THE INFLUENZA REPORT

Avian influenza, human (35): Indonesia (BA), susp

2009-02-12T15:48:00.001-08:00

Date: Wed 11 Feb 2009
Source: The Jakarta Post [edited]
<http://www.thejakartapost.com/news/2009/02/11/avian-flu-detected-cockfighting-village.html>

Avian flu detected in cockfighting village
------------------------------------------
A local man suspected of having bird flu rested in his home in Jagapati
village, Badung, [island of Bali] a place well known for cockfighting,
while officials continued to cull fowls in the area. The 20 year old man
was resting in his bedroom when The Jakarta Post visited. A field doctor
who has been treating and observing the man, said he began showing symptoms
of influenza Monday [9 Feb 2009], just a few days after the report of a
possible bird flu outbreak in the area. "We've given him Tamiflu "the
medicine required to treat bird flu suspects" and we'll continue to observe
him every 5 hours," the doctor Tresna said Tuesday [10 Feb 2009]. She said
her patient seemed to be getting better but declined to rule out the
possibility of bird flu, saying that she was still waiting for results of
blood tests, which were sent to Jakarta on Monday [9 Feb 2009]. "We can't
know for sure until we've received the results of his blood tests, which we
will get in 2 weeks," she said.

It is the latest resurgence of the much-dreaded avian flu in Bali since the
death of a 29 year old woman, who allegedly died after being infected by
the H5N1 virus on August 2007. The virus was first detected on Wednesday
last week [4 Feb 2009], when a villager reported the sudden and nearly
simultaneous death of 15 fowls in the area to the Badung Animal Husbandry
and Fisheries Agency. The dead fowl tested positive of bird flu. The agency
has since culled as many as 133 fowls in the district, with further culling
to continue in the days to come until all the villages' estimated 180-fowl
population has been eliminated. "We have culled 133 fowls so far, including
the 40 we aim to finish off today [11 Feb 2009]. We'll continue the
elimination for as long as it takes," said I Made Badra, head of the Badung
Animal Husbandry and Fisheries Agency, in Jagapati on Tuesday [10 Feb 2009].

According to Badra, the resurgence of the virus was related to the wet
season, which may have weakened a certain fowl's immune system enough to
catch bird flu, quickly spreading to others. Another possibility, he said,
was the transportation of an infected chicken from Java to Jagapati to use
for cockfighting.

The Bali government has banned unlicensed live animal transportation into
Bali and cockfighting, but the latter remains a staple in the island due to
the religious and traditional nature of the so-called sport. On the other
hand, the ban on animal transportation seems to have been fully implemented
since the detection of rabies virus late last year [2008]. However, Badra
said there was a good chance that infected fowls escaped detection because
they might have been transported before the rabies scare. "For now we'll
continue to urge the public to not transport live animals into Bali," he
said. "We should all really learn from what happens to people who come in
contact with sick animals," he said, referring to the alleged death of the
29 year old woman from bird flu and the recent alleged deaths from rabies.

[byline: Andra Wisnu]

--

[This suspected human case of avian influenza on the island of Bali is the
first since 2007. The results of laboratory tests are not available yet and
the patient is not seriously ill. The presence of avian influenza in
poultry in the area is the main reason for the diagnosis of suspected avian
influenza.

The location of Bali in the Indonesian archipelago can be found by
accessing the HealthMap/ProMED-mail interactive map of Indonesia at
<http://healthmap.org/promed/en?g=1650535&v=-2.6,120.9,5>. The location of
Badung district in the centre of the island of Bali can be seen on the map
at <http://www.baliguide.com/bali_map.html>. - Mod.CP]

Avian influenza, human (34) - Viet Nam, WHO

2009-02-11T15:55:00.001-08:00

Date: Wed 11 Feb 2009
Source: World Health Organization (WHO), Epidemic and Pandemic Alert and
Response (EPR) disease outbreak news [edited]
<http://www.who.int/csr/don/2009_02_11/en/index.html>

Viet Nam: avian influenza situation - WHO update
------------------------------------------------
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 23 year old woman from Dam Ha district, Quang Ninh province.
She developed symptoms on 28 Jan 2009 and was hospitalized on 31 Jan 2009.
She is currently in a serious condition and is known to have had recent
contact with sick and dead poultry prior to the onset of her illness.
Further investigations are currently underway. Control measures have been
implemented and close contacts are being identified and monitored.

Of the 108 cases confirmed to date in Viet Nam, 52 have been fatal.

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

[This the official WHO confirmation of the 52nd human case of avian A/H5N1
influenza in Viet Nam. The female patient remains alive although in serious
condition.

A map of the provinces of Viet Nam can be accessed at
<http://www.angelfire.com/co/hongnam/vnmap.html>. Quang Ninh is a coastal
province located in the northern area. The HealthMap/ProMED-mail
interactive map of Viet Nam showing the northern, central, and southern
areas is available at <http://healthmap.org/promed/en?v=14.9,108.5,5>. -
Mod.CP]

Avian influenza, human (33): Egypt (MN), WHO

2009-02-11T15:25:00.000-08:00

Date: Mon 9 Feb 2009
Source: World Health Organization (WHO) Epidemic and Pandemic Alert and
Response (EPR) disease outbreak news [edited]
<http://www.who.int/csr/don/2009_02_09/en/index.html>

Egypt: avian influenza situation - WHO update 4
-----------------------------------------------
The Ministry of Health and Population of Egypt has announced a new human
case of avian influenza A(H5N1) virus infection. The case is a one and a
half year old boy from the Maghagha District of Menia [Al Minya]
Governorate. His symptoms began on Fri 6 Feb 2009 and he was hospitalized
at the Maghagha Fever Hospital on 7 Feb 2009 where he remains in a stable
condition. Infection with the H5N1 avian influenza virus was confirmed by
the Egyptian Central Public Health Laboratory.

Investigations into the source of his infection indicate a history of close
contact with dead poultry prior to becoming ill.

Of the 55 cases confirmed to date in Egypt, 23 have been fatal.

[This is the official WHO confirmation of the 55th human case of avian
A/H5N1 influenza in Egypt and the 406th globally
(<http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_02_09/en/index.html>).

The HealthMap/ProMED-mail interactive map of Egypt is available at
<http://healthmap.org/promed/en?g=353183&v=26.5,29.9,5>, and a map of the
governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. Al Minya governorate
is located at 15 on this map. - Mod.CP]

Avian influenza, human (32): Viet Nam

2009-02-11T15:24:00.001-08:00

Date: Sun 8 Feb 2009
Source: Thanhnien News [edited]
<http://www.topix.com/vn/thanh-hoa/2009/02/quang-ninh-woman-suspected-of-contracting-bird-flu>

[In ProMED-mail post "Avian influenza, human (30): Viet Nam 20090207.0557",
the 2nd confirmed case of human avian A/H5N1 influenza was described as a
male patient. Several other reports which have now appeared describe the
patient as a female and rank the case as suspected only. One of these
reports is reproduced below. - Mod.CP]

A 23 year old woman is suspected of contracting the H5N1 strain of bird flu
after suffering severe respiratory problems in northern Quang Ninh Province
on Saturday [7 Feb 2009], health officials said. The woman of Quang Ninh
Dam Ha District was admitted to the Quang Ninh General Hospital on Tuesday
[3 Feb 2009] with high fever, low blood pressure, and severe respiratory
problems, doctors said.

But doctors reported they were unable to conclude whether she had been
infected with the H5N1 virus. One test showed she carried it, but another
was negative. Health experts were dispatched on Saturday [7 Feb 2009] to
Quang Ninh to carry out further examinations. Work to disinfect Dam Ha
District also began Saturday. Quang Ninh, where the world renowned Ha Long
Bay is located, is about 150 km (93 miles) from Hanoi.

Before this latest case, an 8 year old girl in the northern province of
Thanh Hoa who fell sick after eating duck and chicken raised on her
family's farm was diagnosed with the bird flu. She has since recovered, but
her 13 year old sister died in the hospital earlier without being tested
for the virus before her burial, health officials said.

The Mekong Delta province of Ca Mau reported Saturday [7 Feb 2009] that
bird flu has spread among 4 local communes, prompting the culling of 3250
birds to contain the epidemic. The Ca Mau government also asked agencies
concerned to take further measures against the spread of the disease in the
province.

The Mekong Delta province of Soc Trang began disinfection work Saturday [7
Feb 2009] after 700 birds were recently reported to have died of the flu.

The avian flu has thus far infected poultry in 4 provinces in the country:
Ca Mau, Bac Lieu, and Soc Trang in the Mekong Delta region and Nghe An in
the north. H5N1 remains largely confined to birds, but experts fear it
could mutate into a form that is easily transmitted by humans and spark a
pandemic that could kill millions worldwide. Since 2003, Viet Nam has
recorded 52 human deaths from bird flu, the 2nd highest toll after
Indonesia, where the virus has killed 115 people.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[A map of the provinces of Viet Nam can be accessed at
<http://www.angelfire.com/co/hongnam/vnmap.html>. Quang Ninh is a coastal
province located in the northern area. The HealthMap/ProMED-mail
interactive map of Viet Nam showing the northern, central and southern
areas is available at <http://healthmap.org/promed/en?v=14.9,108.5,5>. -
Mod.CP]

Panasonic Orders Some Expatriate Families Home on Concern of Flu Pandemic

2009-02-10T06:04:00.001-08:00

Feb. 10 (Bloomberg) -- Panasonic Corp., the world's largest maker of consumer electronics, ordered Japanese employees in several emerging markets to send their families back to Japan on concern of a potential influenza pandemic.

The company in December instructed staff assigned to parts of Asia, Africa, eastern Europe and South America to repatriate their families by September, Akira Kadota, a spokesman for Osaka- based Panasonic, said by telephone today. He declined to comment on the number of employees or households affected.

Panasonic said last week it will cut about 15,000 jobs and report a loss this year. More than half of the company's 209 subsidiaries outside Japan as of April 2008 were in the Asia- Pacific region.

"It's a bit of a surprise," said Naoteru Teraoka, who helps oversee $21 billion at Chuo Mitsui Asset Management Co. in Tokyo. "I would understand if there was a sudden outbreak that warranted concern, but there don't seem to be any recent developments."

Panasonic may be the first major company to order families home on concern people wouldn't receive needed health care in case of a widespread flu outbreak. A pandemic could kill 71 million people worldwide and lead to a "major global recession" costing $3 trillion, according to a worst-case scenario outlined by the World Bank in October.

"This is part of our preparations for a new type of influenza," Kadota said by telephone. "We chose areas after considering the prevalence of bird flu, and the capability of medical facilities and access to them. This is not part of the cost cutting."

Singapore Staff Spared

The world is closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three pandemics occurred, according to the World Health Organization.

The company has been reviewing how to handle a pandemic, and decided to repatriate families after consulting Japan's government and the Geneva-based WHO, Kadota said.

Honda Motor Corp., Japan's second-biggest carmaker, considered bringing home families of expatriates in China after a woman in Beijing infected with bird flu died on Jan. 5, said Hideto Maekawa, a spokesman for the company. The carmaker has advised employees to cut down on "unnecessary and non-urgent" business trips, he said.

