Avian and Pandemic Flu Situation Report

March 2009

Adam Crowe, CEM, MPA

Human Disease Developments

Indonesian health officials stated that four more people have died of H5N1 over the past month. If the World Health Organization (WHO) confirms the cases, the country's count will rise to 145 cases and 119 deaths.

Egypt's health ministry announced that a 2-year-old boy was hospitalized with an H5N1 infection. The ministry stated that his family had had contact with sick and dead poultry. The case will be listed as Egypt's 57th if it is confirmed by the World Health Organization (WHO).

Animal Disease Development Negal, India and Egypt reported outbreaks of H5N1 in local bird populations.

International Preparedness

Malaysia is the first country outside Europe to approve a pre-pandemic avian influenza vaccine called Prepandrix which is manufactured by GlaxoSmithKline.  Cambodia announced that it has launched an $11 million project to control and prepare for avian and seasonal influenza. The project is funded with International Development Association support, which includes donations from the United States, Japan, and the European Union.

Domestic Preparedness

Within a Congress-approved spending bill, nearly $700 million was designated for pandemic spending and is based upon a requested made by former President Bush to support activities at the U.S. Department of Health and Human Services (HHS) and the U.S. Centers for Disease Control and Prevention. Unfortunately, none of these funds are for state or local public health agencies. The HHS pandemic funding includes $425 million for vaccine production capacity, $42 million for production of egg-based vaccines, and $40 million for medical countermeasures for HHS staff members and contractors.

To encourage businesses and organizations to prepare for a flu pandemic, the Alabama Department of Public Health (ADPH) is offering free preparedness supplies to groups that write continuity plans and receive pandemic preparedness education. Those who qualify have their choice of two kinds of free supplies: personal protective equipment (masks, gloves, sterilization products, face shields) or comfortcare items (fever and pain reducers, electrolyte drinks, anti-diarrheal medicine, inflatable mattresses, disposable pillows, and blankets).

The U.S. Department of Health and Human Services (HHS) has released seven guidance documents on cleaning of transportation vehicles and facilities during an influenza pandemic. The recommendations cover trucks, aircraft, passenger and cargo ships, transit stations, passenger rail cars, port-of-entry detention facilities, and ambulances. The aircraft guidance, for example, spells out which parts of the airplane should be cleaned and disinfected after a passenger has arrived in the United States with a potential case of pandemic flu. All seven guidance can be downloaded by clicking here.

Treatment, Detection, and Prevention

The World Health Organization (WHO) and the International Federation of Pharmaceutical

Manufacturers and Associations (IFPMA) released a report indicating that the world's capacity to produce vaccines for an influenza pandemic has risen sharply in the past 2 years, but it would still take an estimated 4 years to meet the global demand if a pandemic emerged now. Specifically, if a pandemic emerged this year, the most likely case is that manufacturers could produce 2.5 billion doses in the first 12 months after they received the production strain. It would take 4 years to produce enough to meet total global demand (meaning two doses for each of the world's 6.7 billion people).  

CDC Researchers have identified and tested human monoclonal antibodies (mAbs) that can neutralize influenza A viruses including lethal H5N1 avian influenza. The findings raise hopes for a universal flu vaccine and shed light on new options for preventing and treating influenza infections. Monoclonal antibodies—highly specific infection-fighting proteins derived from the same cell lineage—are being used to treat some cancers and immunologic diseases. Physicians sometimes used a basic form of the therapy during the "Spanish flu" pandemic of 1918-19, by administering blood products from recovering patients to sick patients.  

Studies confirmed that influenza A/H1N1 viruses have become widely resistant to Tamiflu without losing their ability to make people sick. To the surprise of many, H1N1 resistance to Tamiflu rose sharply last year, reaching 12.3% in the United States and 16% worldwide. So far this season, it is far higher: more than 98% (321 of 325) of H1N1 isolates tested by the U.S. Centers for Disease Control and Prevention (CDC) were resistant to the drug. The findings also underscore the possibility that H5N1 could gain resistance to Tamiflu, calling into question the value of stockpiling the drug in preparation for a potential flu pandemic.

Sanofi-Aventis announced yesterday that it signed an agreement with Mexico to build a $100 million facility to manufacture influenza vaccines in Ocoyoacac, Mexico. Sanofi stated that it would collaborate with Bimex, a Mexican federal vaccine maker, to perform some manufacturing steps and distribute the influenza vaccines in Mexico. The facility will have the capacity to make up to 25 million seasonal flu vaccine doses and will be able to switch to pandemic vaccine manufacturing once the WHO declares a flu pandemic.

Numbers and Statistics for H5N1 (Confirmed by WHO since 2003):

Total Case: 411 

Total Deaths: 256 

Mortality Rate: 62.3%