Responses to Avian Influenza and State of Pandemic Readiness - Fourth Global Progress Report - October 2008 [UN - excerpts]

[Giuseppe]

Responses to Avian Influenza and State of Pandemic Readiness - Fourth Global Progress Report - October 2008 [UN - excerpts]

Responses to Avian Influenza and State of Pandemic Readiness - Fourth Global Progress Report - October 2008

[Full PDF text: http://un-influenza.org/files/ProgressReport2008.pdf ]

Executive summary
It is now nearly five years since H5N1 highly pathogenic avian influenza (HPAI) spread across Southeast Asia and then to the rest of Asia, Europe and Africa. The rapid spread, significant socioeconomic losses, numerous human deaths, and the potential threat of a human pandemic influenza triggered concerted global action to control the disease and prepare for the next influenza pandemic.

Since then around US$2.7 billion has been pledged and US$1.5 billion disbursed globally by the donor community to fight against HPAI and to aid pandemic preparedness. In addition, proportionately enormous funding and human resources have been expended by countries affected and at‐risk of HPAI and in preparing for a pandemic.

The threat posed over the last 5 years has mobilized an unprecedented coming together of the animal health, human health, disaster preparedness and communication sectors to work in a cross discipline, cross sector and cross boundary way. At the last International Ministerial Conference on Avian and Pandemic Influenza held in New Delhi (4‐6 December 2007) it was acknowledged that significant progress made towards eliminating HPAI in many infected countries, but serious concerns remained.

In response to requests from participants at the New Delhi Conference, the United Nations System Influenza Coordinator (UNSIC) and the World Bank have produced this Fourth Global Progress Report on Responses to Avian Influenza and Pandemic Readiness.

The report

i) describes international financial assistance provided to date;
ii) assesses national capacities to respond to HPAI and prepared for the next influenza pandemic;
iii) analyses implications of this progress for animal and human health and
iv) recommends some key next steps.

It focuses on progress with responses to avian influenza and with pandemic preparedness between June 2007 and June 2008, but also looks back over the last three years. Information was provided by national authorities from 148 countries that responded to an UNSIC survey questionnaire supplemented by with case studies, interviews and reports from UN system bodies and other partners. The information on donor pledges, commitments and disbursements has been collected by the World Bank via a donor polling exercise.

A global analysis of the situation now in mid to late 2008 indicates fewer outbreaks in poultry, fewer newly infected countries, fewer human cases and fewer deaths compared to the same period in 2006 and 2007. Over 50 of the 61 countries that have experience an H5N1 outbreak, have successfully eliminated the disease.

However, the virus remains entrenched in several countries and the threat of further outbreaks of HPAI in poultry (and sporadic cases in humans) persists. The threat of an influenza pandemic remains unchanged. While these findings suggest that HPAI strategies are successful when properly implemented, they also highlight that sustained vigilance and continued investment is needed in both surveillance and capacity to respond to HPAI.

Significant progress has been made during the last year, and there is now near global awareness of the issue and the need to enable nations and communities to prevent, prepare and be able to respond to HPAI and pandemic influenza. Surveillance capacities have improved significantly over the past 3 years and there is now greater awareness and more incentives for reporting. Significant efforts are still needed in biosecurity and fundamental behavior change by poultry owners/ producers remains a long term objective. There is still the need for high political commitment to improve and invest in animal and public health systems. Many countries have made substantial progress for their national pandemic preparedness; in some regions sophisticated advancements continue to be made in deepening and developing preparations. However, many of the plans have not yet been fully endorsed or made operational ? in particular at the local level and preparations in sectors beyond health need to be strengthened. Whilst the threat remains, it can be concluded that the world is significantly better prepared to respond to HPAI and to mitigate the impacts of the next influenza pandemic.

Need remains for continued advocacy, support and monitoring of preparations to ensure the capacity to respond to the threat of HPAI (and in many cases other zoonosis) is strengthened and made sustainable. In addition, it is essential to review, adapt and update pandemic preparations which will not only be of benefit in the event of pandemic but for the general resilience of a country against other emergencies.

