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Egypt: ECDC summary situation

AVIAN INFLUENZA –HUMAN HEALTH – EGYPT

12 June 2007

WHO have reported 2 new cases of H5N1 avian influenza infection in the Qena Governorate in Egypt. The 2 cases are children aged 4 and 10 years. The 4 years old developed symptoms on 7th of June and is currently hospitalized in stable conditions. The 10 years old developed symptoms on 1st June and died on 9th June. The previous report of cases from Egypt was in April 2007. Overall, 36 confirmed cases have been reported in Egypt so far, out of which 15 are known to have died.

WHO latest avian influenza update

WHO timeline of major events

Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO

AVIAN INFLUENZA –ANIMAL HEALTH – VIETNAM

7th June 07

Over recent weeks, there have been a number of reports of outbreaks of H5N1 in poultry farms in Vietnam, including several reported to the OIE1,2. Reports suggest that the majority of birds affected are ducks that have not been vaccinated as part of the national vaccination programme carried out in Vietnam. The outbreaks appear to be dispersed all over the country, with the majority in northern and southern Provinces, although a small number of outbreaks have also been reported in the central provinces.

1) Official report to OIE (17th May – 2 cases in duck farms in Nghe An province (Central Viet Nam)

ECDC Comment (07/06/2007): The Vietnamese authorities continue to work to deliver both a general vaccination policy for all poultry in the country, and associated surveillance programme. A positive element is that recent cases have been mainly confined to ducks and there has been little spill-over to chicken farms- this gives a positive indication that chickens and domestic poultry remain protected and the vaccination campaign continues to produce beneficial results. It is likely that the recent wave of outbreaks are in immunological naive duck populations that were either hatched after the main wave of vaccination took place in the country in 2006, or ducks that are were not immunised as part of the national campaign at that time. The next wave of vaccination in spring 2007 is currently underway, and this may have a positive impact on these unvaccinated populations.

What is concerning is that the number of poultry outbreaks are widely geographically dispersed. While this could relate to linked animal movements, and particularly movement of ducks, between infected premises in some cases, it is primarily an indication that H5N1 continues to circulate in large areas of the country. Hence these unvaccinated duck can in some senses be considered to be sentinels for the presence of the virus, although often ducks show no clinical signs following infection.

In terms of human health, the widespread use of vaccination in animals appears to have had a positive effect on the cases of H5N1 in humans- since concerted vaccination began in Viet Nam in 2005, there have been no cases of infection in humans up to May 2007. Though there are reasons to believe that poultry immunisation may make it harder to detect isolated human cases these data gives a strong indication that efficient vaccination has had a significant effect on reducing the level of virus.3,4) However, these outbreaks highlight that silent spread of virus is continuing, and that there is a need for public health authorities to remain vigilant and to act quickly in the event of suspicious symptomology being presented. It is also remains critical that active surveillance in bird populations is continued in order to track and record the presence of virus, and that international efforts continue to support Vietnamese authorities to sequence circulating viruses.

2) Official report to OIE (24th May- 8 cases in farms in several provinces in Northern and Southern Viet Nam)

3) Highly Pathogenic Avian Influenza A/H5N1 – update and overview of 2006.
Euro Surveill. 2006; 11(12): E061221.1

4) EFSA: Opinion of the Scientific Panel AHAW related with the vaccination against avian influenza of H5 and H7 subtypes in domestic poultry and captive birds

Vietnam: ECDC summary situation

AVIAN INFLUENZA –ANIMAL HEALTH – GHANA

8th June 07

There are still outbreaks of H5N1 avian influenza in Ghana that are unresolved. The southern part of the Greater Accra region is involved. This follows earlier reports of outbreaks in the same area in May. Stamping and disinfection are being applied to the affected premises.

AVIAN INFLUENZA –ANIMAL HEALTH – MALAYSIA

12th June 07

A new avian influenza outbreak attributed to H5N1 was reported by the OIE in the Selangor province of peninsular Malaysia. The outbreak involves semifree-ranging village chickens. Control measures were applied since 6 June 2007 and were completed on 10 June 2007. The total number of birds culled was 4,127, consisting of village chickens (63.17%), fighting cocks (16.89%), ducks (2.43%), quails (1.89%) and other birds (15.62%). Clinical and laboratory surveillance is ongoing in the surveillance zone (10-km-radius zone around the index case). Similarly, surveillance in the whole country is also ongoing.

AVIAN INFLUENZA –ANIMAL HEALTH – MYANMAR

9th June 07

There are poultry outbreaks that are still recorded as unresolved, mainly in the Yangon province of Myanmar.

