Wednesday, December 21, 2011

Promoting Pandemic Preparedness In Resource Poor Nations

 


# 6027

 

 

With the release yesterday of the 2011 TFAH  report (see TFAH: 2011 Ready or Not Report) we are reminded of just how complex the problems are in protecting a nation during a natural disaster, pandemic, or bioterrorism attack.

 

Although total preparedness for a severe pandemic eludes even the richest of countries, there are many places in the world where pandemic preparedness barely exists at all.

 

In many regions antivirals, vaccines, antibiotics and professional medical care are scarce or unavailable altogether, and even the lack of soap and clean water can complicate the most basic of advice given during a pandemic; to wash your hands.

 

History has shown that resource poor nations are apt to suffer greater losses during a pandemic, although a lack of good record keeping has obscured the full impact.

 

While the overall fatality rate during the 1918 pandemic in the United States was estimated to be about 2.5% (and less than 1% in some northern European countries), in places like India and Asia some anecdotal reporting suggests as many as 10% of those infected died.

 

Agencies like the World Health Organization, USAID, and NGO’s like CARE and Save The Children are engaged in a daily battle against disease and poverty around the world. The already have to contend with the death and suffering caused by poverty, cholera, malaria, TB, HIV, and scores of other diseases. 

 

Adding a pandemic into this mix, even a `mild’ one, would undoubtedly stretch their resources even thinner  - and despite their best efforts – could potentially claim hundreds of thousands of lives around the world.

 


This reality has inspired agencies and NGOs to create initiatives like the H2P project – a three-year effort which ran from October 2007 through September 2010 - geared towards promoting community & district-level pandemic flu preparedness and response in developing countries.

 

That project came through the hard work of a number of NGO’s and partner organizations, including USAID, IFRC, CORE Group (including American Red Cross, CARE, & Save the Children), AED, InterAction, & several UN agencies, including WHO, WFP, & UN OCHA:

 

 

Recently, Rudolph von Bernuth, Director of Programmes at Save the Children International, addressed a UN/USAID conference in Rome where he warned of the dangers and challenges of inadequate pandemic preparedness in resource-poor populations.

 

You can read his entire speech at this link on Save the Children’s Avian & Pandemic Flu Updates & Guidelines webpage, but I’ve excerpted a small portion below:

 

 

We believe that it is important to look at preparedness from the perspective of the resource-poor districts and communities in which we work around the world, and ask:

 

What kind of actions is it realistic to hope that these communities and districts should be able take in response to a severe wave of pandemic flu?

 

What kind of support will these communities and districts need to take these actions?

 

Are developing country governments and organizations around the world prepared today to provide this kind of support?

 

We believe, that in a severe pandemic scenario, when all countries around the world, and all organizations responding to the pandemic, are themselves struck or preparing to be struck, that it is not realistic to hope that most resource-poor communities will receive substantial quantities of additional supplies like vaccine, anti-virals, or antibiotics.

 

 

In the face of these likely deficits in pharmacological supplies and assistance from outside sources, Save the Children is advocating:

 

. . .  the most important guidance includes that on non-pharmaceutical interventions (NPIs) to reduce flu transmission at household and community levels, along with guidance on home-based care of the ill.

 

Basic, but potentially lifesaving, interventions. 

 

Promoting pandemic preparedness in many resource poor nations has not been easy, or entirely successful, as internal resistance and donor constraints have limited what they can do.

 

But the threat of a severe pandemic has not diminished, and when one comes - ready or not – the world will have to deal with it.

 

And in many places around the world, much of that burden will be shouldered by NGOs.

 

 

As this is the time of year when many people give thought to making gifts or donations to worthy causes, I hope you’ll indulge my mentioning that agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, and others are working around the world to combat poverty and disease, and are on the front lines every day.

They could use your support.

These NGO’s do a great deal with very little, and even small donations can help make a difference.   You can find their websites and blogs in my sidebar.

TFAH: 2011 Ready or Not Report

 


image

 

# 6026

 

 

TFAH, or the Trust For America’s Health, is a non-profit organization that audits and reports on public health issues in the United States. 

 

Yesterday, in the middle of an unusually busy health news cycle, they released their annual report on the readiness of the United States to deal with disease, disasters, and bioterrorism.

 

This year’s big concern is that the gains of the past few years in preparedness may be eroded due to budgetary constraints.