With the threat of HPAI came an increased awareness of health threats at the animal‐human‐interface, and of the importance of a multi‐sectoral response. This better understanding needs to be sustained and advanced: During 2009, the world?s nations should agree on ways to better prevent, prepare and respond to the health, social, economic and political impacts of pandemics and emerging infectious diseases at the at the animalhuman‐ecosystem‐interface.

1. Background and Introduction

Global Avian and Human Influenza (AHI) Situation

1.1 An analysis of the situation world‐wide between January and June 2008 indicates fewer outbreaks of highly pathogenic avian influenza (HPAI) and fewer infected countries compared to the same period in 2006 and 2007. From January ?September 2008, no countries were newly infected (4 countries were newly infected in the first six months of 2007) and only 20 countries have
experienced outbreaks so far (25 countries reported outbreaks in 2007).(1)
1.2 In Asia, the virus is actively circulating in a number of hotspots. The disease appears enzootic in Indonesia and the virus continues to resurface in Pakistan, parts of China, Bangladesh and from time to time in India (West Bengal), Thailand, Lao PDR, Vietnam and the Republic of Korea. Besides Egypt, where infection is endemic, the epidemiological situation in the Middle‐East and
North Africa has improved despite an isolated outbreak in recent months in Israel. Saudi Arabia reported outbreaks in late 2007 but no cases have been detected since then. In Sub Saharan
Africa, while the overall epidemiological situation seems to have improved, in July 2008 Nigeria announced their first outbreak in nearly 10 months. Whilst it is discouraging that this outbreak
has occurred, it is also an encouraging sign that the Nigerian surveillance and control strategies are working, resulting in early detection and response. In Europe there continue to be sporadic
cases of wild and domestic birds infected with H5N1 and other less pathogenic avian influenza but these are well contained especially in the western part of Europe.
1.3 Several countries that detected HPAI infections or re‐infections in 2007 and 2008 have now succeeded in eliminating infection thanks to implementation of effective surveillance, prompt detection and rapid responses.(2) However the virus is still entrenched in several countries and the threat of further outbreaks of HPAI in poultry (and sporadic cases in humans) persists. These findings suggest that (a) HPAI control succeeds when strategies are properly implemented and (b) sustained vigilance and continued investment in both surveillance and capacity to respond to HPAI is required world‐wide.

The threat of an influenza pandemic remains unchanged.

1.4 Human infections with highly pathogenic avian influenza A (H5N1) viruses continue to present a serious and highly complex public health challenge where they occur. At the time of writing, since late 2003, there have been 385 human cases recorded, with more than 245 deaths in 15 countries in Africa, Asia and Europe. In 2008 there have been 36 cases and 28 deaths (predominantly in Indonesia although Egypt, China and Vietnam continue to experience cases and deaths). Bangladesh is the only new country in 2008 to experience a human case.
1.5 Currently, H5N1 still causes infections relatively rarely in people, however when they occur, such infections have been frequently fatal (the case fatality rate this year is 76% in total compared to 63% in total since late 2003).(3) H5N1 viruses continue to evolve and could develop into a much greater public health threat resulting in the next influenza pandemic.

Purpose and Outline of Progress Report

1.6 This Fourth Progress Report on Avian Influenza and State of Pandemic Readiness has been jointly produced by the United Nations System Influenza Coordinator (UNSIC) and the World Bank, with 3 valuable contributions from the Pandemic Influenza Contingency Team (PIC) based in the Office for the Coordination of Humanitarian Affairs (OCHA), the UN Food and Agricultural Organisation (FAO), the World Organisation for Animal Health (OIE), the World Health Organisation (WHO) and the UN Children?s Fund (UNICEF). The collaboration of 148 countries and territories that returned the UNSIC survey was the basis for much of the report content. It focuses on the progress in the response to avian influenza and pandemic preparedness between June 2007 and June 2008, but comparatively covers data from the past three years.
1.7 Previous UNSIC‐World Bank reports have covered the periods January to June 2007 produced in preparation for the New Delhi Intergovernmental Ministerial Conference on Avian and Pandemic
Influenza (December 2007), July to December 2006 for the Bamako Conference (December 2006), and January to June 2006 for the Vienna meeting (June 2006). This report will be released ahead
of time for the next intergovernmental ministerial conference, to be hosted in Sharm El Sheikh, Egypt, in October 2008.
1.8 The report includes presentation of data, analysis and comment in five main subject areas:
(a) global financial and technical assistance,
(b) animal health,
(c) human health,
(d) pandemic preparedness and
(e) communications.

