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If interested, check out this CDC website pertaining to Emergent Infectious Diseases: http://www.cdc.gov/ncidod/EID/index.htmVast Budget Boost Needed to Fight Bird Flu
14:45 25 February 2005
NewScientist.com news service
Debora MacKenzie
http://www.newscientist.com/article.ns?id=dn7067
Chief veterinary officers, health officials and scientists from 28 countries issued an urgent call on Friday for a vast increase in investment to head off the threat of H5N1 bird flu.
They met this week in Ho Chi Minh City, Vietnam, to discuss how to meet the threat posed by the virus, which has spread in poultry throughout east Asia and is known to have killed 43 people so far.
Scientists fear the H5N1 virus, which has killed three-quarters of the confirmed human cases, could evolve into a form that spreads easily among people. "The world is now in the gravest possible danger of a pandemic," said Shigeru Omi, head of the World Health Organization's western Pacific office, at the meeting.
On Friday, Vietnamese officials confirmed yet another human case in the north of the country, the fourteenth since the resurgence of the disease in mid-December 2004. And this week clinical trials began in the US of a vaccine designed to immunise people against H5 flu.
But the meeting in Vietnam, organised by the UN's Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE), called for a renewed focus on stopping the virus from circulating in poultry.
$100 million request
"As long as the virus continues to circulate among animals, it will remain a threat to humans," the meeting declared. In particular, they called for $100 million from rich countries to improve monitoring of poultry in the impoverished region.
They further estimate that "several hundred million dollars" is needed to compensate farmers who report the disease, and to restructure poultry farming so viruses are less likely to spread. This, they said, includes reorganising farms so ducks, chickens, pigs and humans, the main players in the spread and evolution of bird flu, are in less contact.
"Immediate eradication of the disease in the region cannot be envisaged in the short term under the current situation," said Teruhide Fujita of the OIE, as the meeting opened.
"Glaringly insufficient"
More bluntly, Sam Jutzi, head of livestock at FAO headquarters in Rome, told reporters that the $18 million given by donors so far was "glaringly insufficient". Funding for east Asian bird flu monitoring networks runs out in a few months. Jutzi said it would take $300 million to monitor the spread of the virus and vaccinate birds in the region.
Thailand decided last week to introduce limited vaccination for bird flu in especially high-risk bird populations. These included fighting cocks - which are frequently moved around - and free-range ducks - which can roam and show no symptoms of flu.
The Vietnam meeting said "the possibility of vaccinating ducks should be explored", but said it needed more study before it could be done with no risk to human health.
There are concerns that vaccinated poultry can still spread the virus while showing no symptoms, possibly promoting its evolution - a development which has recently led to increased virulence in mammals.
-Britain Reveals Flu Pandemic Plan
http://news.bbc.co.uk/1/hi/health/4305813.stm
Millions of doses of drugs to ward off a flu pandemic are to be stockpiled, the government has announced. It said without the antiviral drugs an outbreak could kill 50,000 in the UK.
Experts say a pandemic is inevitable and will probably emerge in Asia if bird flu mutates with human flu, creating a highly infectious new virus.
The UK Influenza Pandemic Contingency Plan also includes quarantine measures, as well as arrangements for the emergency services.
Concerts and football matches could both be banned and travel restricted in the event of an outbreak to stop the virus spreading.
But the government decided against buying up vaccines as ordinary flu vaccines will not be 100% effective because the strain which would be responsible for any future pandemic has not emerged yet.
It could take up to six months to develop a vaccine once a pandemic has started.
Symptoms
Instead, the Department of Health is to stockpile 14.6 million doses of the antiviral drug Tamiflu, which is made by Swiss drugs firm Roche and works by reducing the symptoms and the risk of a carrier passing on the virus, at a cost of £180m.
It will be enough for a quarter of the population - the World Health Organization's recommended level.
Health officials will be the first in line for the drugs, with the remainder being handed out to whichever part of the population is deemed most at risk.
PLANS IN OTHER COUNTRIES
US - Has been stockpiling antiviral drugs and placed orders for 4m vaccine doses
Italy and France - Both placed orders for 2m vaccine doses
Canada and Australia - Have been buying enough antiviral drugs to cover a quarter of the population
Japan and Holland - Also purchasing antiviral drugs but not on the same scale as others
Several countries, including Canada, the US and Australia, have already started building up reserves of the drugs.
Other countries have also placed orders for a vaccine.
Chief Medical Officer Sir Liam Donaldson said the plan had been published as it must be assumed the government would be unable to stop a future flu pandemic reaching the UK.
"When it does, its impact will be severe in the number of illnesses and the disruption to everyday life.
"The steps we are setting out today will help us to reduce the disease's impact on our population."
Experts have become increasingly worried over recent months about the threat of a pandemic.
Pandemics
There were three flu pandemics during the 20th Century. The worst one in 1918 killed up to 50 million, including more than 200,000 in the UK.
The Asian flu outbreak in 1957 and Hong Kong pandemic 11 years later both killed 1 million each.
And fears of a new pandemic were heightened a month ago after scientists said they believed the bird flu, which has killed 46 people in south east Asia, had been passed from human to human for the first time.
