

 

No human cases have been officially announced in 2009. 

 

Poultry die offs and culling's have become so common in Indonesia that authorities ceased filing OIE reports in September of 2006.  

 

Over the weekend, several reports have emerged on `suspected cases' of human H5N1 infection.   

 

We get these reports due to the hard work and dedication of a small army of volunteer newshounds, who work on the various flu forums.  They use search tools looking for phrases (in Indonesia `Flu burung' is commonly used) of interest, and then translating articles into English.

 

So, on this Monday morning, a roundup of reports coming out of the Indonesian press over the weekend.

 

This first story was found, translated, and posted by Dutchy at FluTrackers,

 

Child eight years Died Suspect of Bird Flu,

Case might not be opened

On Monday, March 2 2009 |

Bekasi, on Sunday - A child age eight years that was stated suspect bird flu died, on Saturday (28/2) at dawn.

 

The child´s body was brought came home his parents in Kandang Hamlet of RT 01/05, Sukaraya Village, the Karangbahagia Subdistrict, the Bekasi Regency.
This child was named Andriansyah or Andri the fourth child from five related the couple Ilyas (42) -Mimin (38).

 

His doctor said the case (box, coffin, ed) might not be opened,” said one of the relatives of casualties, yesterday. The child the Class Ii SD Sukaraya 04, Karangbahagia, Bekasi was sick since last week.

 

 

This report is another retelling of a suspected case I blogged about on Saturday in Indonesia: Suspected Bird Flu Death In Bekasi.  The reference to the `case might not be opened' is the hospital's orders that the casket remain closed for the funeral - a common precaution when burying bird flu cases.

 

Today we learn that some of the medical team who treated Andri failed to wear protective gear, and are now being tested for possible exposure to the virus.   There is no word as to whether any of them have developed symptoms.

 

A Hat Tip to Sally on FluTrackers for this story.

 

Medical team is suspected of contracting Bird Flu Patients

Monday, March 02, 2009 | 14:14 WIB

TEMPO Interactive, Jakarta: suspek bird flu patients who died Saturday ago, allegedly leaving the inheritance. Most likely, Andry, suspected infected bird flu virus infect these three medical officers Annisa Hospital, Cikarang, Bekasi regency, West Java.

 

Currently, blood samples of three medical officers have been taken and examined by the laboratory Penanggulangan National Bird Flu. The three teams are the two medical doctors and the paramedics.

 

They treat smth Andry, eight years, the patient suspek bird flu, Friday (27 / 2) nights ago. Once referred to the Friendship Hospital, Jakarta Timur, Andry died the same morning the next day, Saturday at 07.00.

"The medical staff is in close contact with the alleged victim died," said dr Ruhdiat Rudi, Head of Disease Control and Environmental Health Office Penyehatan Kota Bekasi, told Tempo, Monday (2 / 3).

 

No official information about the medium of transmission of disease from the patient's medical team to the third. Initial allegations, they do not like wearing the mask, wear closed, and not done in isolation rooms.

 

 

The Jakarta Post this morning is reporting on another case, one that newshounds have been posting on since last night, involving a 6 year-old girl from Depok named Nurliga Mahmuda (NLM) who died on Saturday.

 

She was originally diagnosed with typhoid at a local hospital, but transferred to Persahabatan hospital when her condition deteriorated.

 

 

Depok girl dies from suspected bird flu

 

The Jakarta Post ,  Depok   |  Mon, 03/02/2009 6:36 PM  |  Jakarta

 

A 6-year-old girl from Depok with initials NLM died from a suspected case of bird flu at Persahabatan hospital, East Jakarta, on Saturday after having been admitted for treated one day earlier, tempointeraktif.com reports.

MS, the mother of the child, said on Monday that her daughter had died after suffering dizziness and fever, with body temperatures exceeding 40 C.

“My daughter had complained she was feeling dizzy last Wednesday, but it wasn’t until 2 days later that I took her to see a doctor,” MS said.

The doctor had diagnosed her daughter with Typhoid fever and had recommended taking her to Bhakti Yuda Hospital in Depok, West Java.

Subsequently, due to its limited facilities, Bhakti Yuda had then recommended NLM go to Persahabatan hospital for treatment.

“The doctor at Persahabatan hospital said my daughter had only a slim chance of surviving because the virus had already spread through her body,” she said. (ewd)

 

And finally, from South Sulawesi, another suspected case;  Nur Fadillah (7).  

 

A Hat tip to Commonground, of FluTrackers and Pandemic Information News for this report.

 

 

 

Child suspect Bird Flu
[google translation]
Monday, 02-03-2009

Maros, BKM - Animal Husbandry, Fisheries, and Marine Maros District 64 head back to destroy the property of residents in the poultry Tamarampung, Kelurahan Bontoa, Mandai District, last week. Destruction is carried out following a finding of a local citizen suspect (suspect) bird flu.

 

Officer team and the response fast tracking bird flu or Survelance and Participatory Disease Response (PDSR) DKP Maros, Isdarjid Madjid, BKM confirmed when the work space, last week, said his side had found Nur Fadillah (7), the patient suspect bird flu in area.

Yesterday''we get reports of people who suspect bird flu. Therefore, we have begun the destruction of poultry in Mandai District,''he said.

 

Information from Muan father Amin Nur Fadillah, some time ago there are dead birds belonging to neighbors of a sudden. After that, her son fell ill in a fever over 38 degrees centigrade. Feeling suspicious, immediately contact the Department of Health and Animal Husbandry.

 

 

None of these cases have been officially confirmed, and for now all must remain in the `suspect column'.