Panasonic isn't concerned about any single country more than others, and Singapore staff won't be affected by the repatriation, he said. The Nikkei newspaper reported the plans earlier.

International health officials have been monitoring the H5N1 strain of avian influenza for more than a decade for signs it could mutate into a form that is easily spread between humans. H5N1 has infected at least 406 people in 15 countries since 2003, killing 63 percent of them, according to the WHO's Web site. The organization lists 11 cases of the virus in humans this year.

Panasonic shares added 0.9 percent to 1,130 yen. The stock plunged 52 percent last year.

To contact the reporter on this story: Kanoko Matsuyama in Tokyo at kmatsuyama2@bloomberg.net .

Avian influenza (13): Viet Nam (BL, CM)

2009-02-09T10:26:00.001-08:00

Date: Sat 7 Feb 2009
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/article/ALeqM5gOqW_oyU7KRlA57WotO56ldQYi7g>

The H5N1 strain of bird flu has been reported in more localities
across Viet Nam, raising fears of a possible epidemic, official and
media reports said Friday [6 Feb 2009]. The latest outbreak occurred
on a farm in Mekong delta's Ca Mau province, where 300 unvaccinated
ducklings died of the virus, said the national animal health department.

The Hanoi-based office in its earlier reports said avian influenza
had been found in ducks in nearby Soc Trang province and Nghe An
province in the country's central region. The state-run Thanh Nien
newspaper said Friday [6 Feb 2009] that southern Bac Lieu has been
added to the list of bird-flu hit provinces.

"Epidemics could spread easily because of cold weather and local
residents' habit of letting the ducks run around in rice fields,"
Thanh Nien said, adding that thousands of infected poultry have died
or been culled this year [2009].

Earlier this month [February 2009], Viet Nam's capital Hanoi issued a
ban on the widespread use of motorbikes or bicycles to transport
poultry and livestock for fear it could help trigger an epidemic.

However, state media has frequently reported that meat products
continued to be transported by motorbike into the city daily despite the ban.

The communist state, which has been hit by bird flu since 2003,
reported a human case this year [2009], an 8-year-old girl from
northern Thanh Hoa province who has now recovered.

Her 13-year-old sister died in hospital earlier but was not tested
for H5N1 before the burial, health officials said.

Viet Nam has recorded 52 human deaths of bird flu, the 2nd highest
toll after Indonesia, where the virus has killed 115 people.

[The following information is derived from the commentary by
moderators YMA/MPP in PRO/MBDS posting 20090207.0556 (Avian influenza
- MBDS region (06): Viet Nam):

At present, the provinces in Viet Nam affected by H5N1 infection in
poultry within the last 21 days are Ca Mau, Soc Trang, Nghe An and
Bac Lieu provinces. Bac Lieu is the latest province reporting an H5N1
outbreak, while this outbreak is likely to spread from the
neighboring provinces, Ca Mau and Soc Trang, which reported the H5N1
outbreak recently and are under quarantine.

In the meantime, Ca Mau province has reported new H5N1 outbreaks in 5
hamlets. The previous outbreak was on 2 Feb 2009. Current updates on
the H5N1 situation in Viet Nam are available (in Vietnamese) on the
Ministry of Agriculture and Rural Development website at
<http://www.mard.gov.vn/portal/page?_pageid=35,1&_dad=portal&_schema=PORTAL>.

Information on the recent H5N1 outbreaks from Ca Mau, Soc Trang and
Nghe An provinces reported to the World Organisation for Animal
Health (OIE) is available at
<http://www.oie.int/wahis/reports/en_fup_0000007775_20090206_171401.pdf>.

For maps of Viet Nam with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/vietnam_admin01.jpg> and
<http://www.angelfire.com/co/hongnam/vnmap.html>.

The HealthMap/ProMED-mail interactive map of Viet Nam can be accessed
at <http://healthmap.org/promed?v=14.9,108.5,5>. This map shows other
outbreaks in Viet Nam and surrounding countries that have been
reported on ProMED-mail. The postings can be directly accessed
through this map. - Mod.AS]

Avian influenza, human (31): Egypt (MN)

2009-02-09T10:25:00.001-08:00

[1]
Date: Date: Sun 8 Feb 2009
Source: Reuters [edited]
<http://www.reuters.com/article/asiaCrisis/idUSL8703822>

An Egyptian boy has contracted the bird flu virus, the state-run news
agency quoted the Health Ministry as saying on Sunday [8 Feb 2009],
the 2nd such case in the last week and the 55th case since the virus
reached Egypt in 2006. The 18-month-old boy from the province of
Minia in central Egypt 1st showed symptoms on Friday [6 Feb 2009]
after coming into contact with dead birds and was admitted to
hospital on Saturday. He was administered the antiviral drug Tamiflu
and is now in a stable condition, the health ministry said.

On Wednesday [4 Feb 2009], the ministry reported a 2-year-old boy in
the Suez province was in hospital after contracting the virus.

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. Some 5 million Egyptian households depend on poultry as a
main source of food and income.

Since 2003, the virus has infected 404 people in 15 countries and
killed 254 of them. It has killed or forced the destruction of more
than 300 million birds. Egypt has had the most cases outside of Asia.

[2]
Date: Sun 8 Feb 2009
Source: China view, Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-02/09/content_10784501.htm>

A baby from southern [central?] Egypt has contracted the bird flu
virus, which brings the number of human cases to 55 in the country,
the Health Ministry announced Sunday [8 Feb 2009]. The
one-and-a-half-year-old boy showed symptoms on Friday [6 Feb 2009]
after he had contact with infected birds, the ministry said in a statement.

The boy from the Upper Egyptian governorate of Minia, some 220 km
south of Cairo, is now in a stable condition after being treated with
the antiviral drug Tamiflu, according to the statement.

Egypt is the most affected country by the deadly avian influenza
outside Asia. It reported its 1st H5N1 virus in dead poultry in
February 2006 and the 1st human case in March of the same year. The
death toll of the human cases of bird flu in the populous country is 23.

The World Health Organization (WTO) has said that as of 5 Feb 2009,
some 405 people in 15 countries have contracted the virus, and 254 of
them died of the disease.

[The most recent 3 human cases in Egypt have all been young children
living in different provinces who have had contact with diseased poultry.

The HealthMap/ProMED-mail interactive map of Egypt is available at
<http://healthmap.org/promed/en?g=359796&v=26.5,29.9,5>, and a map of
the governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. Al Minya
governorate is located at 15 on this map. - Mod.CP]

Avian influenza, human (30): Viet Nam

2009-02-07T10:15:00.001-08:00

Date: Sat 7 Feb 2009
Source: Reuters UK [edited]
<http://uk.reuters.com/article/homepageCrisis/idUKHAN433627._CH_.2420>

Viet Nam has new human bird flu case
------------------------------------
A 23-year-old man has tested positive for the deadly H5N1 virus in
northern Viet Nam, a state-run newspaper reported on Saturday [7 Feb
2009]. The online Lao Dong newspaper (<http://www.laodong.com.vn>)
quoted health officials as saying the man from Dam Ha district in the
northern province of Quang Ninh, about 150 km (93 miles) from Hanoi
had fallen ill and tests showed he carried the bird flu virus. The
report quoted doctors as saying the man had high fever and severe
respiratory problem.

Prior to this case, Viet Nam has this year confirmed one case of
human infection in the northern province of Thanh Hoa, involving an
8-year-old girl who fell sick after eating duck and chicken raised on
her family's farm. She has recovered.

On Saturday, the agriculture ministry said bird flu had infected
poultry in 3 provinces in the country, Ca Mau and Soc Trang in the
south and Nghe An in the central region.

The H5N1 flu remains largely a virus among birds, but experts fear it
could mutate into a form that is easily transmitted by humans and
spark a pandemic that could kill millions worldwide.

[Byline: Nguyen Nhat Lam and Sugita Katyal]

--
Communicated by
ProMED-mail Rapporteur Mary Marshall

[This is the 2nd case of avian A/H5N1 influenza virus infection
recorded in Viet Nam in 2009, bringing the total number of cases
since 2003 to 108 (with 52 fatalities). The present condition of the
patient and the circumstances of his exposure to avian influenza
virus infection are not stated. Outbreaks of avian influenza in
poultry have not been reported in Quang Ninh province so far. The
preceding case was an 8-year-old girl in Thanh Hoa province who
survived. Her 13-year-old sister was a suspected case of avian
influenza virus infection, but this has not been confirmed as she
died subsequently and apparently no diagnostic materials are available.

A map of the provinces of Viet Nam can be accessed at:
<http://www.angelfire.com/co/hongnam/vnmap.html>. Quang Ninh is a
coastal province located in the the northern area. The
HealthMap/ProMED-mail interactive map of Viet Nam showing the
northern, central and southern areas is available at:
<http://healthmap.org/promed/en?v=14.9,108.5,5>. - Mod.CP]

Avian influenza (12): China, human, animal infections

2009-02-07T10:13:00.001-08:00

Date: Fri 6 Feb 2009
Source: Reuters [edited]
<http://uk.reuters.com/article/middleeastCrisis/idUKPEK142436>

China defends bird flu vaccination plan despite deaths
------------------------------------------------------
China's Ministry of Agriculture on Friday [6 Feb 2009] defended its
bird flu vaccination programme, stating there had been no outbreaks
since last June [2008] despite a number of human cases, some fatal,
this year. Human cases and the appearance of dead wild birds in Hong
Kong have caused some experts and media reports to question whether
the virus is widespread but undetected in China.

A total of 5 people died of bird flu in China in January [2009], in
regions far removed from each other and in which there were no
reported cases of bird flu in birds. In addition, 3 others have
become ill, of which 2 have recovered, a toddler infected in Hunan
and a young man in Guizhou. Apart from the discovery of a case during
routine sampling in eastern China's Jiangsu province in December
[2008], Chinese testing has not detected any bird flu since June [2008].

The Ministry of Agriculture said in a report on its Web site that the
strain found in Jiangsu was a variant, requiring the modification of
the vaccine programme in the surrounding provinces of Zhejiang,
Shanghai, Anhui and Shandong.

Meanwhile, 2 ducks and a goose found in Hong Kong have tested
positive for H5N1, the strain of bird flu that can infect humans.
Hong Kong closed its Mai Po nature preserve as a precaution for 21
days from Friday [6 Feb 2009], after a dead grey heron found there
also tested positive for bird flu.

Hong Kong authorities are still testing 14 other dead birds found
last week on Lantau Island. "We're checking water currents" to see if
the birds were washed ashore from mainland China, a government
spokeswoman said.

China has vaccinated aggressively since bird flu first reappeared
among humans in Asia in 2003. But vaccination does not eliminate the
virus. In 2008, China reported 6 outbreaks of bird flu that killed
9000 birds and led to the culling of 590 000 birds.

