New Zealand assisting with managing Tokelau influenza-like outbreak

[Sally Furniss]

http://www.moh.govt.nz/moh.nsf/0/957...900112F77?Open

Media Release
30 March 2009

New Zealand assisting with managing Tokelau influenza outbreak

New Zealand health authorities are working closely with their counterparts in Tokelau to help manage an influenza outbreak affecting more than one in every ten people on the three remote atolls of Tokelau.

The New Zealand territory with only slightly more than 1500 residents spread over three atolls more than 500 km north of Apia has around 150 people reported ill with influenza.

Health services on each atoll have acted swiftly to limit the spread of the disease. The school on Atafu, the northern-most atoll, has been closed, public gatherings halted, sick people advised to stay home and hand washing messages reinforced.

Wellington public health services and Capital and Coast Health have been working with the NZ Ministry of Health and WHO providing advice and additional health supplies such as vaccines, which along with antiviral supplies will be shipped to Tokelau on the overnight boat trip from Samoa. The Wellington-based Office of the Administrator of Tokelau is also actively involved with coordination and support.

Nursing support from Wellington has been offered to Tokelau and if required they would need to fly to Apia in time to catch the fortnightly boat from Apia to Tokelau as the atolls have no air service.

Ministry of Health officials are closely monitoring the situation and working with the Minister of and Director for Health for Tokelau – both of whom are based in Samoa.

Background:
The first case was reported on Tokelau on 16 March.
The number of people reported sick with influenza type symptoms on Sunday 29 March was 147.
Confirmation of the type of influenza is expected to take some time for swabs to be sent to New Zealand for testing.



For further information, please contact Media Advisor Michael Flyger: 04 496 2265 or 027 434 6878

[RiSi]

HI

Does anyone have a case definition at this stage?

[sharon sanders]

Welcome RiSi!

[RiSi]

Thanks, great to be here!

My main focus is on the pandemic side but thought I'd tap into this topic for a colleague.

[Sally Furniss]

Welcome RiSi

[Sally Furniss]

Posted at 01:41 on 31 March, 2009 UTC

Children in Tokelau have been worst affected by a flu outbreak which has so far infected 10 percent of the islands’ population.

The Ministry of Health says about 150 people, most of them children, have contracted the influenza-like virus.

A Wellington Hospital Nurse, Bronwen Markham, who’s heading to Tokelau says children are more prone to contract the illness because of their hygiene habits.

She says she and an oficial from the World Health Organisation are expected to arrive in Tokelau by Thursday to deliver about 1,400 flu vaccinations.

News Content © Radio New Zealand International
PO Box 123, Wellington, New Zealand

http://www.rnzi.com/pages/news.php?op=read&id=45667

[Sally Furniss]

Posted at 21:26 on 30 March, 2009 UTC
New Zealand health authorities are working with Tokelau’s officials to manage an influenza-like outbreak affecting more than one in every ten people on the country’s three atolls.
Tokelau has about 1500 residents spread over three atolls, and around 150 people have reported ill with influenza.
The school on Atafu, the northern-most atoll, has been closed, public gatherings halted, sick people advised to stay home and hand washing messages reinforced.


Dr Fran McGrath, from New Zealand’s Ministry of Health says the symptoms are a fever, malaise, and muscle aches.

“But because the children haven’t been exposed to it before then there’s a large number of them are picking it up. A small number appear to be needing antibiotics but but the majority of children appear to be, it just appears to be a normal course of a flu-like illness really.”

Dr Fran McGrath says New Zealand health services and the World Health Organisation are providing advice and additional health supplies such as vaccines, which along with antiviral supplies will be shipped to Tokelau on the overnight boat trip from Samoa.
They have also offered nursing support.
News Content © Radio New Zealand International
PO Box 123, Wellington, New Zealand

[Sally Furniss]

Tiny Tokelau battles flu outbreak

By New Zealand correspondent Kerri Ritchie

Ten per cent of the population of the tiny Pacific island nation of Tokelau is sick as the island battles an influenza outbreak.

Tokelau is 500 kilometres north of Samoa, and has a population of just 1,500.

New Zealand health professionals will tomorrow make the 26-hour boat journey from Samoa to Tokelau.

Deputy director of public health, Fran Mcgrath, says the flu has hit locals hard.