 

Egypt Reports 56th Human Bird Flu Case

 

# 2850

 

 

 

For the fifth time since the beginning of the year, Egypt is reporting another H5N1 bird flu infection, this time in a 2 year-old boy.

 

Unlike the previous cases this year, this child is reportedly in critical condition, and on a ventilator.

 

Of the 56 confirmed cases in Egypt, 23 have been fatal.

 

 

 

 

Two-year-old boy becomes Egypt's 56th bird flu case

Sun Mar 1, 2009 6:53pm GMT

 

CAIRO, March 1 (Reuters) - A two-year-old Egyptian boy has contracted the bird flu virus and is in critical condition, the state-run news agency quoted the Health Ministry as saying on Sunday, becoming the 56th case in the Arab country.

 

The Middle East News Agency (MENA) quoted Assistant Health Minister Nasr el-Sayyed as saying the boy, Youssef Abdel-Azim from the province of el-Fayoum in central Egypt, showed symptoms on Wednesday after coming into contact with dead birds.

 

He was administered the antiviral drug Tamiflu and remains in crticial condition on an artificial ventilator at a hospital in Cairo, Sayyed said, according to the agency.

 

Egypt is one of the only countries affected by bird flu that does not offer compensation for farmers when poultry is destroyed, which many experts say is the best way to ensure rapid detection of new outbreaks.

 

(Continue . . .)

Japan: Aichi Prefecture Strain Identified As H7N6

 

# 2849

 

 

When the story first broke, we were told that the bird flu outbreak on a quail farm near Toyohashi, Japan involved an H7 virus.  

 

Today, we learn that the virus is the H7N6 strain.

 

Influenza `A' viruses are categorized by their H (Hemagglutinin) and N (Neuraminidase) surface glycoproteins. 

 

Scientists have identified 16 different Hemagglutinin and 9 different Neuraminidase proteins. Theoretically, they could combine to produce 144 different flu strains.

 

In practice, there are currently only 3 strains of `human adapted' influenza `A' viruses in wide circulation; H1N1, H1N2, and H3N2.

 

In contrast, there are more than a dozen avian flu viruses commonly found in poultry and wild birds.  While we don't often hear about the more obscure, low pathogenic avian viruses, they are out there.

 

H7 viruses have been associated with human infection on rare occasion, most often producing only mild symptoms. 

 

This summary from the CDC.

 

 

Influenza A H7

Nine potential subtypes of H7 are known. H7 infection in humans is rare but can occur among persons who have direct contact with infected birds. Symptoms may include conjunctivitis and/or upper respiratory symptoms. H7 viruses have been associated with both LPAI (e.g., H7N2, H7N7) and HPAI (e.g., H7N3, H7N7), and have caused mild to severe and fatal illness in humans.

 

 

This report from AFP.

 

 

Japan quail farm bird flu 'not H5N1': govt

March 1st, 2009 

 

The Japanese agriculture ministry said Sunday an outbreak of bird flu at a quail farm was not H5N1, the form of the disease that can be deadly to humans.

 

Government scientists said the disease in central Japan was the less-virulent H7N6 strain.

 

Workers sanitised the farm in Aichi prefecture Sunday and prepared a large trench to bury most of the 320,000 birds there.

 

The ministry announced the outbreak Friday, adding that the virus was weak in its toxicity and had not killed any animals. It added that no humans had been infected.

 

In April and May last year several dead swans tested positive for the H5N1 strain of bird flu in Hokkaido, northern Japan.

A Novel Approach For A Novel Strain

 

 

# 2848

 

 

Thus far, the creation of H5N1 vaccines for humans has been complicated by the low immune response that test subjects have shown to the antigens produced. 

 

Practically all of the vaccines we've seen to date will require two shots, 30 days apart, to confer reasonable immunity. 

 

Now, scientists in Hong Kong have produced a new type of H5N1 vaccine, by piggybacking 5 proteins from a pair of H5N1 viruses onto the existing, and relatively easy to produce, smallpox vaccine. 

 

This vaccine is adjuvanted by the addition of immune stimulatory cytokine IL-15.

 

 

Despite the hopes for this approach, testing has only been done on mice at this point.  More animal testing (first on ferrets, then monkeys) will be required before human clinical trials can begin.

 

In other words, this vaccine, like so many others we have heard about in the past few months, is still years away.

 

This from Reuters.

 

 

 

Experts fight H5N1 bird flu using smallpox vaccine

 

01 Mar 2009 08:02:47 GMT

Source: Reuters

By Tan Ee Lyn

 

HONG KONG, March 1 (Reuters) - Scientists in Hong Kong and the United States have developed an experimental H5N1 bird flu vaccine for people by piggybacking it on the well-tested and highly successful smallpox vaccine.

 

Initial tests on mice showed the vaccine to be highly effective, they told a news conference in Hong Kong on Sunday.

 

"It produced a lot of (H5N1) antibodies and the speed of antibody response was far higher with this strategy than the Sanofi one," said Malik Peiris, a microbiologist and bird flu expert at the University of Hong Kong.

 

Peiris was referring to Sanofi-Aventis's <SASY.PA> H5N1 bird flu vaccine for humans, which has been approved for use in the United States.

 

In an article published in the current Journal of Immunology, the experts from Hong Kong and the U.S. National Institutes of Health described how they inserted five key components of the H5N1 virus into the smallpox vaccine.

 

"We put in many other proteins into that vaccine; we are using it like a carrier, if you like, a piggyback," Peiris said.

 

The vaccine uses a Vietnam strain of the H5N1 virus and appeared to be broadly protective. Mice which were inoculated with it successfully fought off an Indonesian strain of H5N1, according to the scientists.

 

(Continue . . . )