Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)
(1) [ECDC, SEASONAL INFLUENZA, AVIAN INFLUENZA, EGYPT, POULTRY, ANTIVIRALS, PANDEMIC PREPAREDNESS] EUROPEAN CENTRE OF DISEASES PREVENTION AND CONTROL - INFLUENZA NEWS, EXCERPTS
(1a) AVIAN INFLUENZA
There are fluctuating reports in the media of influenza A(H5N1) and other avian influenza infections in birds and humans.
ECDC monitors these carefully as part of its epidemic intelligence work. However without laboratory confirmation ECDC only rarely mentions these media reports in this output.
(1b) AVIAN INFLUENZA ? ANIMAL HEALTH ? EGYPT
7th July 2008
The Egyptian authorities have provided summarised information to the OIE on 19 outbreaks of Highly pathogenic avian influenza A(H5N1) in poultry farms and backyard poultry between February and June 2008.
The majority of the reported outbreaks were in the Nile delta area in the north of the country.
The OIE report states that over 100,00 birds have either been killed by the infection or destroyed as part of containment efforts.
ECDC comment:
The Egyptian authorities continue to work hard to control infection, and it is positive that the disease outbreaks continue to be reported to the OIE.
However the summary information presented in the latest report to the OIE highlights the widespread dissemination of AI infection in Egypt, and the difficult task that the authorities face in containing an infection that most observers now consider to be endemic in at least some parts of the country.
So far in 2008, there have been 7 human cases and 3 deaths due to A (H5N1) in Egypt, which is the second highest country incidence of infection this year.
(1c) P.H. DEVELOPMENTS ? PANDEMIC INFLUENZA ? PREPAREDNESS - Report on a Member State workshop to consider international avian and pandemic strategy
In May, the UK Government held a workshop to consider how to carry forward its ongoing commitment to support the international community in preventing avian influenza and improving global pandemic preparedness. A report of the workshop has recently been published. (see link below)
The workshop sessions focused on four themes: the interoperability of plans; the major challenges of the next 3-5 years including development of the New Delhi Avian Influenza and Pandemic Preparedness Ministerial Meeting Road Map (1); the roles and priority functions of international players; and the UK?s role in funding and supporting international activities.
The workshop report focuses on more overarching planning issues rather than detailed planning and preparedness needs, and also focuses on collaborative efforts across all sectors with very little mention of health sector planning.
However, the workshop concluded that there remained several important areas where more work is needed at the global level to improve preparedness.
These are highlighted in the report but include
- greater consistency and interoperability of plans at international level.
- improved business continuity planning and cross-sectoral planning to ensure continuity of essential supplies and services
- increased legitimacy of the global consensus on pandemic preparedness activities agreed at the Intergovernmental conference in New Delhi, India in 2007 (1).
- The need to continued and sustained funding, and overarching organisation. Pandemic planning and avian influenza control would also benefit from more effective regional coordination,
- Recognition that there were benefits in taking a holistic approach to pandemic planning to improve general disaster management, but that there was a danger that over-reliance on generic planning, and particularly including emerging infectious diseases as a planning focus, could dilute the impact of pandemic planning.
The document also highlights mechanisms by which an individual Member State (in this case the UK) could contribute to improve global pandemic preparedness and avian influenza control.
ECDC comment (9/07/08):
Although the document was developed in the UK, the conclusions have broad application.
These focus on the need for more global planning activities across governments and societal planning in general.
This is also something that ECDC has identified as a need in EU/EEA countries, and UNSIC has also given prominence to this area in its reports on the status of global pandemic preparedness. (2) (3)
The possible mechanisms by which the Member State concerned could facilitate improvements to global pandemic preparedness are also likely to be applicable to other Member States in the EU.
See:
Report on UK international avian and pandemic influenza strategy workshop held in London on 12th May 2008
1) New Delhi International Conference on Avian and Pandemic Influenza: Vision and Road Map, proposed by the host country India (
http://www.undg.org/docs/8368/avianroadmap.pdf)
2) ECDC Technical report: Pandemic Influenza Preparedness in the EU/EEA
Status report as of Autumn 2007, Stockholm, December 2007
3) UN System Influenza Coordinator (UNSIC) & World Bank: Responses to avian influenza and state of pandemic readiness. Third global progress report- December 2007.
http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc
(1d) P.H. DEVELOPMENTS ? SEASONAL INFLUENZA ? VACCINES & ANTIVIRALS - Influenza A(H1N1) virus resistance to oseltamivir, summary of the global situation
The WHO has published the preliminary findings from available data on the Global prevalence of oseltamivir resistance in H1N1 viruses.