"This is an isolated population so there is not a high level of immunity," he said.

Four children are in hospital, and schools have been shut and village chiefs have been advised to cancel all public gatherings.

http://www.abc.net.au/news/stories/2...31/2531418.htm

[Shiloh]

Source: http://news.bbc.co.uk/2/hi/asia-pacific/7973531.stm

Flu epidemic hits Pacific island

Medical officials from New Zealand are trying to get aid to the remote South Pacific islands of Tokelau, which have been hit by a flu epidemic.

The tiny archipelago, where one in 10 people are sick, is a 26-hour boat ride from its nearest neighbour, Samoa.

Most of the 150 people affected are children. Four have been hospitalised so far, according to media reports.

Public gatherings have been cancelled, schools closed, and sick people have been told to stay home.

Health officials from New Zealand and the World Health Organization are due to arrive with vaccines on Wednesday.

"This is an isolated population so there is not a high level of immunity," New Zealand's deputy director of public health, Fran Mcgrath, told the Australian Broadcasting Corporation.

Tokelau is made up of three coral atolls which have no airport, no roads and no capital city.

The territory is just 4.7 sq miles (12 sq km), lying halfway between Hawaii and New Zealand.

Officials say they will deliver about 1,400 flu vaccinations and obtain sample swabs to try to identify the strain of the influenza virus.

Wellington has governed Tokelau since 1926, and gives it substantial aid.

The people of Tokelau have rejected self-government in two referendums over the past three years.

[HenryN]

Severe flu outbreak ravages Tokelau

The Dominion Post Last updated 05:00 31/03/2009




Wellington health authorities are sending vaccinations and other health supplies to remote Tokelau after a flu outbreak has struck the population hard.
Public gatherings have stopped in the New Zealand territory and sick people have been told to stay at home, the Health Ministry in New Zealand says.
By Sunday, nearly 150 people had been reported sick with influenza 10 per cent of the population, which numbers about 1500 residents over the three atolls. The first case was reported on March 16.
A ministry spokesman said the strain had not yet been identified.
Capital and Coast District Health Board is sending a senior nurse to act as an adviser. Bronwen Markham, who works as a project manager at Wellington Hospital, flies to Apia today.
Influenza experts in New Zealand have warned this flu season could be the deadliest in years.
http://www.stuff.co.nz/dominion-post/news/2302695/Severe-flu-outbreak-ravages-Tokelau

[HenryN]

Updated map

http://maps.google.com/maps/ms?hl=en...,0.003455&z=18

[HenryN]

News Asia-Pacific

Flu virus hits South Pacific atolls

New Zealand health officials have despatched medical aid to the Tokelau islands, a tiny isolated cluster of atolls in the South Pacific, to try to stem a growing flu outbreak. So far 10 per cent of the 1,500 population on the New Zealand island territory have reportedly fallen sick, most of them children. The Tokelau islands are made up of three tiny atolls located about 500km north of Samoa, and some 4,000km from New Zealand's capital, Wellington. The flu epidemic has forced schools to close and public gatherings to be cancelled, officials in Wellington said on Wednesday. Michael Flyger, a spokesman for New Zealand's health ministry, said latest figures showed that nearly 150 people have been reported sick, but he said the outbreak was not yet at "crisis point". He told the Associated Press that it was "very, very unlikely" that the unknown flu strain had originated from the atolls. "It's most likely a strain that has existed previously and has been brought onto the atolls by somebody returning or visiting," added Flyger. Flyger said that being a small and isolated population, the inhabitants "tend to be what we call immunologically-naive, they don't get a lot of exposure to this sort of stuff so it can infect them a little more easily". The first flu case was reported on March 16 and the outbreak had since spread to all three atolls, stretching the health resources of a few doctors and nurses "scattered around". Medical response Isolation has made the Tokulau islanders are vulnerable to infections [GALLO/GETTY] New Zealand authorities have already sent a nurse, vaccinations and other medical supplies by boat from Samoa, and are expected to arrive by this weekend. Fran McGrath, New Zealand's deputy director of public health, told Australian media that the government and the World Health Organisation had responded to residents' requests for medical assistance. She said the response team will help to determine the source of outbreak and infection, as well as clinical and logistical support. McGrath said Tokelau's isolated population does not have a high level of immunity to even the common flu or other viral conditions. The three Tokelau atolls - Atafu, Fakaofu, Nukunonu - have no capital, airfield, sea port, cars or television. Polynesian village chiefs take turns as national leader for a year. Tokelau's residents are New Zealand citizens who twice in recent UN-supervised votes have declined independence. http://english.aljazeera.net/news/as...471700866.html