The purpose of this report is to provide an analysis of:
i) International financial assistance provided to date;
ii) National capacities to respond to HPAI and prepare for the next influenza pandemic;
iii) Implications of this progress for animal and human health ;and
iv) Some key next steps.

Study Methods: Design, Collection, Analysis and Limitations

1.9 Data and information for the current report was obtained from six principle sources:
? National authorities, surveyed by UNSIC: including responses from Ministries of Agriculture, Ministries of Health, National Disaster Committees and other responsible governmental agencies;
? Information collected from donor countries (by the World Bank) covering pledges, commitments, and disbursements in support of avian and human influenza control and pandemic preparedness;
? Case studies and illustrative examples of ongoing programs or projects;
? A report prepared by FAO, which assesses the capacity to prevent, detect and respond to HPAI in 54 countries where FAO is either implementing projects or there is a fluid epidemiological
situation;
? Information from UN system and partner agencies; Reports from informants within the international community on coordination of external support and successes and challenges encountered during programme implementation; and
? Other published studies and assessments.
1.10 For the collection of UNSIC primary data, a survey of 46 questions was posed to 178 countries or territories (where the report refers to countries this also infers territories). The survey was made available in the six official UN languages. Overall, 148 responses to the survey were received, giving a response rate of over 83%. Of the 148, 127 were from the same countries as 2007 which provides an 86% global comparison. Questions were intended to be applicable to countries in a variety of situations. The full list of responding countries can be found in Annex I Table 1. The questionnaire contained a combination of questions, some repeated from previous years? surveys to enable comparisons and new or adapted questions that were asked for the first time. The new or adapted questions are in response to changing circumstances: progress identified in previous reports was recognized, and now new dimensions of countries? capacities and preparedness need to be assessed.
1.11 In line with the December 2007 report, where possible responses to the data collection exercise were sought from contacts points within the national authorities. UN country level focal points were available to assist national authorities in this exercise; countries in which UN officials completed the questionnaire are specifically marked in Annex I Table 1. The draft report has also
been circulated to those national authorizes who have taken part for their review.
1.12 As per previous reports, responses have been aggregated along World Bank Regional classifications (Annex I Table 1). In addition this year?s analysis has also been conducted via new disaggregations:
? To enable the identification of specific progress, same country responses to repeated questions from previous years have been analyzed;
? In an effort to distinguish the unique situation of countries with experience since 2003 of HPAI infection and those without (infected ? non‐infected), disaggregation occurs on this basis (as
per reports to OIE of 25 July 2008); and
? To enable further distinction of where the challenges remain, disaggregation also occurs on a country income scale (as per World Bank classifications, Annex I Table 4).
1.13 The reader is asked to bear in mind that the data and interpretation of results based on the UNSIC survey reflects the assessment by national officials and remains indicative. Whilst it has not
proved possible for UNSIC and the World Bank to validate all those responses, it is hoped that by including inputs from the UN Technical Agencies and independent sources the report will provide
a broader assessment. However, these results presented here remain indicative.
1.14 UNSIC and the World Bank are jointly responsible for the preparation, content and production of the report, and for any revisions that may be issued.
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1) Global Early Warning System for Major Animal Diseases, including Zoonoses (GLEWS)
2) FAO/ AGAH Programming Unit: FAO Contribution to the UNSIC report January ? June 2008

(...)
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Box 1.1
As the majority of human cases occurred in Indonesia, which has always experienced a higher mortality rate than other countries, this number
may not indicate a trend.