 

First an excerpt from the press release, then a link to the study and the conference call, followed by a link to a report by Lisa Schnirring at CIDRAP news.

 

Press Release

For Immediate Release: December 20, 2011

Report Finds Preparedness for Bioterror and Health Emergencies Eroding in States Across the Country

Cuts to Key Programs Could Hurt Ability to Detect and Respond to Crises

Washington, DC, December 20, 2011 -The Trust for America's Health (TFAH) and Robert Wood Johnson Foundation (RWJF) released the ninth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism today, which finds key programs that detect and respond to bioterrorism, new disease outbreaks and natural or accidental disasters are at risk due to federal and state budget cuts.

Some key programs at risk due to continued cuts to federal public health emergency preparedness funds include:

  • 51 of the 72 cities in the Cities Readiness Initiative are at risk for elimination; the Initiative supports the ability to rapidly distribute and administer vaccines and medications during emergencies;
  • All 10 state labs with "Level 1" chemical testing status are at risk for losing top level capabilities, which could leave the U.S. Centers for Disease Control and Prevention (CDC) with the only public health lab in the country with full ability to test for chemical terrorism and accidents;
  • 24 states are at risk for losing the support of Career Epidemiology Field Officers - CDC experts who supplement state and local gaps to rapidly prevent and respond to outbreaks and disasters, such as during the H1N1 flu pandemic and responding to the health impact of the Gulf Oil Spill in 2010; and
  • The ability for CDC to mount a comprehensive response to nuclear, radiologic and chemical threats as well as natural disasters is at risk due to potential cuts to the National Center for Environmental Health. All 50 states and Washington, D.C. would lose the support CDC provides during these emergencies.

"We're seeing a decade's worth of progress eroding in front of our eyes," said Jeff Levi, PhD, Executive Director of TFAH.  "Preparedness had been on an upward trajectory, but now some of the most elementary capabilities - including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas - are experiencing cuts in every state across the country."

(Continue . . .)

Download the full report

Download a recording of the News Conference Call

 

 

And for good measure, Lisa at CIDRAP filed this report last night. Follow the link to read it in its entirety.

 

Preparedness report card spells out programs at risk for cuts

Lisa Schnirring * Staff Writer

Dec 20, 2011 (CIDRAP News) – Public health programs that detect and respond to bioterror events and disease outbreaks are at risk from federal and state budget cuts, a threat that could worsen over the next year if automatic across-the-board cuts kick in, according to an annual preparedness report card released today.

The big-picture preparedness view and warning come from Trust for America's Health (TFAH), a nonprofit health advocacy group, and the Robert Wood Johnson Foundation.

(Continue . . . )

Hong Kong: CHP Enhances Human Surveillance For H5N1

 

image

Photo Credit – FAO

 

# 6025

 

There is probably no place on earth that responds to the bird flu threat as promptly and as solidly as does Hong Kong. They have a long history with the virus, starting in 1997 with the first 18 human cases (six of which were fatal), and took extraordinary measures at that time to halt the outbreak.

 

Hong Kong also bore the brunt of the SARS outbreak in 2003, seeing more than 1,700 cases (with nearly 300 fatalities).

 

As one of the most densely populated places on earth (population 7 million +), Hong Kong authorities are mindful of how quickly an infectious disease could spread.

 

Accordingly, they have built an enviable surveillance and response system.

 

The recent discovery of a dead chicken positive for the H5N1 virus at a Wholesale Poultry Market has led to a major cull of poultry and the raising of avian flu alert level to `serious’.

 

There are no reports of human infection from the H5N1 virus, but authorities are stepping up surveillance just the same. The following statement from the Centre for Health Protection helps to illustrate just how seriously they view the threat of avian influenza.

 

 

21 December 2011

CHP enhances surveillance on human influenza A(H5N1) infection 

The Centre for Health Protection (CHP) of the Department of Health (DH) has enhanced its surveillance on human influenza A (H5N1) infection after the Government has raised the response level for avian influenza from "Alert" to "Serious" as a chicken carcass sample taken from the Cheung Sha Wan Temporary Wholesale Poultry Market (Wholesale Poultry Market) was tested positive of the highly pathogenic H5N1 avian influenza virus.

 

A telephone hotline 2125 1111 has been set up to answer public enquiries today from 9am to 6pm.