[HenryN]

Updated map
http://maps.google.com/maps/ms?hl=en...4,3.537598&z=8

[HenryN]

NZ sends health officials to flu-affected Tokelau


Last Updated: 21 hours 39 minutes ago
A small group of New Zealand health officials are on their way to Tokelau to help the tiny island nation cope with its worst health crisis in 30 years.

About 10 per cent of the 1,500 people living there are reporting flu-like symptoms.

All public gatherings have been cancelled and schools closed.

The World Health Organisation and New Zealand's ministry of health have been monitoring the outbreak and say it's likely it was started by a visitor carrying the virus.

The Deputy Director of Public Health in New Zealand, Fran McGrath, says a number of health professionals from New Zealand have now embarked on a 26-hour boat journey from Samoa to reach Tokelau.

"Given that there are a couple of nurses on each of the atolls and that's the main health work force, supported by some hospital aid and - on two of the atolls, a doctor - they're quite stretched," she said.

"They requested some support and that's what the WHO and NZ Health Service are providing."

http://australianetworknews.com/stor...43.htm?desktop

[HenryN]

commentary

[tropical]

Unfortunately, we can see here how discutable are the countries official pandemic flu plans if they are based on the "usualy taken" 2,5% CFR, at the same time stamping of scaremongering some others projections of 10-30% or more CFR in an serious novel flu pandemic.

The situation is similar:
- an relatively naive population to the virus (childs and many seniors)
- no vaccines applyed before the contagion
- additional infections need antib. also
- and assuming that in a serious pandemic what are now seasonal curable form infected numbers, than could be fatalities

and more, it would be much more worst for the other countries because:
- this very distant islands have NOT airports, trains/..., and large ports, so they are pretty more isolated than the majority of places would be, and stil they catch the virus from some carrier.

That means that there would be no real possibility to miss an serious novel pandemic virus in modern overcrowded cities, if not beeing ducked in an private shelter for months (or until some matched vacc. come) ...

But stil, the supposed esigue pandemic CFR remains in the plans and preparations ...

P.S. Couldn't be finaly created a critical sci. mass to push an new decision for additional vaccine strain changings at least for the northern 09/10 hemisfere in the light of the cited facts about the resistance (post #15, and prior)

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04...rel="nofollow"

Commentary

Flu Epidemic in Pacific Atolls Raises Concerns

Recombinomics Commentary 13:04
April 1, 2009

A small group of New Zealand health officials are on their way to Tokelau to help the tiny island nation cope with its worst health crisis in 30 years.

About 10 per cent of the 1,500 people living there are reporting flu-like symptoms.

All public gatherings have been cancelled and schools closed.

"Given that there are a couple of nurses on each of the atolls and that's the main health work force, supported by some hospital aid and - on two of the atolls, a doctor - they're quite stretched," she said.

The above comments describe a flu outbreak in Tokelau (see map). The small island community has no airfield, roads, or automobiles, so treatment and updates are delayed. The influenza strain has not been determined, but vaccines and anti-virals are in route and expected to arrive on Sunday.

The flu season is beginning in the southern hemisphere, and this outbreak may signal the severity of the upcoming season, although this population is somewhat immunologically naïve and the spread may not signal a trend for a more diverse population.

However, there were widespread outbreaks which led to school closings in Japan and South Korea, which were linked to Tamiflu resistant H1N1. Moreover, reports from Japan and Taiwan suggested that the H1N1 was vaccine resistant. The dominant H1N1 in these countries had acquired A193T as one of the changes at positions 187, 189, and 196 (G189A). The H1N1 target for the southern hemisphere is unchanged, so vaccine resistant H1N1 strains would be resistant to the vaccine in route to Tokelau. The current target, A/Brisbane/59/2007, was isolated prior to acquisitions on HA and NA that are associated with the fixing of H274Y, so the ability to halt the worldwide dominance of Tamiflu resistant H1N1 will be limited this season in southern hemisphere as well as next season in the northern hemisphere, since the H1N1 target for then 2009/2010 season is also unchanged.