Latest Research on the Continued Threat of Influenza Pandemic and the Transmissibility of H5N1 (Focus on 2008)

Five years after the re‐emergence of H5N1, sporadic cases and small clusters of human infections with H5N1 avian influenza persist and the virus remains a substantial threat to global public health security. Other avian influenza A sub‐types (H7, H9) also present a potential danger but to date H5N1 viruses constitute the most imminent and important pandemic influenza threat. Thus far this year (between 1 January and 10 September 2008), 36 human cases of H5N1 have been confirmed in five countries1 of which, Bangladesh reported its first human case. When compared with the same period during the years 2005, 2006 and 2007, this year has witnessed the fewest number cases. (2)

There has been little reported change in epidemiological features. As with previous years, the case fatality rate of the virus has been high; H5N1 human infections have, by a large majority, been sporadic and are believed to have been acquired through avian‐to‐human transmission, usually following human exposure to sick or dead poultry.(1),(6)

There has been no report suggesting human‐to‐human transmission amongst the few cluster cases that emerged so far in 2008.

Nevertheless, studies have suggested that, in the recent past, limited, non‐sustainable human‐to‐human transmission has probably occurred amongst clusters of epidemiologically linked cases in a small number of countries, including China, Indonesia and Pakistan.

Since the re‐emergence of the threat in 2003, there has been no evidence of sustained human‐to‐human transmission of H5N1 and the WHO alert level has remained at Phase 3 (no or very limited human‐to‐human transmission).

However, despite the fact that there have been fewer cases in fewer countries thus far in 2008 when compared with the same periods in the past couple of years, it is important to underscore that the virus is now entrenched in parts of Asia and Africa and that the threat of an H5N1 pandemic influenza undoubtedly persists.

1) Bangladesh, China, Egypt, Indonesia and Vietnam
2) Year 2005: 69 cases (as of 16 September 2005); Year 2006: 97 cases (as of 08 September 2006); Year 2007: 64 cases (as of 31 August 2007)
Sources :
? Uyeki TM. Global epidemiology of human infections with highly pathogenic avian influenza (H5N1) viruses. Respirology 2008; 12: S2‐S9.
? WHO (2008). Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO
? Writing Committee of the Second World Health Organization Consulation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus (Abdel‐Ghafar AN, Chotpitayasunondh T, Gao Z et al). Update on Avian Influenza A (H5N1) Virus Infection in Humans. N Engl J Med 2008; 368 (3): 261‐273.
? Wang H, Feng, Z, Shu Y et al. Probable limited person‐to‐person transmission of highly pathogenic avian influenza (H5N1) virus in China. Lancet 2008; 371 (9622): 1427‐34.
? Yang, Y, Halloran ME, Sugimoto J, Longini IM. Detecting Human‐to‐Human transmission of Avian Influenza A (H5N1). Emerg Infect Dis 2007; 13(9):1348‐53.
? WHO (2008). Avian influenza ? situation in Pakistan ‐ update 2 (03 April 2008). Available at: http://www.who.int/csr/don/2008_04_03/en/index.html .
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[Giuseppe]

Re: Responses to Avian Influenza and State of Pandemic Readiness - Fourth Global Progress Report - October 2008 [UN - excerpts]

UN: Birdflu pushed back, pandemic threat remains [Reuters.com]

UN: Birdflu pushed back, pandemic threat remains

Tue 21 Oct 2008, 18:53 GMT
By Patrick Worsnip
UNITED NATIONS, Oct 21 (Reuters) -

International efforts have pushed back the spread of bird flu this year but the risk of a global influenza pandemic killing millions is as great as ever, the United Nations and World Bank reported on Tuesday.


Most countries now have plans to combat a pandemic, but many of the plans are defective, said the report, issued before a bird flu conference due to be attended by ministers from some 60 countries in Sharm el-Sheikh, Egypt, from Friday to Sunday.