[Byline: Lucy Hornby and Tan Ee Lyn]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Following the information on human cases in China without data on
animal outbreaks, and the suspicion that dead infected birds were
being washed ashore in Hong Kong from mainland China (allegedly
coming from China's Pearl River Delta), ProMED-mail included, in its
posting 20090205.0514 of 5 Feb 2009, the following comment: "The
Chinese authorities may consider publishing details of their recent
active surveillance activities undertaken to investigate the source
of said human infections." The current posting may be seen as China's
initial response. Additional details on the number and locations of
investigations applied and samples tested, will help.

China's last (2) reports to the OIE on H5N1 in animals date back to
19 Dec 2008 (Immediate Notification) and 26 Dec 2008 (Follow-up
Report 1). They addressed 2 outbreaks in Jiangsu; see, including map, at
<http://www.oie.int/wahis/public.php?page=event_summary&reportid=7623>.
- Mod.AS

The presence of human cases in the absence of reported avian
outbreaks may be seen as a discrepancy that needs to be addressed --
unless they are claiming that all the human cases were related to
exposure to healthy appearing poultry that were H5N1 infected and
excreters.... - Mod.MPP]

Seasonal influenza, vaccine mismatch - Taiwan

2009-02-07T10:11:00.001-08:00

[1]
Date: Tue 3 Feb 2009
Source: Taiwan Times [edited]
<http://www.etaiwannews.com/etn/news_content.php?id=855358&lang=eng_news>

Flu vaccines not as effective this year as in the past
------------------------------------------------------
Influenza vaccines that proved to be effective late last year have
failed to live up to expectations early this year, the Department of
Health (DOH) said Tuesday [3 Feb 2009]. Chou Jih-haw, Deputy
Director-general of the DOH's Centers for Disease Control, said more
than 3.2 million free flu shots were given to the public in autumn
and winter last year. "Judging from the number of influenza cases in
the fourth quarter of 2008, it was significantly lower than in the
same period the previous year," Chou said. "But this year, tests of
flu viruses on the patients showed that the results have not been as
good as expected," he continued.

Chou said influenza vaccines given in autumn 2008 and this winter
should be effective against the H1N1 and H3N2 viruses, and tests
taken from patients who were inoculated last year proved their
effectiveness. But in January [2009], tests found the vaccines did
not work [were not protective?] on 70 percent of those with H1N1
viruses and 40 percent of those with the H3N2 virus. A vaccine is
considered effective if it controls the virus in 80 percent to 90
percent of those inoculated. Chou would not categorize the vaccines
as ineffective, however, because influenza viruses are "prone to
mutation," meaning that the virus formula for producing vaccines must
be changed on a yearly basis.

A former CDC Director suggested Tuesday that part of the problem may
be that flu viruses tend to strike Taiwan between 6 months and 2
years earlier than European countries and the United States. Su
Ih-jen, Director of the Division of Clinical Research of the National
Health Research Institutes, said that because of the time lag,
influenza vaccines produced by European and American pharmaceutical
makers based on data provided by the World Health Organization could
not keep up with the outbreak of flu in Asia. Su noted that with
close exchanges between Taiwan and China, Taiwan has become an
outpost of influenza outbreaks.

The World Health Organization began to address the issue of different
prevalent viruses in Asia and Europe last April [2008]. Currently, 2
out of 5 major vaccine manufacturers have made inroads into China,
and the production of Asian influenza vaccines "has become a trend,"
he said. Su suggested that the virus in every influenza outbreak is
slightly different, and that "it can show major changes about every 5
years, so the effectiveness of vaccines can diminish."

[Byline: Lilian Wu]

[2]
Date: Thu 5 Feb 2009
Source: Taipei Times [edited]
<http://www.taipeitimes.com/News/taiwan/archives/2009/02/05/2003435334>

Experts recommend switching to Asian-made flu vaccines
------------------------------------------------------
Anticipating a bigger wave of flu infections caused by a form of the
virus that has become resistant to medication and vaccines, doctors
and academics urged the government to switch to Asian versions of the
flu vaccine. Health officials last week said that with employees
returning to work en masse after the Lunar New Year holiday, flu
infections from increased human interaction in crowded places could
spread fast.

Fear of the flu heightened when the Centers for Disease Control (CDC)
said on Tuesday [3 Feb 2009] that 2 strains of the influenza type A
had mutated slightly and developed resistance to the flu medication
Tamiflu [oseltamivir]. Tamiflu was still 30 percent effective in
fighting the virus in October [2008], but the virus has recently
developed 100 percent resistance against the drug, the CDC said.

"The H1N1 strain [of the flu virus] has mutated into a form that is
70 percent variant from the vaccine, and the H3N2 strain is 40
percent variant," said CDC Deputy Director-general Chou Jih-haw,
referring to the government-funded vaccine inoculation offered free
of charge last year to children, the elderly and other high-risk
groups. CDC statistics showed that influenza type A comprised about
80 percent of all reported cases this winter. The type A H1N1 and
H3N2 strains are currently circulating among flu victims.

"The H1 strain is weaker than the H3 strain. Although the H1 strain
may infect more people [because of its mutation], it is less likely
to make patients critically ill," said Huang Li-min, a pediatrician
at National Taiwan University Hospital.

However, Huang said that he was not sure whether the H1N1 strain
would mutate into a form that could result in critical conditions. He
recommended that doctors prescribe 2 types of flu medication
simultaneously, such as Tamiflu [oseltamivir] combined with
amantadine, another type of flu treatment. This way, in case the
virus strain has developed resistance to certain drugs, the
medication may still be effective in controlling the disease, he said.

The flu virus undergoes minor changes from time to time, and a major
variant emerges about every 5 years, said Su Ih-jen, Director of the
National Health Research Institute's division of clinical research.
Su urged the government to switch from European-made vaccines to
Asian-made ones, saying the latter was more "up to date" with new
virus strains. "In 2005, we published research showing that the virus
strains in Taiwan were 2 years ahead of Europe," he said. "We should
be using Asian versions of the vaccine to stay up to date with the
disease." In response, Chou said the CDC would assess the need to
switch to the vaccines used in China, which he said would be more
effective in combating the ever-changing virus.

[Byline: Shelley Huang]

[Vaccine mismatch is being invoked to explain the relatively poorer
protective response obtained by vaccination in Taiwan in the current
year compared to that obtained in the preceding year. This is
attributed to progressive change in the epidemic virus as a
consequence of accumulation of mutations in the viral genome.
According to the above reports previous research in Taiwan has
suggested that: "virus strains in Taiwan were 2 years ahead of
Europe." On this basis it is proposed that vaccines more in harmony
with requirements in south and southeast Asia should be developed locally.

Increasing resistance of current epidemic strains to the antiviral
drugs Tamiflu and amantadine in Taiwan is considered to be another
consequence of the mutability of the virus rather than a consequence
of the enhanced use of these drugs in clinical practice. In contrast
a recent study in Europe (Kramarz et al., Eurosurveillance, Vol. 14,
Issue 5, 2009
(<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19112>)
based on analysis of prescription data concluded that while the
precise relationship between oseltamivir [Tamiflu] use and resistance
of influenza A(H1N1) to oseltamivir remains uncertain, the available
data do not suggest a link between the rapid rise in the proportion
of the resistant A(H1N1) and the use of oseltamivir in Europe. - Mod.CP]

[A map showing the location of Taiwan is available at:
http://www.worldatlas.com/webimage/countrys/asia/tw.htm> -CopyEd. EJP]

Avian influenza (11): France (VD), LPNAI H5N3

2009-02-05T18:50:00.001-08:00

Date: Tue 3 Feb 2009
Source: DEFRA, International disease monitoring - Preliminary
outbreak assessment, Ref: VITT 1200/LPAI - France [edited]
<http://www.defra.gov.uk/animalh/diseases/monitoring/pdf/ai-france-090203.pdf>

Low Pathogenic Avian Influenza in France: H5 non-N1
-----------------------------------------------
1. Disease Report
The French authorities have recently reported an outbreak of Low
Pathogenicity Avian Influenza (LPAI) on a duck breeding farm in
Vendee region [see map at the above URL. - Mod AS]. The birds were 12
months old and at the end of their moult. Preliminary testing
confirmed the virus to be of the H5 type (but not N1) [later
identified as H5N3; see commentary. - Mod.AS]. Disease control
measures have been put in place, including a 1 km restriction zone.

2. Situation assessment
Sporadic findings of LPAI are not uncommon across the EU. This
particular [H5N3] strain in France appeared to have caused about one
percent mortality in the affected flock. Infection with LPAI in ducks
and geese is generally asymptomatic. However, in this specific case,
the ducks may have been more susceptible to infection due to stress
associated with moulting. According to TRACES (the EU electronic
trade notification system), there have been 24 consignments of live
poultry from France to the UK since 1 Jan 2009. One consignment
originated from the Vendee region; however, it came from a holding at
least 45 km away from the affected premises, and it was for turkeys.

[According to the French notification to the OIE submitted on Wed 4
Feb 2009, the mentioned outbreak, caused by LPAI serotype H5N3, had
started on 29 Jan 2009 and resolved already on 1 Feb 2009, when the
entire affected holding was stamped out. The final diagnosis was
confirmed on 1 Feb 2009 by AFSSA's (France's food safety agency)
national laboratory at Ploufragan. The location was Les Brandes, La
Garnache, Vendee. A map is included; see
<http://www.oie.int/wahis/public.php?page=single_report&pop=1&reportid=7764>.
The notification included the following description of the affected
population: "The affected farm has only one closed premises with
about 5000 breeding ducks in late moult (no lay) and aged 12 months.
Thu 29 Jan 2009: signs of prostration. 50 birds found dead. Fri 30
Jan 2009: 25 birds found dead. Sat 31 Jan 2009: 15 birds found dead.
Sun 1 Feb 2009: slaughter at the premises." The notification included
the following epidemiological comments: "Source of the outbreak(s) or
origin of infection - unknown or inconclusive. No recent entry of
poultry on the farm. No recent exit of poultry or eggs from the farm."

Germany has also reported recently outbreaks of LPAI H5N3 (see
<http://www.defra.gov.uk/animalh/diseases/monitoring/pdf/poa-ai-gp.pdf>).
The total number of reported outbreaks in Germany currently stands at
33. - Mod.AS]

Avian influenza (10): China (HK)

2009-02-05T18:49:00.001-08:00

[1]
Date: Thu, 5 Feb 2009
Source: Xinhua [edited]
<http://news.xinhuanet.com/english/2009-02/05/content_10766219.htm>

A spokesman for Hong Kong's Agriculture, Fisheries and Conservation
Department (AFCD) said Wednesday [4 Feb 2009] that the dead goose and
2 dead ducks found in Sha Lo Wan, Lantau Island in Hong Kong last
week were confirmed to be H5N1 positive after a series of laboratory tests.

AFCD staff collected the carcasses of a goose and a duck on 29 Jan
2009 at a beach near Sha Lo Wan football pitch. Another dead duck was
found on 31 Jan 2009 at the same location.

The spokesman said that 2 more dead chickens were collected on the
coast opposite Yeung Hau Temple in Tai O, Lantau on Wednesday [4 Feb
2009], adding that preliminary tests for the H5 virus are being arranged.