 

CHP is carrying out medical surveillance of poultry wholesalers and workers in  in the Wholesale Poultry Market as well as local chicken farmers to follow up on their health condition.

 

At the moment, there is no human case of avian influenza infection in Hong Kong. DH and the Hospital Authority (HA) have enhanced the work on testing of human infection of avian influenza.  Particular attention will be paid to those who visited or worked in the Cheung Sha Wan Wholesale Market.

 

A spokesman for the CHP has called on members of the public to seek medical treatment immediately if they develop symptoms of high fever or influenza-like illness. Public and private hospitals as well as clinics should report to CHP immediately when there is any suspected case of avian influenza.

 

The CHP has written to all medical practitioners alerting them of the latest development and has liaised closely with HA to step up surveillance. The department has also sent letters to institutions, elderly homes and schools to remind them to be vigilant against avian influenza.

 

The spokesman reminded the public to remain vigilant against avian influenza infection and to observe the following measures:


*Avoid direct contact with poultry and birds or their droppings; if contact is made, wash hands thoroughly with soap and water;
*Cook poultry and eggs thoroughly before eating;
*Wash hands frequently;
*Cover nose and mouth while sneezing or coughing, hold the spit with tissue and put it into a covered dustbin;
*Avoid crowded places and contact with sick people with fever;
*Wear a mask when you have respiratory symptoms or need to take care of patients with fever;
*When you have fever and influenza-like illnesses during a trip or when coming back to Hong Kong, consult doctors promptly and reveal your travel history.

For further information on avian influenza, please visit the CHP website: www.chp.gov.hk.

 

Ends/Wednesday, December 21, 2011

WHO e-Atlas Of Natural Disaster Risks To Europe

 

 

# 6024

 

 

Natural disasters can strike anywhere, and just about anytime, but there are some times and places when the likelihood of disaster is greater than others.

 

To help nations, communities, and individuals to prepare, the World Health Organization’s  Regional Office for Europe (WHO/Europe) has released an online-only, interactive e-Atlas of disaster risks for Europe.

 

 

Focusing on five major natural disaster threats (seismic activity, floods, landslides, heat-waves and winds), this e-Atlas maps the relative risks of their occurrence across 32 countries of the European Region.

 

The WHO e-atlas of disaster risk for the European Region. Volume 1. Exposure to natural hazards. Version 2.0

Available in:

English (HTML)

2011
ISBN 978 92 890 0243 1
This publication is only available online.

This e-atlas models the distribution of five natural hazards – seismic activity, floods, landslides, heat-waves and winds – and populations’ exposure to them in 32 countries of the European Region. It provides the baseline data and maps needed to assess where the potential for damage may be the greatest and to underpin the call for more resources to improve emergency preparedness, reduce the health risks to vulnerable populations and aid the emergency response. This information also supports the identification, planning and prioritization of areas for prevention and mitigation activities.

The aim of the e-atlas is to raise awareness of disaster risk among ministries of health and other health stakeholders, and so stimulate improvement in their disaster-management capacity.

 

 

Inside you’ll find interactive maps, like the one below showing relative seismic risks, that allows you to pan, or drill down closer to view areas at most risk.

 

image

Photo Credit – WHO/Europe

 


You can find similar online e-Atlases available for the Eastern Mediterranean region and for Africa

 

 

  • The WHO e-atlas of disaster risk for the Eastern Mediterranean Region (HTML)

  • The WHO e-atlas of disaster risk for the African Region (HTML)
  • Tuesday, December 20, 2011

    Hong Kong Raises Alert Level On Finding H5N1 Positive Poultry

     

     

    image

    Photo Credit – FAO

    # 6023

     

     

    Although a report on Hong Kong raising their bird flu alert level has been bouncing around the news wires for a couple of hours (see News Channel Asia coverage  here) I’ve been waiting for a bit more detail to emerge on this story. 

     

    First from today’s (Dec 21st) RTHK (Radio – Television Hong Kong) News reports.

     

    Dead chicken tests positive for H5N1

    A dead chicken found at the Cheung Sha Wan Temporary Wholesale Poultry Market has tested positive for H5N1 birdflu, prompting authorities to order a cull of all 17-thousand birds being held there.

     

    All trading of live poultry there will also be shut down for the next 21 days. The Secretary for Food and Health, York Chow, says authorities are still trying to track down the source of the virus. Meanwhile, Hong Kong has raised its avian flu alert level to 'serious.'