The report, fourth in a series since a bird flu scare swept the globe three years ago, followed a new World Bank estimate that a severe flu pandemic could cost $3 trillion and result in a nearly 5 percent drop in world gross domestic product.

The highly pathogenic H5N1 bird flu virus is endemic in poultry in parts of Asia, but experts fear it will mutate into a form that is easily passed from human to human, sparking a pandemic similar to three others in the past century.

The U.N.-World Bank report said that in the first nine months of this year no countries were newly infected with highly pathogenic bird flu, compared with four in the first half of 2007.

Just 20 countries had experienced outbreaks so far this year, compared with 25 last year.

Since late 2003, there have been 387 cases of humans catching the disease from birds, of whom 245 have died in Asia, Africa and Europe. Among those, there have been only 36 human cases this year, of which 28 proved fatal.

"This particular virus, H5N1, is a much milder threat now than it was in September 2005," U.N. influenza coordinator David Nabarro told a news conference.

PANDEMIC THREAT UNCHANGED
The report added that H5N1 was still "actively circulating among poultry in a number of hotspots" and was entrenched in Indonesia and Egypt. It called for continued vigilance and investment worldwide to combat the disease, saying, "The threat of an influenza pandemic remains unchanged."

Nearly all the 148 countries that provided data for the report have contingency plans in place to deal with a pandemic, the authors said.

But many plans were "not legally or logistically feasible" and lessons from simulations had not been drawn on to revise plans, they said. Authorities in rich countries were better prepared than in poor countries, they added.

"We worry that many of those plans have still not been adequately tested to see whether or not they will be valid when the pandemic actually starts," Nabarro said.

"It's not enough just to have written a plan and have everybody signing off on it, you also have to check it, test it and make sure that it works."

Nabarro also said that while the focus had been on H5N1, "any influenza virus could cause a pandemic and we just can't say for certain when the next pandemic will come.

"The World Bank has estimated that more than 70 million people could die worldwide in a severe pandemic. According to a Stanford University Web site, 20 million to 40 million people died in the so-called Spanish Flu influenza pandemic in 1918 and 1919.

In its latest study, a September update of a report first published two years ago, the World Bank raised the cost of such a pandemic to more than $3 trillion from $1.5 trillion to $2 trillion and said world GDP could drop by 4.8 percent.

(Editing by Peter Cooney)
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<cite cite="http://africa.reuters.com/wire/news/usnN21311198.html">News | Africa - Reuters.com</cite>

[Giuseppe]

Re: Responses to Avian Influenza and State of Pandemic Readiness - Fourth Global Progress Report - October 2008 [UN - excerpts]

CIDRAP >> UN: Pandemic risk remains despite progress on H5N1

UN: Pandemic risk remains despite progress on H5N1

Lisa Schnirring * Staff Writer
Oct 23, 2008 (CIDRAP News) ?

So far this year no new countries have been hit by H5N1 avian influenza outbreaks, and fewer previously affected countries have reported fresh outbreaks, but the threat of an influenza pandemic has not changed, according to a recent progress report from the United Nations (UN) and the World Bank.


The 115-page update on the global avian influenza status and pandemic planning efforts was released in advance of an international conference on avian and pandemic flu that starts tomorrow in Sharm el-Sheik, Egypt, according to the UN's summary of the report, the fourth in an annual series.

The report is an analysis of survey responses that the UN's influenza coordinator compiled from 148 countries.

The findings also include information that the World Bank provided on the international pledges, commitments, and expenditures for avian influenza prevention and control.

Too little testing
David Nabarro, the UN's influenza coordinator, told reporters at an Oct 21 press conference that despite widespread pandemic planning efforts, only 53% of countries have tested their plans in the past year. He said in a UN press release that the findings are sobering, particularly in light of a recent World Bank report that put the potential economic cost of a global influenza pandemic at up to $3 trillion, nearly 5% of the world's gross domestic product.