AFCD will continue to closely monitor the situation and investigate
into the possible causes of the recent discovery of bird carcasses,
said the spokesman.

The spokesman said a ban on backyard poultry has been in force since
2006. Unauthorized keeping of 5 kinds of poultry -- chickens, ducks,
geese, pigeons or quails -- is an offense with a maximum fine of 50
000 HK dollars [USD 6450]. Repeat offenders are subject to a maximum
fine of 100 000 HK dollars [USD 12 900].

[2]
Date: Wed 4 Feb 2009
Source: The Nation, Thailand [edited]
<http://www.nationmultimedia.com/worldhotnews/30094866/-Hong-Kong-expert-warns-of-%22terrible%22-China-bird-flu-outbreak>

Experts in Hong Kong were carrying out tests Tuesday [3 Feb 2009] on
dead birds washed up on beaches amid fears of a large unreported
avian-flu outbreak in neighbouring mainland China.

Three of 12 birds found on the Hong Kong island of Lantau in the past
5 days have so far tested positive for H5N1, the bird-flu strain that
can be deadly in humans.

Islanders said dead birds have been washing ashore in recent days and
they believe they come from China's Pearl River Delta, which flows
out into the South China Sea surrounding Hong Kong [map at
<http://www.photography.spentbrothers.com/China84/map.jpg>. - Mod.AS].

On Monday [2 Feb 2009] alone, the carcasses of one goose, 5 chickens,
a duck and 2 other birds were found, bringing to 12 the number of
dead birds found on Lantau since Thursday [29 Jan 2009].

Five people in China died of bird flu in January 2009 alone, 2 more
than in the whole of 2008. Three other people were infected.

However, speaking on Hong Kong's government-run radio station RTHK
Tuesday [3 Feb 2009], infectious diseases expert Lo Wing-Lok warned
that the outbreak in China could be far bigger than officials have admitted.

"This is suddenly something very serious," said Lo, a legislator and
chairman of the Hong Kong Medical Association. "We have to confirm
the source of these dead birds, whether it is local or from the mainland."

Lo said there were already indications that "something extraordinary"
was happening in China because of the large number of [human]
bird-flu cases reported in a short period of time.

"In January [2009], there were 8 human cases reported to have come
down with H5N1 infection," Lo said. "The source of the infection, of
course, is poultry. Poultry infection may be widespread in the
mainland, and, because of that, (infected) birds may find their way
across the border through the water currents, through fishing boats,
from visitors bringing a few birds at a time. These are all
possibilities we need to consider."

A Hong Kong government spokesman said officials were working with
mainland authorities to try to work out the source of the dead birds
on the island, which has no poultry farms.

He said the Hong Kong government would "conduct a study on water
currents and weather" to see whether the carcasses were being washed
ashore from China.

The World Health Organization said China has recorded 38 bird-flu
cases since the disease resurfaced in 2003, including 25 deaths.

Hong Kong saw the 1st outbreak in modern times of bird flu to infect
humans in 1997, when 6 people died and 12 others were infected but survived.

Since then, it has carried out 2 mass culls and introduced strict
market controls and border controls with China, avoiding human deaths
in any of the recent bird-flu outbreaks to sweep the region.

--
Communicated by:
David Cameron Duffy, PhD
Professor/PCSU Unit Leader/CESU Director
Department of Botany
University of Hawaii Manoa
Honolulu, HI, USA
<dduffy@hawaii.edu>

[The improved human surveillance in China has most likely been
reflected in the increased numbers of confirmed cases this year
(2009), which is definitely a sign of hard work and training of
health care professionals countrywide. One can only wonder that there
has been a similar lag in surveillance in the Agricultural section,
involving a lot of small farms with the population not reporting
poultry die offs. One suspects that the surveillance among the major
poultry breeders has improved significantly, but that the smaller
producers are still very much below the radarscope and are hiding
their flocks from the official sector when there are die offs. - Mod.MPP]

******
[3]
Date: Wed 4 Feb 2009
Source: AFP [edited]
<http://www.google.com/hostednews/afp/article/ALeqM5iq8X_3NtMiA79Y46b2fmMxRsBjNA>

China may have experienced outbreaks of bird flu among poultry
recently, the UN's Food and Agriculture Organisation said Wednesday
[4 Feb 2009], even though the government had yet to report any cases
this year [2009].

The FAO's comments come after 8 people contracted the H5N1 bird flu
virus in China this year [2009] -- 5 of whom died -- compared with
just 3 cases in all of 2008.

"There must have been some virus circulation or possibly some
outbreaks lately," Vincent Martin, senior technical adviser on bird
flu for the FAO in China, told AFP.

But he said the FAO had received no reports of bird flu cases in
poultry from the agriculture ministry since December 2008, when an
outbreak occurred in the eastern province of Jiangsu.

"There must be some suspicions of the disease reported to the
Ministry of Agriculture, and some of those suspicions might have come
up positive," he said.

"We are waiting to receive some reports describing the overall
epidemiological situation and the results of investigations."

The number of cases in China this year [2009] has aroused some public
concern, although the World Health Organization has said the overall
situation is "within expectations at this time of the year."

Cold weather encourages the spread of the virus, and the Lunar New
Year holiday -- a risky period when hundreds of millions of people
move across the nation to see relatives and eat meals that include
poultry -- has just ended.

But Martin said the pattern this year [2009] was unusual. "There are
more cases than last year [2008], including in places where the
disease was not reported before, like in Jiangsu province (poultry
outbreak) or Shandong province (human case)," he said.

Lo Wing-lok, an infectious disease expert in Hong Kong, said that if
no poultry outbreak in China was accompanying the current human
cases, the latter could have been triggered by a mutation in the H5N1 virus.

"Maybe the virus has been changing so that it becomes a more easily
transmittable virus between bird and man," he said.

So far, 25 people have died from avian influenza in China since the
disease reemerged in 2003, according to World Health Organization figures.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Hong Kong's HPAI surveillance and reporting records are rather
exemplary; the observations regarding possible unidentified or
unreported outbreaks in mainland China deserve serious attention.
Since, fortunately, no human to human infections are (yet?!) known to
occur, the source of the recent human infections must be sought in
the animal kingdom. The Chinese authorities may consider publishing
details of their recent active surveillance activities undertaken to
investigate the source of said human infections.

China's last (2) reports to the OIE on H5N1 date back to 19 Dec 2008
(Immediate Notification) and 26 Dec 2008 (Follow-up Report 1). They
addressed 2 outbreaks in Jiangsu; see, including map, at
<http://www.oie.int/wahis/public.php?page=event_summary&reportid=7623>.
- Mod.AS]

Avian influenza, human (29): Egypt (SUZ)

2009-02-05T12:12:00.001-08:00

[1]
Date: Thu 5 Feb 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-02/05/content_10764811.htm>

Egypt confirms 54th human case of bird flu
------------------------------------------
On Wed 4 Feb 2009 the Egyptian Health Ministry confirmed that a
2-year-old baby has been infected with bird flu virus, which brings
the number of human cases of bird flu to 54 in the populous country.

The baby from the Suez governorate, some 120 km (75 mi) east of
Cairo, was admitted to hospital with a high temperature, the state
MENA news agency quoted Health Ministry spokesman, [Abdul Rahman
Shaheen], as saying. The baby contracted the deadly virus after being
in contact with infected birds, said [Shaheen].

This is the 3rd case of human bird flu in Egypt in 2009. On 25 Jan
2009, a 2-year-old baby from the Delta governorate of [Al-Minufiyah],
some 65 km (40 mi) north of Cairo, was hit by the deadly disease. On
12 Jan 2009, a 21-month-old baby girl from Kerdasa, 6th of October
governorate, was infected with the virus.

Egypt reported its 1st H5N1 virus in dead poultry in February 2006
and the 1st human case in March of the same year.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Thu 5 Feb 2009
Source: Kuwait News Agency (KUNA) [edited]
<http://www.kuna.net.kw/NewsAgenciesPublicSite/ArticleDetails.aspx?id=1973620&Language=en>

Two-year-old struck with bird flu
--------------------------------
Health authorities [in Cairo] announced Wednesday [4 Feb 2009] that a
new case of bird flu has been discovered in the province of Suez
involving a male child, thus bringing the number of people struck by
this disease in the country to 54 since its appearance in Egypt in
February 2006.

The afflicted child is 2 years old, said Dr [Abdul Rahman Shaheen],
spokesman for the ministry of Health, adding that the flu symptoms
began to appear on the child last Monday [2 Feb 2009], following
which he was admitted to the hospital for observation. He had come in
contact with dead birds while playing which resulted in his running
up high fever and severe coughing and other symptoms normally
associated with the bird flu. This took place last Friday [30 Jan 2009].

The disease had struck dead 22 people in Egypt since its appearance,
and the authorities [in Cairo] fear its resurgence mainly because
poultry shops, chicken-coop keepers at home, and bird collectors
mishandle dead birds, which exposes these people to the deadly flu.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Remarkably all 3 cases of avian A/H5N1 influenza recorded in Egypt
during the 1st few weeks of 2009 have been children 2 years of age or younger.

The HealthMap/ProMED-mail interactive map of Egypt is available at
<http://healthmap.org/promed/en?g=359796&v=26.5,29.9,5>
and a map of the governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The Suez
governorate is located at 26 on this map. - Mod.CP]

AVIAN INFLUENZA, HUMAN (28): CHINA (HUNAN), WHO

2009-02-04T16:15:00.001-08:00

Date: Mon 2 Feb 2009
Source: World Health Organization (WHO) Epidemic and Pandemic Alert
and Response (EPR) disease outbreak news [edited]
<http://www.who.int/csr/don/2009_02_02/en/index.html>

China: avian influenza situation - WHO update 4
-----------------------------------------------
The Ministry of Health in China has announced a new confirmed human
case of H5N1 infection. The case is a 21-year-old female from Xupu
County, Hunan province. She had onset of symptoms on 23 Jan 2009 and
remains in hospital in a clinically stable condition. Investigations
into the source of her infection indicate possible exposure to sick
and dead poultry.

Of the 38 cases confirmed to date in China, 25 have been fatal.

AVIAN INFLUENZA, HUMAN (23): EGYPT, WORLD HEALTH ORGANISATION

2009-02-04T16:14:00.001-08:00

Date: Mon 26 Jan 2009
Source: World Health Organization (WHO) Epidemic and Pandemic Alert
and Response (EPR) disease outbreak news [edited]
<http://www.who.int/csr/don/2009_01_26/en/index.html>

Egypt: avian influenza situation - WHO Update 2
-----------------------------------------------
On 26 Jan 2009 the Ministry of Health and Population of Egypt has
announced a new human case of avian influenza A(H5N1) virus infection.
The case is a 2-year-old female from Manofia [Al-Minufiyah]
Governorate, Shebin Elkom District. Her symptoms began on 23 Jan 2009
and she was immediately hospitalized. She remains in a stable
condition. Infection with the H5N1 avian influenza virus was confirmed
by the Egyptian Central Public Health Laboratory.

Investigations into the source of her infection indicate a recent
history of contact with sick and dead poultry.

