World Health Assembly addresses pandemic flu

May 19, 2005 (CIDRAP News) – The world has an unprecedented warning that pandemic influenza may be imminent, the World Health Organization (WHO) said in a report that urges swift action to prevent global illness and death.

A WHO report, "Strengthening pandemic influenza preparedness and response," is slated for discussion tomorrow at the organization's annual World Health Assembly (WHA) in Geneva.

Although distinct from the recent report produced by experts convened by the WHO in Manila on May 6 and 7, this document makes similar points about the threat of a flu pandemic.

"The virus may be evolving in ways that increasingly favor the start of a pandemic," the report states, later adding, "The ecology of the disease and behavior of the virus have created multiple opportunities for a pandemic virus to emerge."

Changes have occurred since a year ago, when the WHO advocated eliminating the virus in its animal reservoir. Experts now agree it is endemic in parts of Asia, and the public health focus is shifting to reducing the risk for people exposed to H5N1, particularly subsistence farmers, and improving response to illness, such as with a vaccine. However, the report says, creation of a vaccine "has moved forward, but not with a speed appropriate to the urgency of the situation."

Vaccines against H5N1 are being made and tested now, although the virus has changed since the current vaccine seed stock was created.

The WHO report suggests that vaccine against the H5 subtype should be produced in bulk and stored.

"Even if the actual pandemic H5 subtype virus shows mutational changes when compared with the current H5N1 strain, a vaccine that is protective against infection due to that strain could confer almost as much protection," WHO said. "Stockpiles of an H5N1 vaccine would be useful in the early phase of a pandemic when large-scale production of a vaccine has not yet been initiated."

The report also emphasizes the importance of preparedness, particularly stressing vigilance for clusters of respiratory disease cases in affected countries.

The meeting about pandemic flu caps a week of high-profile discussions on the topic that began May 16, when the WHO director-general sounded a warning as he convened the annual assembly.

Calling avian flu "the most serious known health threat the world is facing today," Lee Jong-wook, MD, MPH, noted the importance of the window of time between hints of a pandemic and its actual occurrence.

"By good fortune we have had time—and still have time—to prepare for the next global pandemic, because the conditions for it have appeared before the outbreak itself. We must do everything in our power to maximize that preparedness," he said.

Mike Leavitt, US secretary of health and human services, said in Geneva on May 16 that transparency, strong surveillance, and communication are essential parts of a response. Leavitt's remarks were posted on the US State Department's Web site.

Leavitt also urged strong international collaboration, with an emphasis on developed countries effectively helping developing countries control the virus and treat patients. He urged health ministers to support a draft resolution on pandemic preparedness and response, offered by the United States and several other nations, saying it "provides a good blueprint for action."

The WHO's top flu official, Klaus Stohr, emphasized that fast response is important, according to a story published today by Agence France-Presse. "We are working on pandemic preparedness on borrowed time," he said.

While health officials in Geneva discussed the possible pandemic, new avian flu developments were reported in Asia:

  • A positive serum sample from a poultry worker has led to concerns about human H5N1 infection in Indonesia, which has been plagued with poultry outbreaks. The worker, from hard-hit South Sulawesi province, is being retested, according to an Associated Press (AP) story May 18. He has shown no signs of illness, the AP reported. The WHO said the serum sample was positive for avian flu antibodies, which on its own doesn't constitute a confirmed case. The worker returned to health officials for more blood tests, which are expected to be done within 2 weeks. Indonesia has tested 83 people for exposure to H5N1, according to an earlier report in the Jakarta Post. This is the first positive finding.
  • Chinese authorities confiscated contaminated eggs from Vietnam hidden in the carry-on luggage of two airline passengers on separate flights, according to The Standard newspaper of China. Dogs sniffed out the 45 chicken, duck, and goose eggs Apr 28. The duck and goose eggs tested positive for the presence of H5N1 virus, the newspaper said.
  • Thailand and Hong Kong are collaborating to create an Asian bank of influenza vaccine and antiviral drugs, the Thai News Agency (MCOT) said today. The countries will establish a bank of the antiviral drug oseltamivir and serve as a regional resource in event of a pandemic flu, a Thai official announced yesterday in Geneva. The collaboration will help link Hong Kong's expertise in laboratory diagnosis with Thailand's expertise in epidemiology, said Thailand's health minister, Suchai Charoenratanakul. The partnership also will include research and the exchange of lab samples of the virus, the story noted.

See also:

WHO draft report "Strengthening Pandemic Influenza Preparedness and Response"
http://www.wpro.who.int/entity/emerging_diseases/documents/docs/A58_13en.pdf

Draft resolutions presented at WHA meeting; pandemic flu resolution is EB115.R16
http://www.who.int/gb/ebwha/pdf_files/EB115-REC1/e/Resolutions.pdf

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