"When planning for an extraordinary concern like an influenza pandemic, it's not enough just to have a written plan and have everybody signing off on it," he said in an Oct 21 press release. "You also have to check it, test it, and make sure that it works, and then revise [it] on the basis of assimilation."

Pandemic plans need to include both social distancing and pharmaceutical strategies, but not all countries are prepared to apply both strategies, the report said. Some haven't established the logistical and legal provisions needed to enact social distancing measures.

The UN said it found great disparities in preparedness among countries, with, for example, wealthier countries more likely to have planned for pharmaceutical interventions. "Given the interdependence of countries when responding to a pandemic, preparedness within poorer countries will be a critical element of the world's readiness for the next pandemic," the report said.

Also, some individual countries have made progress on plans to maintain essential services during a pandemic, but more nations need to engage the private sector to accomplish multisector planning. The UN recommended that for 2009, countries develop protocols, frameworks, and indicators for longer-term multisector pandemic preparedness and fund the efforts through their all-hazard preparedness mechanisms.

In response to reporters' questions about pandemic planning transparency, Nabarro said he's noticed more openness among some countries, such as China. However, he said he was concerned that interactions among countries were "sometimes a bit tense."

Outbreaks and surveillance
In reporting that no new countries had H5N1 outbreaks through September, the UN report said for comparison, four countries reported the virus for the first time in the first 6 months of 2007. Only 20 countries have experienced outbreaks so far this year, down from 25 reported in 2007.

Bangladesh is the only new country that has reported a human H5N1 case this year, according to the UN's findings.

Nabarro said he was concerned about Nigeria and Togo, which have both reported recent H5N1 outbreaks.

The UN said effective surveillance, prompt detection, and rapid response have helped many countries eliminate outbreaks. The report notes that surveillance for animal diseases, including H5N1, has substantially improved over the past 3 years, with 75% of countries not reporting that they are able to detect highly pathogenic avian flu. For some countries, though, surveillance systems are still in the planning phase, and some planning hasn't included risk assessments to target priority areas.

However, the threat of further outbreaks in poultry and sporadic infections in humans persists, because the H5N1 virus is still entrenched in many countries. "The threat of an influenza pandemic remains unchanged," the report said.

Funding is eroding
The World Bank reported that the gap between what's needed to control avian influenza and boost preparedness and what world donors are pledging has been increasing since 2005. Though major donor nations have continued their support, the number slipped from 25 at the Beijing donor's conference in 2006 to 17 at the Bamako conference in 2006, and to 9 at the New Delhi conference in 2007.

Donors have pledged $2.7 billion, of which $2 billion has been committed. Of that amount, $1.5 billion has been disbursed, of which 59% was cash or loans and 41% was in-kind contributions. Declines in funding threaten the sustainability of control and planning investments that have already been made, according to the report.

"Such high commitment and disbursement rates within two and a half years of the establishment of the financing framework reflect the exceptional commitment of the donors and the efficient movement of grant funds," the report said.

East and Southeast Asian countries received 56% of the funds, Eastern Europe and Central Asia received 22%, and Sub-Saharan Africa, the Middle East, and North Africa got 20%, according to the report. Only $125 million remains in available funding, the World Bank said. "Grant finance will continue to be needed to sustain critical capacities and actions in the medium to longer term."
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<cite cite="http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/oct2308unreport.html">CIDRAP >> UN: Pandemic risk remains despite progress on H5N1</cite>

[Giuseppe]

Re: Responses to Avian Influenza and State of Pandemic Readiness - Fourth Global Progress Report - October 2008 [UN - excerpts]

World is not prepared for bird flu pandemic, says UN [Daily News Egypt]

World is not prepared for bird flu pandemic, says UN

By Sherine El Madany
First Published: October 24, 2008
CAIRO:

While most countries are planning for a flu pandemic, "many plans have not been tested and may well fail once the next influenza pandemic starts," warned the United Nations and the World Bank in a recent report.