Of the 53 cases confirmed to date in Egypt, 23 have been fatal.

AVIAN INFLUENZA, HUMAN (20): NEPAL, SUSPECTED

2009-02-04T16:13:00.001-08:00

[1]
Date: Sun 25 Jan 2009
Source: China View, Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-01/25/content_10717281.htm>

Nepal has found a patient from Damak, eastern Nepal, to be a
suspected case of human bird flu infection, the Nepali national news
agency RSS reported on Sunday [25 Jan 2009]. Damak of Jhapa district
is some 320 km east of the Nepali capital Kathmandu. In mid-January
2009, the 1st case of bird flu in poultry was detected in Kakarbhitta
of the same district.

According to the report, bird flu has been suspected to have infected
a patient from Damak, who was taken to nearby BP Koirala Institute
for Health Sciences (BPKIHS) in Dharan. Communication spokesperson
for BPKIHS Bijay Rimal said bird flu virus has been suspected to have
been found in the patient's blood sample during tests in the
institute's laboratory. He said the patient's blood sample has been
sent for further tests in a sophisticated laboratory. He said the
patient was showing symptoms of bird flu infection. The BPKIHS,
however, did not reveal where the patient's blood sample had been sent.

Rimal, however, said it cannot be officially confirmed whether the
patient is infected with bird flu yet as the institute lacked a
specific lab to test bird flu. The patient has been referred to
Dharan by Lifeline Hospital in Damak following 3-day treatment there.

AVIAN INFLUENZA, HUMAN - CHINA (05): XINJIANG, FATAL

2009-02-04T16:12:00.001-08:00

Date: Sat 24 Jan 2009
Source: China View, Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-01/24/content_10714041.htm>

Another death from bird flu reported in China
---------------------------------------------
A 31-year-old woman has died of bird flu in northwest China's
Xinjiang Uygur Autonomous Region, becoming the 4th death from the
disease in the country so far this year [2009], the local health
department said Saturday [24 Jan 2009]. The woman, a resident in the
regional capital Urumqi, died at 4:40 a.m. Friday [23 Jan 2009]. She
had been to a poultry market before she fell ill on [10 Jan 2009],
said Wang Xiaoyan, deputy director of the regional health department.

She was confirmed to have been infected with the H5N1 strain of avian
influenza by the Chinese Center for Disease Control and Prevention on
Saturday [24 Jan 2009].

Before the death in Xinjiang, 3 others have died of bird flu and
another has been infected in the country so far this year [2009]. The
1st death was a 19-year-old woman in Beijing on [5 Jan 2009],
followed by a 27-year-old woman in Shandong on [17 Jan 2009] and a
16-year-old boy in Hunan on [20 Jan 2009].

A 2-year-old girl who was critically ill with the disease was out of
danger at a hospital in Shanxi on Friday [23 Jan 2009] after her
vital signs remained stable for 6 consecutive days. The death rate
for bird flu patients is above 60 percent.

[Byline: An, editor]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[Xinjiang Uygur Autonomous Region has reported a 31-year-old female
as a new death from H5N1 infection. Her death was the 4th death from
H5N1 avian influenza infection in China during 2009. The previous
death from H5N1 infection was a 16-year-old boy from Guizhou
province. He died at Huaihua city of Hunan province on 20 Jan 2009
(see prior PRO/MBDS posting Avian influenza, human - China (04):
Hunan ex Guizhou, fatal, WHO 20090121.0257).

The cumulative number of confirmed human cases of avian influenza
A/(H5N1) reported to the WHO, dated 22 Jan 2009, is available at:
<http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_01_22/en/index.html>
where 34 cases and 22 deaths in China had reported to WHO since 2003.
Of note is that 2 deaths from Xinjiang and Hunan provinces are not
included in this report yet.

For a map of China with provinces, see:
<http://www.lib.utexas.edu/maps/middle_east_and_asia/china_pol01.jpg>.

For the interactive HealthMap/ProMED map of China with links to other
ProMED-mail and PRO/MBDS postings in China and surrounding areas,
see: <http://healthmap.org/promed?v=36.5,103.9,4>. - Mod.YMA]

[see also:
Avian influenza, human - China (04): Hunan ex Guizhou, fatal,
WHO 20090121.0257
Avian influenza, human - China (03): Shandong, fatal 20090118.0219
Avian influenza, human - China (02): Shanxi ex Hunan 20090118.0218
Avian influenza, human - China: Beijing, WHO 20090108.0078
2008
----
Avian influenza, human - MBDS region (11): China (Guangxi), WHO 20080222.0726
Avian influenza, human - MBDS Region (10): China (Guangxi) 20080221.0705
Avian influenza, human - China (02): Guangdong, WHO 20080227.0797
Avian influenza, human - China: Guangdong 20080225.0764
Avian influenza, human: China (Jiangsu), Pakistan, WHO 20080110.0135
2007
----
Avian influenza, human (05): China (Fujian), WHO conf. 20070530.1749
Avian influenza, human (04): China, RFI 20070526.1683
Avian influenza, human (03): China (Anhui) 20070329.1077
Avian influenza, human: H9N2, China (Hong Kong SAR) 20070320.0980]

AVIAN INFLUENZA, HUMAN (14): INDONESIA, WORLD HEALTH ORGANIZATION

2009-02-04T16:10:00.000-08:00

Date: Thu 22 Jan 2008
Source: World Health Organization (WHO), EPR, Disease Outbreak News [edited]
<http://www.who.int/csr/don/2009_01_22/en/index.html>

The Ministry of Health of Indonesia has announced 2 new confirmed
cases of human infection with the H5N1 avian influenza virus. A
29-year-old female from Tangerang District, Banten Province developed
symptoms on 11 Dec 2008, was hospitalized on 13 Dec 2008 and died on
16 Dec 2008. The investigation indicated that she visited a wet
market to buy fresh produce, including chicken meat, on a daily
basis. Household contacts were placed under medical observation, and
none developed illness.

The 2nd case, a 5-year-old female from Bekasi City, West Java
Province developed symptoms on 23 Dec 2008, was hospitalized on 27
Dec 2008 and died on 2 Jan 2009. The investigation indicated that she
visited a wet market to buy chicken meat and eggs 2 days prior to
symptom onset. Contacts were placed under medical observation, and
none developed illness.

Laboratory tests confirmed the presence of the H5N1 avian influenza
virus in both cases.

Of the 141 cases confirmed to date in Indonesia, 115 have been fatal.

AVIAN INFLUENZA (10): CHINA (GUIZHOU, SHANDONG)

2009-02-04T16:09:00.001-08:00

[1] & [2] Guizhou province
[3] & [4] Shandong province

******
[1] Guizhou province
Date: Mon 19 2009
Source: Xinhua News Agency [Chinese, trans. Rapp.DS, edited]
<http://hn.rednet.cn/c/2009/01/19/1693505.htm>

On the afternoon of 16 Jan 2009, Huaihua City No. 1 People's Hospital
admitted a transfer patient from Guizhou Province. The preliminary
diagnosis was pneumonia of unknown origin, suspected avian influenza.
The patient is 16 years old, a male student. He is a resident of
Qiandongnanzhou in Guizhou Province. The patient fell ill on 8 Jan
2009 in Guizhou. Because his condition deteriorated, he was
transferred to Huaihua in Hunan Province for treatment on 16 Jan 2009.

After receiving a report, the provincial health bureau and provincial
CDC [Centre for Disease Control and Prevention] quickly sent experts
to Huaihua to provide guidance on treatment and prevention work.
Provincial CDC tests were positive for H5N1 avian influenza RNA. On
19 Jan 2009, China CDC ran confirmatory tests which were positive for
H5N1 avian influenza RNA. Epidemiological investigations found that
the patient had contact with diseased poultry carcasses prior to falling ill.

AVIAN INFLUENZA, HUMAN (11): CHINA, WORLD HEALTH ORGANIZATION UPDATE

2009-02-04T15:50:00.000-08:00

Date: Mon 19 Jan 2009

Source: World Health Organization (WHO), EPR, Disease Outbreak News [edited]
<http://www.who.int/csr/don/2009_01_19/en/index.html>

As of Mon 19 Jan 2009, the Ministry of Health in China has reported 3
new cases of human infection with the H5N1 avian influenza virus.

The 1st case is a 27-year-old female from Jinan City, Shandong
Province. She developed symptoms on 5 Jan 2009, was hospitalized, and
died on 17 Jan 2009. The source of her infection is presently under
investigation.

The 2nd case is a 2-year-old female from Luliang City, Shanxi
Province. She developed symptoms on 7 Jan 2009, was hospitalized, and
is in a critical condition. The source of her infection is presently
under investigation. [Other accounts state that the child acquired
infection in Hunan province and was taken by her grandparents to
Shanxi province, where she was treated. - Mod.CP]

The 3rd case is a 16-year-old male from Huaihua City, Hunan Province.
He developed symptoms on 8 Jan 2009, was hospitalized on 16 Jan 2009,
and is in a critical condition. The case had exposure to sick and dead poultry.

All 3 cases were confirmed by the national laboratory. All contacts
have been placed under medical observation and remain healthy to date.

Of the 34 cases confirmed to date in China, 22 have been fatal.

AVIAN INFLUENZA, HUMAN (164): INDONESIA

2006-10-13T15:14:00.000-07:00

Date: Thu 12 Oct 2006
Source: The Washington Post online, Reuters report,Thu 12 Oct 2006 [edited]
http://www.washingtonpost.com/wp-dyn/content/article/2006/10/12/AR2006101201191.html

An Indonesian man who had been suffering from bird flu for days died early
on Thu 12 Oct 2006, a hospital official said, taking Indonesia's death toll
from the disease to 52.

"He died because of breathing problems which he had suffered since he was
admitted to the hospital," said Hadi Yusuf, who heads the bird flu ward at
Hasan Sadikin hospital in Bandung, West Java's provincial capital. The
government had acknowledged the 20 year old victim as a bird flu case
earlier this week.

The man's brother died with bird flu symptoms on Sunday but due to lack of
testing there has been no positive confirmation he had the disease. A 3rd
sibling, a 15 year old girl, is currently being treated at Hasan Sadikin
hospital. "She is doing allright, no fever. We are still looking into
whether she has [contracted avian influenza virus]. The 3rd testing will be
conducted today," Yusuf told Reuters by phone. Two previous tests have
found [no] trace of bird flu.

Relatives of the three siblings are also being tested. The disease spread
into the family when a member brought chickens with the virus to their house.

Indonesia has more bird flu deaths than any other country. The government
has faced criticism for not doing enough to combat the disease, endemic in
birds in almost all provinces in the archipelago of 17 000 islands. Unlike
other bird flu-affected nations such as Thailand, culling poultry is not
easy in Indonesia because of fierce opposition from farmers and the
logistical difficulties in dealing with millions of backyard fowl. Farmers
oppose culling because of low compensation. However, at times residents of
areas where someone has died of the disease demand aggressive culling by
the government.