Leading UK expert John Oxford, professor of virology at Queen Mary's School of Medicine, said: "If the flu does arrive we will have to throw the book at it."
But he said the public should not become too alarmed and could take comfort that the government was putting a plan in place now.
Professor Pat Troop, chief executive of the Health Protection Agency, said it was a matter of when, not if, the flu would strike.
"We do not want to cause panic but we have to take it seriously.
"We have to do this planning and also stockpiling and if it does happen we will have to put in quite tough public health measures."
A WHO spokeswoman said it was a "good idea" to start stockpiling antiviral drugs but said there was still work that could be done on vaccines.
"You can prepare the ground. There are licensing hurdles to be scaled and there is research that can be done to see what can provoke an immune response so that it will take as little time as possible when the time comes."
Both the Tories and Liberal Democrats said the plans were too late and the government should have acted months ago.
The row has drawn in the drugmaker as well as industry regulators and independent scientists. Supporters of Tamiflu said the researchers conclusions were flawed and insisted the drug is both safe and effective. The dispute over the benefits of Tamiflu, and to a lesser extent of GlaxoSmithKlines Relenza, blew up with the joint publication by the respected Cochrane Review research network and the British Medical Journal of an analysis of trial data, which found no evidence behind claims the drugs cut hospital admissions or reduce complications.
The reviews main findings were that the medicines had few if any beneficial effects, but did have adverse side effects that were previously dismissed or overlooked, but Roche, which has been under fire for several years over its refusal to allow the Cochrane team unrestricted access to Tamiflu data, rejected the findings, saying it fundamentally disagrees with the overall conclusions of their study. We firmly stand by the quality and integrity of our data, reflected in decisions reached by 100 regulators across the world and subsequent real-world evidence demonstrating that Tamiflu is an effective medicine in the treatment and prevention of influenza, the company said in a statement.
Tamiflu sales hit almost US$3 billion in 2009 mostly due to its use in the H1N1 flu pandemic but they have since declined. The drug, one of a class of medicines known as neuraminidase inhibitors, is approved by regulators worldwide and is stockpiled in preparation for a potential global flu outbreak. It is also on the WHOs essential medicines list. The US has spent more than US$1.3 billion buying a strategic reserve of antivirals including Tamiflu, while the British government has spent almost ￡424 million (US$703 million) on a stockpile of about 40 million Tamiflu doses Heneghans team say their analysis is the first based on full data from 20 trials of Tamiflu, known generically as oseltamivir, and 26 trials of Relenza, also known as zanamivir.
At a briefing in London to present their findings, Heneghan said the money spent on stockpiles has been thrown down the drain because until now, the full data had not been seen by regulators, governments, doctors or patients. The original evidence presented to government agencies around the world was incomplete and when they [the Cochrane review team] eventually received the full information on these drugs, the complete evidence gives a very much less positive picture, said Fiona Godlee, editor of the British Medical Journal, which has spearheaded a four-year long campaign to force Roche to reveal all its Tamiflu data.
The Cochrane review found that compared with a placebo, or dummy pill, Tamiflu led to a quicker alleviation of flu-like symptoms of about half a day (down from seven days to six-and-a-half days) in adults, but the effect in children was more uncertain. There was no evidence of a reduction in hospitalizations or in serious flu complications such as confirmed pneumonia, bronchitis, sinusitis or ear infections in either adults or children, the team said.
MORE
The flu strain, known as H7N9, now mostly infects birds but it has infected at least 779 people in outbreaks in and around China, mainly related to poultry markets. The World Health Organization said earlier this year that all bird flu viruses need constant monitoring, warning that their constantly changing nature makes them "a persistent and significant threat to public health." At the moment, the H7N9 virus does not have the capability to spread sustainably from person to person. But scientists are worried it could at any time mutate into a form that does.
To assess this risk, researchers led by James Paulson of the Scripps Research Institute in California looked at mutations that could potentially take place in the genome of the H7N9 virus. They focused on the H7 hemagglutanin, a protein on the flu virus surface that allows it to latch onto host cells. The team's findings, published in the journal PLoS Pathogens on Thursday, showed that in laboratory tests, mutations in three amino acids made the virus more able to bind to human cells — suggesting these changes are key to making the virus more dangerous to people.
Health officers cull poultry at a wholesale market, as trade in live poultry is suspended after a spot check at a local street market revealed the presence of H7N9 bird flu virus, in Hong Kong
Scientists not directly involved in this study said its findings were important, but should not cause immediate alarm. "This study will help us to monitor the risk posed by bird flu in a more informed way, and increasing our knowledge of which changes in bird flu viruses could be potentially dangerous will be very useful in surveillance," said Fiona Culley, an expert in respiratory immunology at Imperial College London. She noted that while "some of the individual mutations have been seen naturally, ... these combinations of mutations have not," and added: "The chances of all three occurring together is relatively low."
Wendy Barclay, a virologist and flu specialist also at Imperial, said the study's findings were important in showing why H7N9 bird flu should be kept under intense surveillance. "These studies keep H7N9 virus high on the list of viruses we should be concerned about," she said. "The more people infected, the higher the chance that the lethal combination of mutations could occur."
Study: Three Mutations Could Make Bird Flu a Potential Pandemic