     

    Hong Kong was the site of the first human cluster of H5N1 infection 15 years ago and bore the brunt of the SARS outbreak in 2003. Last year, they saw their first human infection from the H5N1 virus since 2003.

     

    Authorities there are, quite understandably, quick to act whenever there is even a hint of threat from a novel flu virus.  At this time, it should be noted, there are no indications of any human cases.

     

    Here is the press release from the  HKSAR government website :

     

     

    Chicken carcass sample found in Cheung Sha Wan Temporary Wholesale Poultry Market tested positive for H5N1 virus

    The Secretary for Food and Health, Dr York Chow, yesterday (December 20) announced that a chicken carcass sample taken from the Cheung Sha Wan Temporary Wholesale Poultry Market (Wholesale Poultry Market) was tested positive of the highly pathogenic H5N1 avian influenza virus during regular surveillance of the Agriculture, Fisheries and Conservation Department (AFCD).

     

    Staff from AFCD found the concerned chicken carcass sample from the Wholesale Poultry Market yesterday morning. The Government is tracing the source of the chicken carcass.  It is not certain at this stage whether the chicken came from local farm or was imported.

     

    In view of the finding of highly pathogenic H5N1 avian influenza virus in the local wholesale poultry market, the Government has raised the response level for avian influenza from "Alert" to "Serious".

     

    Dr Chow convened a meeting of the Steering Committee on Avian Influenza last night, which decided to implement a series of measures to prevent the spread of the virus and to protect public health.

     

    Measures by the Administration include the following:

    (1) The Director of Agriculture, Fisheries and Conservation declared the Wholesale Poultry Market as an infected place. AFCD will cull all poultry in this market, which amounted to more than 17,000 in total number, in the morning of December 21. The Wholesale Poultry Market will be closed until January 12, 2012.

    (2) Local farms are stopped from dispatching chickens to the market for 21 days. During the period, AFCD would step up inspection on local farms and collect more samples for tests in order to monitor if any of the local farms is infected. AFCD had inspected all 30 chicken farms in Hong Kong yesterday and no abnormality had been detected so far.  AFCD would continue to step up inspection on local farms in the coming few days and conduct virus tests for chickens.

    (3) Imports of live poultry including day-old chicks would be suspended for 21 days. The Government of the Hong Kong Special Administrative Region has notified the Mainland authorities of the case. The relevant inspection and quarantine bureaux have been requested to stay alert and take all necessary precautions to prevent avian influenza in registered live poultry farms which supply Hong Kong with poultry. The Mainland authorities indicated that no abnormality has been detected from the registered live poultry farms.

    (4) The Food and Environmental Hygiene Department (FEHD) would request all live poultry retail outlets to be thoroughly cleansed and disinfected to prevent the virus from growing and accumulating in the environment. Prohibition of overnight stocking of live poultry at all retail outlets has been implemented since 2008. As such, no live poultry was kept after 8pm last night at the retail level. In other words, there would be no live chicken supply at the retail level during the closure of the Wholesale Poultry Market.

    (5) The Centre for Health Protection (CHP) would contact poultry wholesalers and workers in the Wholesale Poultry Market as well as local chicken farmers to follow up on their health condition. The Hospital Authority (HA) has prepared for contingency response measures. CHP and HA have also urged doctors and public hospitals to report any suspected case of avian influenza. 

    (6) The Administration has stepped up cleansing and biosecurity measures in the Hong Kong Wetland Park, and has also contacted the World Wild Fund Hong Kong requesting them to step up their biosecurity measures to reduce the risk of avian influenza in Mai Po Nature Reserve.

     

    Dr Chow said recent detection of H5N1 virus in local wild birds indicated that the disease remained a threat to our community.

     

    "It is unfortunate that an avian influenza case is detected before the Winter Solstice, necessitating a halt to the supply of live chickens.  I understand that it will cause inconvenience to the public, and the poultry trade will also encounter losses. However, to safeguard public health, we need to adopt decisive and effective measures to prevent and control the spread of the virus," Dr Chow said.

    Dr Chow called for concerted effort from the community to guard against avian flu.  Members of the public should strictly observe personal and environmental hygiene, and stay away from dead birds, avoid contact with wild birds, live poultry and their droppings. Members of the public should consult their doctors for medical advice promptly if they have fever or flu symptoms.