.

[HenryN]

http://tvnz.co.nz/health-news/flu-hi...d-hard-2614644

Flu hits tiny island hard

Published: 7:47PM Thursday April 02, 2009

Source: AAP

ONE News

A flu epidemic which has swept through the tiny, isolated Pacific island of Tokelau has been contained.

One in 10 of the islanders have been struck down by the illness and New Zealand medics are en route to the small archipelago to treat the ill and administer influenza vaccines to all 1,450 residents.

But the journey is a long one as Tokelau has no airport, seaport or roads, and it is 26 hours by boat from its nearest neighbour, Samoa.

"The nurse and her assistant are on the boat now but it will take some time," said Tokelau's director of health, Lee Pearce, who is based in Samoa.

"But in the meantime we can say it's well-controlled and contained, and the number of new cases reported everyday is dropping quickly."

Tokelau, a territory of New Zealand, is made up of three coral atolls which occupy just 12 square kilometres of land.

Islanders first reported the outbreak in mid-March and more than 150 people have been affected so far. Dr Pearce said most of the ill were children, and four had been hospitalised.

"That is particularly worrying as children and elderly are the most vulnerable to severe illness," she said.

She said the country's extreme isolation and small population meant the flu had hit locals particularly hard.

"When this type of outbreak happens in countries like Australia the numbers just get absorbed by the larger population, but when there are so few people and immunity is so low it is really felt," Pearce said.

Experts say it is very unlikely the virus originated from the island, and was presumably carried there by a visitor.

The population would be vaccinated annually from this year on, to ensure such an outbreak is not repeated, the director said.

[Sally Furniss]

Wellington Hospital nurse consultant Bronwen Markham is back on dry land after agreeing to be part of a Ministry of Health response to a suspected influenza outbreak threatened to overwhelm health services on the isolated atolls.


A swift response was required with nearly 150 people reported sick out of a population of 1500 people on the three atolls, more than 500km north of Samoa, separated by 60km of open ocean, which make up New Zealand's last remaining dependent territory.


With about 10% of the population reported ill, Tokelau's acting Director-General of Health, Lee Pearce (on leave from her job as Capital and Coast's Pacific health services manager), sought urgent assistance from the New Zealand Health Ministry on March 29. Bronwen took her partner Carl Reller, an environmental manager at the NZ Transport Authority who is also a medical technologist, along for support and to help educate local nurses on using the rapid test kits.


After a flight to the Samoan capital of Apia, where they met Lee Pearce and World Health Organisation doctor Jacob Kool, they caught the fortnightly sailing to Tokelau. “Everyone spreads their mattresses on deck like in a marae and looks after each other as best they can.” After 45 hours in horrific sea swells they finally arrived at Fakaofo late on April 1.



After reaching Atafu they met with the Taupulega who granted permission at a formal meeting to proceed with the work of vaccinating and screening. The team then headed to the hospital to set up a base. Nurses were trained in vaccination technique then, accompanied by members of the team proceeded to vaccinate the community going from house-to-house. Approximately 200 of the 350 doses were administered on the first day, which was a majority of the population on Atafu.



Local health services had acted swiftly to limit the spread of the disease. The school had been closed, public gatherings banned, sick people advised to stay home and the message of hand washing reinforced.
"We were feted like heroes - people were so touched that New Zealand was at last acknowledging they existed. They are incredibly generous people; we were overfed like there was no tomorrow."


The team spent nine days in Tokelau, testing and treating the sick, vaccinating the population and training nurses. The nature of the illness remains a mystery.

Tests showed negative results for influenza Type A and B and instead results show it to be an 'influenza-like illness' with similar symptoms to the flu but of shorter duration and not as dangerous.
http://www.ccdhb.org.nz/News/2009_archive/09_04_28.htm

[Sally Furniss]

“Dr Kool has sent samples to Australia but it looks like an ‘influenza-like illness’, i.e., similar symptoms to the flu but of shorter duration and mercifully not as dangerous.

http://www.spc.int/ppapd/index.php?o...d=500&Itemid=1