While international efforts have pushed back the spread of bird flu this year, the threat of a global influenza pandemic killing millions remains, and could pause risks to world health, cautioned several international experts in advance of an international convention held in Egypt.

"Coming on the heels of a World Bank study suggesting that the economic cost of a pandemic could top a staggering $3 trillion, this continuing lack of preparedness remains a cause of concern," noted the report, issued before the bird flu conference due to be attended by ministers from some 60 countries in Sharm El Sheikh, starting Saturday.

The report ? fourth in a series since a bird flu scare swept the globe three years ago ?followed a new World Bank estimate that a severe flu pandemic could cost $3 trillion and result in a nearly 5 percent drop in world gross domestic product.

The UN said that even a mild flu pandemic might kill 1.4 million people worldwide, while the death toll from a severe global outbreak could reach 70 million.

Ambassador John Lange, special representative on avian and pandemic influenza at the US Department of State, told Voice of America ahead of the conference that avian influenza is most prevalent in Egypt, Bangladesh, Nigeria, Indonesia, and other countries in Southeast Asia.

?Several recent outbreaks have occurred in these countries, reminding leaders of the gravity of the problem.?

Bird flu first appeared in Egypt in February 2006.

Since then, 50 people have been infected with the virus known as H5N1, with 22 fatalities.

The country is the worst hit outside Asia by avian flu.

?Mortality rate in Egypt stands at 44 percent, which is much lower than world average at 63.3 percent,? said Abdel Rahman Shahin, spokesperson to the Ministry of Health. ?But the huge loss is in animal wealth.?

He explained that outbreak of the virus took a huge toll on Egypt?s poultry industry, with losses estimated at LE 2 billion.

According to a report by the Food and Agriculture Organization (FAO) released in July, Egypt has informed that avian influenza is endemic throughout the country's poultry.

Egyptian authorities said that 1,086 outbreaks caused by the H5N1 virus had been reported since February 2006, for the most part in the Nile Delta region.

More than one million birds are said to have died from the virus and almost nine million culled.

Shahin made his remarks ahead of the Sixth International Ministerial Conference on Avian and Pandemic Influenza scheduled for Saturday to Sunday.

The parley is to review global progress and plan future efforts for pandemic preparedness and bird flu control.

Ministers and representatives from 116 countries ? including 50 health and agriculture ministers ? will attend the conclave in Sharm El Sheikh that is organized in collaboration with the European Union and a number of international organizations.

"The conference in Sharm El Sheikh will provide the opportunity to talk about what Africa needs in financial terms to continue the fight against bird flu, as well as the early diagnosis and prevention of the virus," Egypt?s Health Minister Hatem El Gabaly said in a press statement.

According to the World Health Organization, avian influenza has so far killed 245 people out of a total 387 confirmed cases worldwide.

The highly pathogenic H5N1 bird flu virus is endemic in poultry in parts of Asia and Africa ? namely in Indonesia and Egypt ? but experts fear it will mutate into a form that is easily passed from human to human, sparking a pandemic similar to three others in the past century.

No countries reported new infections of their poultry by the H5N1 bird flu virus in the first nine months of 2008, as compared with four in the same period last year, the UN report said.

The study also pointed out that only 20 countries which have previously reported infections experienced outbreaks between January and September 2008, down from 25 in the same period last year.

"The pace of sporadic human infections and deaths from H5N1 has slowed since last year, with 28 confirmed deaths in 2008 compared to 59 in 2007, but the threat of an influenza pandemic remains," the report read.

Ambassador Lange placed the threat of avian and pandemic influenza within the larger context of global health issues competing for limited resources. He acknowledged that compared to diseases like HIV/AIDS and tuberculosis, avian influenza today remains a more distant threat.

However, he warned that if the avian virus mutates, the ensuing pandemic could be global and devastating, spreading rapidly and affecting millions. According to Lange, it would be the event of our lifetime.
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<cite cite="http://dailystaregypt.com/article.aspx?ArticleID=17333">Daily News Egypt - Full Article</cite>