     

    Dr Chow noted the incident has reflected the effectiveness of the Government's established surveillance on avian influenza virus.  Such effective surveillance has enabled contingency measures to be taken swiftly.

    Ends/Wednesday, December 21, 2011
    Issued at HKT 04:15

    NSABB Recommends Limiting Details In Publication Of Controversial H5N1 Research

     

    UPDATED at bottom

     

    # 6022

     

     

    According an NIH press release, the National Science Advisory Board for Biosecurity (NSABB) has made a recommendation to the HHS regarding a pair of controversial H5N1 research projects awaiting publication.

     

    These research projects have produced a highly virulent and transmissible strain of the H5N1 virus in the laboratory, prompting concerns that their publication could provide a blueprint for bio-terrorists (see The Biosecurity Debate On H5N1 Research).

     

    Specifically, the non-binding recommendation reads:

     

    NSABB recommended that the general conclusions highlighting the novel outcome be published, but that the manuscripts not include the methodological and other details that could enable replication of the experiments by those who would seek to do harm.

     

     

    More details are available in the full press release below:

     

    Press Statement on the NSABB Review of H5N1 Research

    The U.S. government remains concerned about the threat of influenza, for the risks it poses seasonally, as well as its potential to cause a pandemic. Our domestic and global influenza surveillance efforts have become increasingly capable, along with expanded vaccine manufacturing capacity and assistance to other countries in their efforts to detect and respond to a pandemic. To enhance the detection of and response to influenza outbreaks, the U.S. government supports a broad range of domestic and global preparedness and response efforts that include research on better diagnostics, vaccines, and therapeutics.

     

    Currently, H5N1 avian influenza virus — the strain commonly referred to as "bird flu" — rarely infects humans and does not spread easily from person to person. However, many scientists and public health officials are concerned that the virus could evolve in nature into a form that is transmissible among humans — an event that could potentially make this deadly virus an extremely serious global public health threat. Thus research on factors that can affect the transmissibility of the H5N1 virus is critically important to international efforts to prepare and prevent threats to public health.

     

    While the public health benefits of such research can be important, certain information obtained through such studies has the potential to be misused for harmful purposes. The National Science Advisory Board for Biosecurity (NSABB) — an independent expert committee that advises the Department of Health and Human Services (HHS) and other Federal departments and agencies on matters of biosecurity — completed a review of two unpublished manuscripts describing NIH-funded research on the transmissibility of H5N1. These manuscripts — which describe laboratory experiments that resulted in viruses with enhanced transmissibility in mammals – concluded that the H5N1 virus has greater potential than previously believed to gain a dangerous capacity to be transmitted among mammals, including perhaps humans, and describe some of the genetic changes that appear to correlate with this potential.

     

    Following its review, the NSABB decided to recommend that HHS ask the authors of the reports and the editors of the journals that were considering publishing the reports to make changes in the manuscripts. Due to the importance of the findings to the public health and research communities, the NSABB recommended that the general conclusions highlighting the novel outcome be published, but that the manuscripts not include the methodological and other details that could enable replication of the experiments by those who would seek to do harm.

     

    The NSABB also recommended that language be added to the manuscripts to explain better the goals and potential public health benefits of the research, and to detail the extensive safety and security measures taken to protect laboratory workers and the public.

     

    HHS agreed with this assessment and provided these non-binding recommendations to the authors and journal editors.

     

    Recognizing the significant potential benefit of the information about the experimental details to the global influenza surveillance and research communities, the U.S. government is working to establish a mechanism to allow secure access to the information to those with a legitimate need in order to achieve important public health goals. The U.S. government is also developing a proposed oversight policy that would augment existing approaches to evaluating research that has the potential to be misused for harmful purposes.

     

    The NSABB supports the overall goals of the National Institutes of Health, in conducting safe, ethical and informative research to enhance health, lengthen life, and reduce the burdens of illness and disability. To learn more about the NSABB, visit www.biosecurityboard.gov.

     

    About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

     

     

    UPDATE:  1245 hrs EST 12/20/11

     

    As these are non-binding recommendations, the ball is now firmly in the court of the scientific journals seeking to publish these studies.

     

    The following statement from the journal Science, indicates they are considering the requests seriously, but have concerns, and are still evaluating how to proceed.

     

     

    Science: Editor-in-Chief Bruce Alberts on Publication of H5N1 Avian Influenza Research