--
There is some confusion regarding the number of human avian fatalities in
Indonesia. According to WHO Update 34 (see: Avian influenza, human (157):
Indonesia 20060929.2797), as of Thu 28 Sep 2006, the Ministry of Health in
Indonesia confirmed the country's 52nd death from H5N1 avian influenza. A
20 year old man, whose infection was announced on 27 Sep 2006, died early
in the morning of 28 Sep 2006. Of the 68 cases in Indonesia confirmed at
that date in Indonesia, 52 had been fatal. Therefore the 20 year old man
described above, who died on 12 Oct, should be identified as the 53rd
fatality. Currently the WHO cumulative list (11 Oct 2006) indicates 69
cases and 52 deaths (see:
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_10_11/en/index.html).

AVIAN INFLUENZA (204) - CHINA (NINGXIA, INNER MONGOLIA)

2006-10-13T12:01:00.000-07:00

Date: Thu 12 Oct 2006
Source: FIC, 9 Oct 2006 [edited]
http://www.flu.org.cn/en/news_detail.asp?newsId=12218 [translated by FIC
from the original, 5 Oct 2006

Chinese notification at MOA website
http://www.agri.gov.cn/ztzl/fkqlg/yqfb/t20061005_697228.htm; edited]

A H5N1 outbreak in poultry was confirmed by the reference lab of [China's]
MOA on 3 Oct 2006. The outbreak occurred in Yinchuan [capital and largest
city] of Ningxia Hui [autonomous region] of China, where 1000 poultry died
and 72 930 were culled.

--
The above information was included in China's Avian Influenza follow-up
report No. 20 to the Office International des Epizooties, dated 4 Oct 2006,
mentioning the name of the affected village, He Lanshan. The same
notification included details of another outbreak, namely in the village of
Xincheng, Baotou, Inner Mongolia, where 985 poultry died and 8990 were
culled; see http://www.oie.int/eng/info/hebdo/aIS_76.htm#Sec9.

AVIAN INFLUENZA (203) - SUDAN (CENTRAL EQUATORIA): OIE

2006-10-13T12:00:00.000-07:00

Date: 5 Oct 2006
Source: OIE Disease Information Vol 19 - No. 40 [edited]
http://www.oie.int/eng/info/hebdo/A_CURRENT.HTM#Sec6

Avian influenza in Sudan: follow-up report No. 3
------------------------------------------------
Identification of agent: highly pathogenic avian influenza virus subtype H5N1.
Date of start of the event: 20 Feb 2006.
Nature of diagnosis: clinical and laboratory.

New outbreaks: There were 6 outbreaks in Juba, Central Equatoria state. Of
the 5000 susceptible birds, there were 50 cases and 50 deaths; 20 were
ducks and 30 were chickens.

Description of affected population: poultry in backyard systems 1600 km
south of Khartoum.

Laboratory where diagnostic tests were performed: Veterinary Laboratory
Agency, Weybridge, United Kingdom
Results: RT-PCR was positive on 8 Sep 2006.

Control measures undertaken: total depopulation of all infected and
in-contact birds in Juba town; total ban of movement of live birds and
poultry meat from Juba town to other areas and counties in southern Sudan.

Other details/comments: the disease is now confined to Khartoum, Gezira,
River Nile and Central Equatoria States.

--
Juba is located in the southern part of Sudan and is the capital of the
autonomous region since the 2005 peace agreement between North and South
Sudan. I assume Central Equatoria and Bahr Al Jebel referred to in a
previous posting are the same location; see below.

Juba is located on the White Nile about 150 km north of Uganda and is the
key gateway to the southern region of Sudan. Of course, there are concerns
that avian influenza is found in poultry this far south while still being
present in Khartoum. As always, effective comprehensive surveillance to
identify infected flocks and areas is the key.

AVIAN INFLUENZA, HUMAN (163): EGYPT, INDONESIA

2006-10-13T11:57:00.000-07:00

In this update:
[1] & [2] Egypt - 15th human case confirmed
[3] Indonesia (West Java) - 70th human case

******
[1] Egypt - 15th human case confirmed
Date: Tue 10 Oct 2006
Source: Reuters Foundation Alertnet [edited]
http://www.alertnet.org/thenews/newsdesk/L10655066.htm

Egypt: new human H5N1 bird flu case detected
--------------------------------------------
Egypt has detected its first human case of the highly pathogenic H5N1 avian
influenza virus since May [2006] in an Egyptian woman who raised ducks from
her home, a World Health Organization official said on Tuesday [10 Oct 2006].

Hassan el-Bushra, regional adviser for communicable diseases surveillance
at the World Health Organization, said the woman had tested positive for
the avian influenza virus in tests carried out by Egyptian health
authorities. The new infection brings the number of human cases in Egypt to
15, of whom 6 have died. All the previous infections were detected between
March and May 2006 after the virus first surfaced in Egyptian poultry in
February [2006].

The woman, 39 years old, of the Nile Delta province of Gharbiya, has been
in hospital since 4 Oct 2006 and has been treated with the drug Tamiflu
(oseltamivir), state news agency MENA said. The woman was on a respirator,
but her condition was stable, MENA said. Her family was being tested for
the virus.

Egypt has had the largest cluster [thatis, number of cases. - Mod.CP] of
human bird flu cases outside of Asia, and the fresh case came a month after
authorities found a cluster of new cases in birds following a 2 month lull
in detected poultry cases.

The initial bird flu outbreak caused panic in Egypt, where poultry is a
major source of protein and where poor families frequently breed chickens
domestically in cities and rural areas to supplement their diet and income.
MENA reported that the newly infected woman had raised a flock of 11 ducks
from her home north of the Egyptian capital. Two became sick and died, and
she then slaughtered the rest before she was hospitalized.

Most of the people infected with bird flu in Egypt became ill after coming
into contact with so-called "backyard" birds, officials say. Egypt has
culled 30 million birds since February 2006 to contain the virus. Chickens
on rooftops may be particularly susceptible to catching the virus from
infected migrant birds, which fly along the densely populated Nile valley
during migration, experts have suggested.

Bushra had earlier said that the fresh cases of bird flu in Egyptian
poultry showed that there was still a risk for human cases, but a large
outbreak was less likely to take hold or spread so long as Egypt continued
to vaccinate poultry. The vast majority of Egyptian commercial poultry
flocks have been vaccinated, while about 20 per cent of domestic birds had
received vaccines, officials say.

Two separate officials said the onset of warm weather, combined with
Egyptian government measures, may have helped keep the virus at bay during
the summer months. But an official from the Food and Agriculture
Organization has said that the onset of cooler weather could still cause a
flare-up of cases in poultry and has urged increased surveillance
accompanied by a fair compensation scheme.

******

[2] Egypt - 15th human case confirmed
Date: Wed 11 Oct 2006
Source: World Health Organization (WHO), CSR, Disease Outbreak News [edited]
http://www.who.int/csr/don/2006_10_11/en/index.html

Egypt: avian influenza situation - WHO update 9
-----------------------------------------------
As of Wed 11 Oct 2006, the Ministry of Health in Egypt has confirmed the
country's first case of human infection with the H5N1 virus since May of
this year [2006].

The patient is a 39 year old woman from the Gharbiya governorate in the
Nile Delta. She developed symptoms on 30 Sep 2006 and was admitted to
hospital on 4 Oct 2006. She subsequently developed pneumonia. She remains
in hospital in a stable condition.

Her recent history includes the home slaughter and defeathering of around a
dozen ducks, when signs of illness and deaths began to occur in the flock.

Egypt reported a recurrence of poultry outbreaks in backyard flocks in
September 2006. Previous human cases occurred from late March through May
2006. To date, the country has reported 15 cases, of which 6 were fatal.

--
The location of the Gharbiya governorate (province) can be found by
accessing the map of Egypt at
http://www.un.org/Depts/Cartographic/english/htmain.htm. It lies to the
north of Cairo in the Nile delta (at 3 on the map).

******
[3] Indonesia (West Java) - 70th human case
Date: Wed 11 Oct 2006
Source: People's Daily online, Xinhua report [edited]
http://english.people.com.cn/200610/11/eng20061011_310840.html

Indonesian woman tested positive for bird flu virus infection
-------------------------------------------------------------
A 67 year old Indonesian woman being treated in hospital is positively
infected by avian influenza, a health official said on Wednesday [11 Oct
2006]. The woman had contact with fowl before she was admitted to hospital
on 7 Oct 2006 in the Hasan Sadikin hospital in Bandung, capital of West
Java province, said Joko Susilo, an official in charge at the anti-bird-flu
center here.

"The woman tested positive for avian influenza," Susilo told the Xinhua
News Agency. He said that the tests were carried out by the Health Ministry
Laboratory and NAMRU, the United States Naval Medical Research Unit based
in Jakarta. Indonesia has become one of the front lines in the fight
against the H5N1 virus.

So far, the country has recorded 52 deaths, surpassing Viet Nam, making
Indonesia the hardest hit country, according to the World Health
Organization. Altogether, 130 out the 146 human deaths caused by bird flu
have occurred in East Asia since 2003, according to the data from the World
Bank.

--
This woman will become the 70th human case of H5N1 avian influenza virus
infection in Indonesia if confirmed by WHO.

AVIAN INFLUENZA, HUMAN (162): OSELTAMIVIR RESISTANCE

2006-10-13T11:55:00.000-07:00

Date: Tue 10 Oct 2006
Source: Bangkok Post online, Tue 10 Oct 2006 [edited]
http://www.bangkokpost.com/News/10Oct2006_news08.php

The bird flu virus has already developed signs of resistance to
oseltamivir, the drug widely used to treat the disease's symptoms in
humans, a research study has found. Yong Poovorawan, who headed a group of
researchers, said his team learned of the resistance which was reflected in
[replacement?] of amino acids in the [viral neuraminidase?]. It was the
first scientific study that could pinpoint such changes -- a result of
genetic [change] of avian flu [virus] -- and its resistance to oseltamivir.

The study would [will?] soon be published in the Emerging Infectious
Diseases Journal and Journal of Virological Methods. "This study will
enable medical science and health personnel to precisely diagnose bird
flu-like symptoms among patients for immediate, appropriate treatment," he
said.

Avian flu resistance to oseltamivir had been confirmed in 4 bird flu
patients in Viet Nam, 3 of whom died in 2005. The Viet Nam cases showed the
possibility that oseltamivir might be less effective than anticipated,
particularly as resistant strains of bird flu become more prevalent. A
previous study in Japan also found a genetic [change] in the H3N2 flu
strain in 18 per cent of patients who took oseltamivir, he said.

Dr Yong, a virologist at Chulalongkorn University's faculty of medicine,
earlier warned the Public Health Ministry and the hospitals run by the
Bangkok Metropolitan Administration to exercise caution when prescribing
oseltamivir in patients with influenza and bird flu-like symptoms, saying
continuous and frequent use of the [drug] without precise diagnoses was
likely to trigger viral resistance. During bird flu outbreaks, health
personnel treated people with flu and bird flu-like symptoms with
oseltamivir, even if they had not been in contact with poultry.

