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Flu expert concerned at lack of national plan
Source: Bangkok Post, Thailand, 2 Apr 06
URL: http://bangkokpost.net/News/03Apr2006_news13.php
A leading influenza expert has expressed concern over the lack of a national plan in preparation for a human pandemic.
She blames it on poor cooperation between relevant agencies, particularly the Public Health, Interior, and Agriculture ministries.
Thailand would be unable to deal with a human flu pandemic if it occurred within the next few months, said director of the influenza programme office Praphasri Jongsuksantikul.
Dr Praphasri lashed out at relevant agencies for failing to come up with guidelines on an emergency response to a possible human flu pandemic. The national committee on avian influenza had had only one meeting to prepare for a major flu outbreak since the body was set up about two years ago, she said.
"It is worrying that concerned agencies, including the Public Health Ministry, have neglected to update the outbreak situation and complete the national guidelines on influenza prevention and preparedness," she said. The guidelines were drafted after an outbreak of avian influenza was confirmed in early 2004, but the manual had never been revised, she said.
She also voiced concern at the unstable political situation, which had hindered state agencies' progress. Amid political changes, she said, officials should focus on enhancing local communities' capacities to prevent and respond to an influenza outbreak. "It's better than sitting still and waiting for a pandemic to attack our people," she said.
The Public Health Ministry last month conducted influenza virus control drills in Ratchaburi and Nakhon Nayok to test the capacity of local agencies in containing the disease. A similar drill will be held in Phetchaburi next month.
The chief of the communicable disease control department, Kamnuan Ungchusak, said the department would collect specimens from the bodies of people who die from lung infections with an unknown virus strain. The project is part of the ministry's studies on the influenza virus. In Thailand around 10,000 people die from pneumonia each year, half of them from an unknown virus type.
"We would like to make sure that our preventive measure is functional. Testing specimens is a crucial part of our study on flu virus mutation," he said.
Dr Kamnuan said Thailand would host an international workshop on bird flu prevention this month. Foreign health officers attending the workshop would be invited to inspect the department of medical sciences' laboratory and avian flu virus research projects.
In August, the ministry will also organise a training course on emergency responses and surveillance of bird flu outbreaks for health officials from Vietnam, Laos, Cambodia, Indonesia and Burma.

From

http://www.ift2004.org/othernews/2006/Pandemic_flu_news_7_APRl_06.htm

Bird flu hits Nigeria's most populous city

Source: AFP, 6 Apr 06
http://news.yahoo.com/s/afp/20060406...NlYwMlJVRPUCUl
A deadly strain of bird flu has been detected in Africa's most populous city, the Nigerian commercial capital Lagos, Information Minister Frank Nweke confirmed.
"The virus has so far been indentified in 12 states, including Lagos, as well as around the federal capital Abuja," Nweke told AFP.
The detection of the virus in Lagos will raise fears that Nigeria's outbreak H5N1 strain of bird flu, which has killed more than 90 people since it broke out in Asia in 2003, could be spreading out of control.
The director of the National Veterinary Research Institute, Dr. Lombi Lami, confirmed that there had been an outbreak in a farm in the Ikeja district of Lagos, but said it had been reported weeks ago.
So far no human cases have been detected in Nigeria's estimated 130 million-strong population. Lagos is home to an estimated 15 million people, many of whom keep chickens in their back yards.
In the three months since the west African country has begun battling avian influenza, more than 450,000 birds have either died or have been killed as part of preventive measures.
Chicken sales have fallen, and many countries have banned Nigerian poultry imports.
Nigeria was the first African country to detect the virus in its poultry and has put in place a large operation to contain it, but it has already been found in nearby Niger and Burkina Faso and there are fears it will spread further.

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?Influenza Inter-Pandemic Preparedness Plan Episode III?
March 2-3, 2006 Phuket Graceland Resort & Spa, Phuket, Thailand

Anti-influenza Agents

Terapong Tantawichien, M.D.

Antiviral agents form an important part of a rational approach to epidemic influenza and are critical to planning for a pandemic. The M2 ion channel-blocking drugs adamantanes (amantadine and rimantadine) and the newer generation, more expensive antiviral compounds (neuraminidase inhibitors) nebulised zanamivir (Relenza?) and oral oseltamivir (Tamifu?) have anti-infuenza activity. Earlier research had shown that all four antiviral medications were similarly effective in reducing the duration by 1 or 2 days of illness caused by influenza A viruses, when used for treatment within the first 2 days of illness. The adamantanes interfere with viral uncoating inside the cell. They are effective only against influenza A and are associated with several toxic effects and with rapid emergence of drug-resistant variants.

Recent evidence indicates that a high proportion of currently circulating influenza A viruses in the United States have developed resistance to adamantine and rimantadine, so these drugs will not have reliable efficacy in regions where there is substantial activity of influenza A (H3N2) or influenza B.

The neuraminidase inhibitors zanamivir and oseltamivir interfere with the release of progeny influenza virus from infected host cells, a process that prevents infection of new host cells and thereby halts the spread of infection in the respiratory tract. The current avian influenza (H5N1) outbreak in Asia, which has a high case-fatality rate, indicates the need for decisive action.

These circulating H5N1 strains are fully resistant to these the M2 inhibitors. Oseltamivir is effective against H5N1 and is used as treatment in Vietnam and Thailand. As for the circulating avian H5N1 viruses that constitute pandemic threats, national preparedness plans have become essential.

In a pandemic hastened by globalization, vaccination is not a viable initial solution because vaccine production requires an estimated 6 months. Instead, neuraminidase inhibitors are influenza-specific antiviral agents that figure strongly in preparedness plans. Many nations are acquiring stockpiles of these drugs because of their effectiveness in influenza treatment and prophylaxis.

The decision to stockpile requires predetermined objectives; non-economic, moral, and ethical implications should be considered. Policymakers have to act decisively, and determine the subpopulations to be given priority, to enable preparedness plans to succeed. Antiviral resistance to neuraminidase inhibitors has been clinically negligible so far but is likely to be detected during widespread use during a pandemic.

There have now been several reports that oseltamivir-resistant influenza A (H5N1) viruses with the H274Y mutation have been isolated from humans with avian influenza infection who were treated with oseltamivir.

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