2) Quality Assurance and Safety: Blood Products and related Biologicals

SCIENTIFIC ADVANCES –AVIAN INFLUENZA – THERAPY

Prophylactic and therapeutic efficacy of human monoclonal antibodies against H5N1 Influenza. Simmons CP, et al
PLoS Med. 2007 May;4(5):e178.

Description (13/06/2007): the authors of the study used blood samples from Vietnamese patients that had recovered from H5N1 infection, to produce specific monoclonal antibodies (mAbs) against H5N1 influenza virus. These monoclonal antibodies were then tested for their ability to neutralize H5N1 and other flu viruses in animal experiments in the laboratory. Four of the selected antibodies neutralized homologous H5N1 viruses in mice, although with different efficacies. The antibodies provided protection from infection with the original virus when given a day before or one to three days after infection. Three antibodies also partly protected the mice against heterologous H5N1 (clade 2). Finally, the researchers showed that the antibodies protected mice by limiting viral replication, especially in the lungs, and by stopping viral spread out of the lungs. According to author’s conclusions the strengths of their approach for the development of human mAbs are: (1) it uses the human immune response rather than that of animal surrogates—the antibodies selected will be those that have been generated in response to the natural infectious pathogen and have protected the individual, (2) it is fast, (3) screening can be performed using functional assays, i.e., neutralization, (4) it allows screening of a large repertoire of antibodies to select those with the most favorable profile (potency and breadth of reactivity), and (5) since the antibodies are of human origin the risks of self-reactivity against self-antigens is minimized when compared with antibodies generated in mice or through phage display.

ECDC Comment (13/06/2007):
This study provides the conceptual basis for the development of an influenza (H5N1) treatment based on passive immunotherapy. Such approach in not new in the field of prophylaxis and treatment of infectious disease and it proved successful for prophylaxis and/or treatment of diseases such as Hepatitis A and B, varicella, rabies, etc. There are also some anecdotal reports of successful use of convalescent blood products during the 1918/19 Spanish influenza1. Having an additional tool for prophylaxis and treatment of patients affected with H5N1 influenza virus and/or a pandemic virus would undoubtedly be an important public health advance. However issues such as effectiveness and safety of the product in humans, ability to test the first products in trials in what at present are isolated cases, the capacity to produce it in large quantities at affordable costs, cross protection against drifted variants of H5N1 or other possible pandemic strains, should all be carefully assessed before a clinical use of the product can be reasonably considered.

Caution would also be needed to extension of the concept back to the approach undertaken in 1918-19 using convalescent human blood products. Transfusions with human blood products always carry a degree of hazard. Blood products are frequently given to patients in resource poor settings, probably excessively so and sometimes with untoward consequences (unintended infections) for recipients and donors. 2)

1) Luke TC, Kilbane EM, Jackson JL, Hoffman SL. Meta-analysis: Convalescent blood products for Spanish influenza pneumonia: A future H5N1 treatment? Ann Intern Med 2006; 145:599–609.

Comment to influenza@ecdc.europa.eu.

Meetings and workshops

Options for the Control of Influenza Conference – June 17-23rd Toronto Canada

This is the 6th of the once every 4 years scientific conference which aims to provide comprehensive, state-of-the-art scientific information for all disciplines involved in influenza prevention, control, and treatment, including seasonal and pandemic planning. It covers an unusually wide range of topics and is a prime place for those from the range of disciplines from basic science to policy, from veterinary and human considerations.

Conference Website: http://www.optionsviconference.com/

4th European Pandemic Preparedness Workshop, Luxemburg Sept 25th-27th 2007.

The fourth Europe-wide workshop is being organised by the European Commission, ECDC and WHO European Region with for this workshop the Commission taking the lead. It will be open to a limited number of senior officials from countries of the WHO Europe region including the EU Member States. These will be those with expertise in influenza pandemic preparedness that are either invited by the organisers or identified by the national authorities.

The report on the Third Joint Meeting in Uppsala in May is available at Third joint EC/ECDC/WHO Workshop on Pandemic Influenza Preparedness

Perspectives in Interpandemic Influenza, Madrid, 12-14 October 2007.

The inaugural Congress on Perspectives in Interpandemic Influenza will take place 12-14 October 2007 in Madrid, Spain. This Congress aim’s to provide an update on the latest treatment and management options available for seasonal influenza. The agenda is focused on therapeutic approaches to patient care, and is targeted at health care professionals in the primary care sector.

Conference website: Perspectives in Interpandemic Influenza