Disease Control Department director-general Thawat Sundarachan agreed that
the anti-viral drug made it harder for doctors and epidemiologists to
identify the virus due to the absence of related bird flu symptoms, citing
the latest death case in Nong Bua Lam Phu province. Several laboratory
tests had to be conducted before the death was confirmed as the country's
17th bird flu fatality [see ProMED-mail post entitled "Avian influenza,
human (155): Thailand, Indonesia 20060927.2757"].

But Dr Thawat insisted only patients with records of touching or eating
chickens that had died mysteriously would be treated with oseltamivir. He
believed that the [drug] was still the best defence against the lethal H5N1
strain of bird flu and other types of human flu. The closely-related
zanamivir drug was also effective, but since the drug had to be inhaled, it
was almost impossible for patients with severe lung damage to use it, he said.

--
This vague report of detection of oseltamivir resistance in Thailand
implies that specific genetic changes have been identified that have
conferred oseltamivir resistance and provided information useful in the
treatment of patients. Instances of oseltamivir resistance in patients have
been reported previously, but there has been no unequivocal confirmation of
transmission of resistant virus from person to person.

Oseltamivir (Tamiflu) and zanamivir (Relenza) inhibit the activity of the
viral neuraminidase, an enzyme that enables influenza virus to escape from
an infected cell and spread to other cells. Several studies suggest that
viral resistance to oseltamivir may be a greater problem than previously
believed. For example, in epidemics of H3N2 influenza in Japan in 2002 and
2003 about 1/5 of children developed resistance by day 4 or later during
treatment with oseltamivir, and about 1/4 of children who shed virus for 3
days or more had drug-resistant influenza viruses. The
neuraminidase-resistant mutations isolated were found to be from 300 to 100
000 times more resistant to oseltamivir than oseltamivir-susceptible virus.

These reports of the emergence of drug resistance make the development of
new anti-influenza molecules a priority. Neuraminidases from influenza type
A viruses form 2 genetically distinct groups: group-1 contains the N1
neuraminidase of the H5N1 avian virus and group-2 contains the N2 and N9
enzymes used for the structure-based design of current drugs. Recently R J
Russell and colleagues have shown by X-ray crystallography that these 2
groups are structurally distinct. Group-1 neuraminidases contain a cavity
adjacent to their active sites that closes on ligand binding. These authors
suggest that this feature may facilitate the design of new
anti-neuraminidase drugs by allowing the size and location of the group-1
cavity to be altered (see: Russell RJ, Haire LF, Stevens DJ, Collins PJ,
Lin YP, Blackburn GM, et al. The structure of H5N1 avian influenza
neuraminidase suggests new opportunities for drug design. Nature 2006; 443
(7107): 37-38.).

AVIAN INFLUENZA, WILD BIRDS - USA (MONTANA) (02): LOW PATHOGENICITY CONFIRMED

2006-10-09T10:21:00.000-07:00

Source: USDA [edited]
http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?contentidonly=true&contentid=2006/10/0402.xml

Avian influenza tests complete On wild northern pintail ducks in Montana
-----------------------------------------------
The United States Departments of Agriculture (USDA) and Interior (DOI)
today [8 Oct 2006] announced final test results, which confirm that a low
pathogenic H5 avian influenza virus was found in samples collected last
month from wild northern pintail ducks in Montana. This type of avian
influenza has been detected several times in wild birds in North America
and poses no risk to human health.

The USDA National Veterinary Services Laboratories (NVSL) confirmed the
presence of low pathogenic H5N3 avian influenza through virus isolation in
2 of the 16 samples collected from wild pintails in Cascade County,
Montana. Initial screening results announced on 21 Sep 2006 indicated that
H5 and N1 subtypes might be present in the collected samples, but further
testing was necessary to confirm the H and N subtypes as well as pathogenicity.

The initial rapid screening tests are highly sensitive and can detect
active and inactive viruses in samples. Varieties of this test can screen
for the presence of all strains of avian influenza virus. Because these
rapid screening tests are highly sensitive, it is not uncommon to have
positive results for a specific subtype on the initial screen test and yet
not be able to isolate a virus of that subtype. This was the case for the
N1 subtype in this sample, which tested as a weak positive in the initial
screen test. During confirmatory testing, an N1 subtype was not isolated,
but instead an N3 was found. As previously announced, genetic testing ruled
out the possibility that the samples carried the highly pathogenic strain
of H5N1 avian influenza that is circulating overseas.

Low pathogenic strains of avian influenza occur naturally in wild birds and
typically cause only minor sickness or no noticeable signs of disease in
birds. In most cases, they cause no signs of infection or only minor
symptoms in birds. These strains are common in the US and around the world.
Low pathogenic avian influenza viruses are very different from the more
severe highly pathogenic H5N1 circulating in parts of Asia, Europe and
Africa. Highly pathogenic strains of avian influenza spread rapidly and are
often fatal to chickens and turkeys.

The Departments of Agriculture and Interior are working collaboratively
with States and academic institutions to sample wild birds throughout the
US for the presence of highly pathogenic avian influenza.

For more information about the collaborative avian influenza efforts, go to

http://www.usda.gov/birdflu,

http://www.doi.gov/issues/avianflu,

or the US government's website for avian influenza and human pandemic preparedness
at

http://www.avianflu.gov/.

AVIAN INFLUENZA (202) - INDONESIA: PORCINE, FELINE

2006-10-09T10:19:00.001-07:00

Source: TempoInteractive [edited]
http://www.tempointeractive.com/hg/nasional/2006/10/06/brk,20061006-85557,uk.html

Bird Flu Virus Infects Pigs in Bali
---------------------------------------
The Team of Veterinary Faculty at Udayana University has found evidence
that the avian influenza (AI) virus has infected pigs in Bali. Wider scale
research is now in process. The AI finding on pigs was due to college
students' research, which diagnosed several ill pigs from May to June 2006.
Out of 20 pigs, 2 were positively infected by H5N1 virus. "The pigs are in
Gianyar and Tabanan," said I Gusti Ngurah Mahardika, a professor at the
faculty, on Fri 6 Oct 2006.

The virus grows in ill pigs, and the pigs cannot be cured by medical
treatment. [At necropsy], there are red blotches on the spleen. By
[immunohistochemistry], the red blotches were viruses on the pigs' tissue.

However, the H5N1 virus was not found in the animals' tissue. "Probably the
virus only passed by, or is called an opportunistic virus," said Mahardika.

The finding has not yet been publicized as a scientific study, but it has
been conveyed to the Bali Breeding Service as a warning.

Virus contagion, according to Mahardika, is likely because with the pattern
of chicken and duck breeding, the animals are free to enter pig stalls. In
Bali, 900 000 pigs live side by side with other cattle.

******
[2]
Date: Sat 7 Oct 2006
Source: The Jakarta Post [edited]
http://www.thejakartapost.com/detailnational.asp?fileid=20061007.H06&irec=5

Cats can carry bird flu, study says
-------------------------------------
Recent studies have revealed that cats can contract the avian influenza
virus and that there is no evidence that migratory birds are responsible
for the spread of the disease.

A study conducted by the Indonesian Environment Information Center (PILI)
in Yogyakarta found that stray cats had caught the H5N1 virus through
contact with infected poultry at traditional markets.

"We are positive that cats can have the virus, although it is yet to be
proven that they can transmit the virus to other animals or humans," PILI
director Iwan Setiawan said on Thursday [5 Oct 2006] after a discussion on
the role of migratory birds in the spreading the virus.

AVIAN INFLUENZA, HUMAN (161): AGE-RELATED SEVERITY

2006-10-09T10:14:00.000-07:00

Avian influenza virus infection and age-related severity
-----------------------------------------------
Health officials and physicians in Indonesia are to be commended for their
proactive testing of children for H5N1 influenza in cases where there are
no obvious symptoms of severe respiratory involvement. It
should be noted that, as yet, there has been no confirmation by laboratory
testing that any of the 7 children below the age of 10 identified in this
report have contracted avian influenza virus infection.

There is good reason for increasing the focus of H5N1 surveillance efforts
on children and adolescents: WHO data published on 3 Oct 2003 indicate that
age-specific morbidity and mortality rates are skewed towards the younger
age cohorts, with approximately half of all WHO confirmed cases coming from
individuals who were less than 20 years old

http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.

The highest number of cases and deaths were observed in the 10 to 39 years
age groups, and only about a quarter were in the less than 10-year-old age
bands.

Data collected from human cases in Viet Nam and Thailand since 2003 show
that disease and mortality from H5N1 avian influenza tend to be more severe
among children than adults

http://www.cdc.gov/mmwr/preview/mmwrhtml/su5501a2.htm and

http://www.prbo.org/cms/docs/birdflu/deJong_and_Hien_2006_J%5B1%5D._Clinical_Virology.pdf,

a factor which is complicated by the fact that severe and fatal H5N1
infections in children and adolescents have been shown to occur in the
absence of respiratory presentations or marked respiratory involvement

http://www.cdc.gov/mmwr/preview/mmwrhtml/su5501a2.htm,

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&
dopt=Abstract&list_uids==15716562,

http://www.cdc.gov/ncidod/EID/vol10no7/04-0415.htm and

http://content.nejm.org/cgi/content/full/353/13/1374.

This represents an apparent change in the epidemiology of the H5N1 virus in
humans subsequent to the 1997 outbreak in Hong Kong, where severe disease
symptoms were seen less frequently among children than adults.

Studies in Viet Nam and Thailand have shown that fatal H5N1 infections in
children may occur as gastroenteritis or encephalitis syndromes in the
absence of any marked respiratory symptoms

http://www.cdc.gov/mmwr/preview/mmwrhtml/su5501a2.htm,

http://content.nejm.org/cgi/content/full/350/12/1179, and

http://www.cdc.gov/ncidod/EID/vol10no7/04-0415.htm.

Studies in Thailand, Viet Nam, and Hong Kong have found that children
infected with the H5N1 bird flu virus often presented symptoms resembling
those typical of other more common fatal diseases of children in Southeast
Asia, such as dengue fever, Japanese encephalitis, cholera, or dysentery

http://www.wpro.who.int/sites/csr/data/data_Graphs.htm,

http://www.cdc.gov/mmwr/preview/mmwrhtml/su5501a2.htm,

http://www.prbo.org/cms/docs/birdflu/deJong_and_Hien_2006_J%5B1%5D._Clinical_Virology.pdf,

http://content.nejm.org/cgi/content/full/350/12/1179,

http://www.cdc.gov/ncidod/EID/vol10no7/04-0415.htm,

http://content.nejm.org/cgi/content/full/353/13/1374,

http://www.cdc.gov/mmwr/preview/mmwrhtml/00050459.htm.

The apparent higher frequency of non-respiratory disease syndromes and
symptoms among children and adolescents reported in the recent literature
on human H5N1 cases suggests that H5N1 infections in children are more
likely to be confused with other more common diseases, and children are
therefore more likely to be overlooked as possible bird flu cases when they
are not associated with infected adults exhibiting classical severe acute
respiratory collapse or "cytokine storm" syndromes.