From the last quarter of 2007 until 13 June 2008, a total of 6978 influenza A(H1N1) viruses have been tested for oseltamivir resistance worldwide and 1077 (15%) were found to be resistant.
Fifty-two countries and territories reported on the test results, the majority of countries being from the European Region.
In their summary report, WHO noted that the number of viruses tested varied considerably by country/territory, ranging from 1?1544, leading to difficulties in the interpretation of comparative data for some countries/territories or Regions.
Data from the European Region of WHO indicated that the situation was highly variable so that though 25% of the A(H1N1) isolates tested showed resistance this statistic was quite misleading locally.
Finland, France, Luxemburg, the Netherlands, Norway, the Russian Federation and Ukraine all reported a prevalence of 25% or greater of oseltamivir-resistant A(H1N1) viruses with Norway reporting the highest prevalence (67%) but equally some countries seemed to be almost free of resistant A(H1N1) viruses[1].
None of the H1N1 viruses from the WHO Eastern Mediterranean Region (11 tested) or the African Region (77 tested) showed the resistance, that is none had the specific NA mutation (H274Y).
Thailand was the only country that submitted data from the South-East Asia Region of WHO and only one 1 resistant virus out of 13 A(H1N1) viruses was found.
In the Western Pacific Region of WHO, China, Hong Kong Special Administrative Region reported a prevalence of 11% oseltamivir resistance in A(H1N1) viruses, while Japan reported a relatively low prevalence (3%), despite having the world's largest per capita use of oseltamivir in clinical practice.
Australia reported three resistant viruses, two of which were isolated from presumed imported cases.
China, Guam, Malaysia, Mongolia, New Zealand, the Philippines, Singapore and the Republic of Korea did not find any resistant viruses.
In the WHO Region of the Americas, Canada and the United States of America reported prevalence rates of 26% and 11%, respectively. Of the 20 viruses tested from countries in Central America, three were found to be resistant, all of which were from Monserrat [2, 3].
The summary table will be updated on a monthly basis, unless the situation changes.
ECDC comment (09/07/2008):
While the seasonal influenza epidemic has come to an end in Europe, efforts are being made by the Members States and international organisations to retrospectively analyse the data available on cases of A(H5N1) viruses resistant to oseltamivir in order to answer some of the most relevant scientific and public health questions.
From the data available it seems unlikely that there was a direct link between oseltamivir exposure and emergence of resistance at the individual patient level and, being the use of oseltamivir limited in most European countries, at community level.
Whether infections with an oseltamivir resistant A(H1N1) virus were associated with different clinical features than infections with oseltamivir susceptible A(H1N1) virus is also under investigation in national studies and international studies coordinated by ECDC.
Continuous monitoring of the global situation by WHO would allow to evaluate whether the oseltamivir resistant A(H1N1) viruses will continue to circulate and further spread thus providing crucial information for future antiviral prophylaxis and treatment policies.
For example it will be important to see if these viruses appear in the Southern Hemisphere when its winter season commences shortly. ECDC and WHO European Region are convening a consultation in the autumn to review the situation ahead of the next European influenza season.
(1e) P.H. DEVELOPMENTS - SEASONAL INFLUENZA- TRAINING
ECDC launches a call for tender to develop training programmes on the prevention and control of human seasonal influenza.
ECDC launches call for tender ECDC has recently launched a call for tender to develop reference curriculum, training materials and a pilot course on ?Design and implementation of programmes of human seasonal influenza prevention and control?.
Details of the call for tender, including technical specification, and deadlines for applications are available on the ECDC website. See
http://ecdc.europa.eu/Competitions/PROC_2008_010/index.html
(1f) Meetings and workshops - Birdflu2008: Avian Influenza and Human Health, Oxford, UK. 10-11 September 2008
The first annual Oxford avian influenza conference, BirdFlu2008, will address most aspects of basic and applied research on avian influenza viruses and their potential health and socio-economic impact on humans.
Conference information can be found at:
http://www.libpubmedia.co.uk/Conferences/BirdFlu2008/Home.htm
3rd ESWI European Influenza Conference, Vilamoura, Portugal. 14-17 September 2008.
The European Scientific Working group on Influenza (EWSI) - an independent group of European scientists promoting the study of influenza ? will hold its third European Influenza Conference in the autumn of 2008.
Conference information can be found at:
http://www.eswiconference.org/
International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.
This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007). The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.
The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.
The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009. A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting. Its last report is available at
http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc
A web-site for the conference in Egypt has now been activated
http://www.imcapi2008.gov.eg/
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