Taken together, I believe that these studies indicate that there is a need
for an increased focus on children and adolescents for human bird flu
surveillance programs, and the explicit targeting of gastrointestinal and
encephalitis symptoms as a differential diagnosis criterion for H5N1
testing of children or adolescents with a history of exposure to poultry.

AVIAN INFLUENZA, HUMAN (160): INDONESIA

2006-10-06T13:51:00.000-07:00

In this update:

[1] South Sulawesi - 7 more suspected cases
[2] Bali, Java & Sumatra - bird viruses unchanged

******
[1] South Sulawesi - 7 more suspected cases
Date: Fri 6 Oct 2006
Source: The Jakarta Post online, Fri 6 Oct 2006 [edited]
www.thejakartapost.com/detailheadlines.asp?fileid=20061006.A06&irec=5

Seven people showing symptoms of bird flu have been admitted to a hospital
in Makassar, South Sulawesi. The patients, most less than 10 years old,
were being treated in the Pakis isolation room at Wahidin Sudirohusodo
Hospital on Thu [5 Oct 2006] for high fever and vomiting. "Our preliminary
clinical diagnosis was that they were infected with the bird flu virus, so
we moved them to the isolation room," said M. Halik, who is responsible for
bird flu treatment at the hospital.

Halik said the 7 patients' blood had tested negative for the H5N1 bird flu
virus. To be certain of the diagnosis, however, he said doctors needed the
results of tests on the patients' nasal mucus from a laboratory in Jakarta.
"We've sent the specimens to Jakarta and are waiting for the test results,"
he said. Family members said chickens near the patients' homes had been
falling ill and dying rapidly without any clear reason, Halik added.

The Wahidin Sudirohusodo Hospital is somewhat overwhelmed by the increasing
number of suspected bird flu patients it is treating. Two isolation rooms
designed to hold 2 patients each have had to accommodate twice that number.
According to the Ministry of Health, a total of 69 people have contracted
bird flu in Indonesia. Of those, 52 have died.

Meanwhile, in Central Java, many chickens have fallen ill and died in
recent days in a possible outbreak of the disease. The H5N1 virus is
believed to be killing poultry in 17 kampongs in the Central Java regencies
of Semarang, Temanggung, Purbalingga, Pekalongan and Pemalang, according to
Kurmaningsih, the head of the Central Java Livestock Husbandry Office.
Rapid tests on dead chickens in Lebdosari kampong, Gisikdrono, in Semarang,
indicated they had the virus. Local authorities later culled 35 other
chickens in the kampong to prevent the disease from spreading.

Kurmaningsih said her office had asked for 10 million more doses of H5N1
vaccine from the central government. "We currently have 12 million doses of
the vaccine, but we want more in order to be ready for a much bigger
outbreak," she said in Semarang on Thursday. Kurmaningsih explained that
despite the massive poultry vaccination drive launched earlier this year
through a program called the National Movement against Avian Influenza, the
infections which started hitting the province in 2003 have continued to
spread. Kurmaningsih said under the program, her office distributed 50
million doses of vaccine to poultry owners in the province in 2004, 14
million doses in 2005 and another 22 million doses this year. "We culled
chickens in Boyolali in 2004. But now we have no plans to do so because the
social impacts (of culling) are so widespread. Besides that we still don't
know whether there will be compensation for the culled chickens," she
explained.

In a related development, the Ministry of Health plans to build modern
laboratories in North Sumatra to diagnose bird flu infections, Aswin Soefi
Lubi, dean of the School of Medicine at the Islamic University of North
Sumatra, said Thu [5 Oct 2006]. Aswin said one of the laboratories will be
built at his medical school. They will be used to test blood from suspected
bird flu victims without having to send the samples to Jakarta.

--
Preliminary diagnostic testing has not confirmed that any of these
patients are suffering from avian influenza. The observation that most are
less than 10 years old and experiencing vomiting suggests that the
diagnosis of avian influenza will not be confirmed by further testing.
Further information is awaited.

******
[2] Bali, Java & Sumatra - bird viruses unchanged
Source: Bloomberg News, Fri 6 Oct 2006 [edited]
http://tinyurl.com/q2w8r

The bird flu virus that's killed one person a week in Indonesia this year
hasn't mutated to become more contagious to people, the country's
Agriculture Ministry said, citing an analysis of virus samples. Tests on 49
samples taken from birds on the islands of Sumatra, Java and Bali showed
the H5N1 avian influenza virus has undergone no major changes, the Ministry
said in a statement today [Thu 5 Oct 2006]. The analysis was undertaken by
a World [Health?] Organization for Animal Health reference laboratory in
Geelong, Australia.

Flu viruses make minor genetic changes when they reproduce, though most of
the time they don't become more infectious in the process. Disease trackers
are monitoring H5N1 to check whether it has mutated to become easily
transmissible between people. Millions could die if the virus sparks a
global outbreak.

In the past 3 years, H5N1 is known to have infected 252 people in 10
countries, killing 148 of them, the World Health Organization said on 3 Oct
2006. Almost all human cases have been linked to close contact with sick or
dead birds, such as children playing with them or adults butchering them or
plucking feathers, according to the United Nations agency. Indonesia has
reported 69 human H5N1 cases, including 52 deaths, since July 2005. So far
in 2006, at least 40 people have died from the virus, mostly through
contact with infected fowl. About 300 million poultry are raised in
backyards in the world's 4th-most-populous country.

Samples of the H5N1 virus taken from birds were collected between September
in 2005 and March, Elly Sawitri, an official at the agriculture ministry's
avian flu center, said in a telephone interview today. Animal health
authorities will dispatch samples collected in the past 6 months for
analysis, Sawitri said. Indonesia agreed to deposit avian flu genetic
information in public databases, such as GenBank, 4 months ago to help
scientists better track dominant variants of the virus and to speed
preparations for vaccines to fight a human outbreak.

The virus may have infected as much as 27 percent of fowl and caged birds
in the Southeast Asian nation, Musny Suatmodjo, Indonesia's director of
animal health, said last week. The Health Ministry and Singapore's Temasek
Life Sciences Laboratory Ltd. are developing a diagnostic kit to speed the
diagnosis of human H5N1 cases. The kit may be available within a year, Tan
Kok Keng, Temasek Life's chief operating officer, told reporters in Jakarta
today.

--
What constitutes a genotypic change enabling H5N1 avian influenza to be
transmitted from human-to-human can only be conjectured at this juncture.
It must be assumed that the statement, "The H5N1 avian influenza virus has
undergone no major changes", means no more than that no progressive or
cumulative changes have been observed in a comparison of 49 isolates of
avian influenza virus isolated fro birds on 3 Indonesian islands.

AVIAN INFLUENZA (201) - CHINA, INDONESIA

2006-10-06T11:48:00.000-07:00

Source: AFP & Todayonline.com [edited]

A new outbreak of bird flu has killed about 1000 poultry in northern China
in the 2nd such case in a week, state media reported. Some 72 930 domestic
poultry have been slaughtered and the outbreak is now under control, Xinhua
news agency said. Laboratory tests had confirmed the H5N1 strain of the
virus, which can be deadly to humans, it added.

The outbreak, in Henan New Village in Yinchuan, regional capital of the
desert-like Ningxia Hui region, follows a similar occurrence in
neighbouring Inner Mongolia. Beijing banned chicken exports from the Baotou
region of Inner Mongolia after H5N1 killed about 1000 chickens and ducks
there. Xinhua said on Tuesday that the Baotou outbreak, which came to light
on 27 Sep, had been brought under control. It was the 1st incidence
reported in China in 6 weeks.

According to official figures, 21 people in China have contracted bird flu
and 14 of them have died. The most recent fatality occurred in July in the
western region of Xinjiang. The latest case in Ningxia Hui brings to 40 the
number of bird flu outbreaks among poultry in China since October 2005.
China confirmed in August that its 1st human bird flu victim died in late
2003, 2 years earlier than previously reported.

--

Chinese media reports the specific location of the avian influenza outbreak
as Helan Mountain Farm's Henan New Village, in Xixia District of Yinchuan
City in Ningxia Hui Autonomous Region. Elsewhere, Helan Mountain Farm is
described as an alfalfa farm on about 2500 acres.

AVIAN INFLUENZA, HUMAN (159): INDONESIA

2006-10-04T15:27:00.000-07:00

Indonesia: Avian Influenza Situation - WHO Update 35
-----------------------------------------------
As of Tue 3 Oct 2006, the Ministry of Health in Indonesia has confirmed the
country's 69th case of human infection with the H5N1 avian influenza virus.
The case is a 21-year-old female from East Java Province. She developed
symptoms on 19 Sep 2006 and was hospitalized on 25 Sep 2006. She remains
hospitalized.

She is the sister of a confirmed H5N1 case, an 11-year-old male who died on
18 Sep 2006. Following that fatal case, health authorities initiated
contact tracing, and on 24 Sep 2006, they received reports of symptoms in
the sister. In line with the national protocol, she was immediately given
the antiviral drug, oseltamivir, and isolated in hospital.

The source of her infection is presently under investigation. Poultry
deaths in the family's household were noted both before and during the
illness of the brother. The woman was likely exposed to these poultry as
well as to her brother.

Of the 69 cases confirmed to date in Indonesia, 52 have been fatal.

AVIAN INFLUENZA (200) - CHINA (INNER MONGOLIA)

2006-10-03T15:20:00.000-07:00

An outbreak of bird flu in north China's Inner Mongolia Autonomous Region
last week has been put under control and no human infection was reported,
according to the regional government. As of zero hour on 2 Oct 2006, no new
deaths of poultry and no human cases of bird flu were reported, a regional
government spokesman said on Monday.

Nearly 1000 chickens and ducks reportedly died suddenly in a poultry farm
in the village of Xincheng in the Jiuyuan District of Baotou city on 27
Sep. The national avian influenza laboratory later confirmed that the H5N1
virus was found in samples taken from the dead poultry.

The owner of the farm and his wife bought some 5400 chickens and ducks
between 21 Aug and 20 Sep from other places in the county. The couple found
more than 70 chickens and ducks dead in the evening of 20 Sep. Dead
chickens and ducks were also found in the following days and the death toll
rose to 985 as of 27 Sep, when the couple reported the case to the
veterinarian station in Baotou city. Baotou city veterinarian station later
reported the case and sent samples of the dead poultry to the Inner
Mongolia Autonomous Regional Animal Epidemic Disease Control Center and the
national avian influenza laboratory.

The local agricultural department immediately quarantined the infected
area. The owner and his wife were also quarantined and people who had close
contact with them were under observation.

To date, 17 616 chickens and ducks have been culled to control the
outbreak. A batch of bird flu vaccines allocated by the Ministry of
Agriculture reached Baotou early Monday morning. All poultry in Jiuyuan
District will be inoculated in the next 10 days.

An investigation is being conducted to find where the farm owner bought
these chickens and ducks and where he sold the poultry.

China has reported 9 outbreaks of bird flu in poultry so far in 2006, in
northwestern Xinjiang Uygur Autonomous Region, north China's Shanxi
Province and Inner Mongolia, east China's Anhui Province, southwestern
Guizhou and Sichuan provinces and the central province of Hunan.