Avian influenza – cumulative number of cases – update 18
19 May 2005
WHO is updating its table showing cumulative numbers of human cases of H5N1 avian influenza broken down according to phases in the outbreak, which began in December 2003. [Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO]. Numbers for Viet Nam, where the vast majority of recent cases have occurred, have been amended in line with case counts provided by the Ministry of Health during late April and May. Since the third wave of infection began in Viet Nam in mid-December 2004, 49 cases have been reported. Of these cases, 17 were fatal. The most recent case was reported to the ministry on 17 April.
WHO has asked the Ministry of Health in Viet Nam to supplement the numbers with data on individual cases. Rapid field investigation of new cases, especially when these occur in clusters, remains essential to assess possible changes in transmission patterns that could indicate improved pandemic potential of the virus.
Since January 2004, when human cases of H5N1 avian influenza were first reported in the current outbreak, 97 cases and 53 deaths have been reported in Viet Nam, Thailand and Cambodia. Viet Nam, with 76 cases and 37 deaths, has been the most severely affected country, followed by Thailand, with 17 cases and 12 deaths, and Cambodia, with 4 cases and 4 deaths.
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U.S. unprepared against new flu -experts The United States still has no licensed vaccine to prevent avian flu and has nowhere near enough drugs to treat the sick if there is an epidemic, experts told Congress on Thursday.
Hospitals have too little capacity to deal with the huge numbers of people who would become sick and the U.S. Health and Human Services Department does not have a plan for dealing with an epidemic, the experts said.
"Although many levels of government are paying increased attention to the problem, the United States remains woefully unprepared for an influenza pandemic that could kill millions of Americans," said Dr. Andrew Pavia, chairman of the Infectious Disease Society of America's Pandemic Influenza Task Force.
"Clearly, we need a much larger supply of drugs and vaccine to control a flu pandemic. We need to build up U.S. manufacturing capacity so that we are not dependent on other countries to meet our needs," Pavia said in remarks prepared for a hearing of the health subcommittee of the House of Representatives' Energy and Commerce Committee.
Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, said the government was working hard to address the threat.
"CDC's influenza budget is $197 million ... a lot larger than just a few years ago," Gerberding said. "We have a lot of work to do, and that work needs to be a priority."
The H5N1 strain of avian flu has killed 37 people in Vietnam, 12 in Thailand and four in Cambodia.
It could sicken up to 20 percent of the world's population if it acquires the ability to pass easily among people, says influenza expert Dr. Albert Osterhaus of the Erasmus Medical Center in Rotterdam, Netherlands.
A pandemic could send 30 million people to the hospital and a quarter of them could die, Osterhaus and colleagues predicted in articles in Thursday's issue of the journal Nature.
Influenza causes epidemics annually and kills 36,000 Americans in a normal season. Different strains emerge almost annually, and a new one can kill many more if it is one that has not affected people in recent years.
A brand-new strain, such as H5N1, could be devastating.
"The U.S. population has no immunity and therefore no protection against this deadly virus," Pavia said.
He recommended that the United States stockpile a larger supply of antiviral drugs, especially oseltamivir, made by Switzerland's Roche under the brand name Tamiflu. Avian influenza resists older antiviral drugs, like amantadine and rimantadine, but Tamiflu can help make an infection less severe.
Although Roche has quadrupled its production capacity for Tamiflu, experts believe global stockpiles will be too small for a pandemic. The current stockpile would treat less than 2 percent of the U.S. population. Pavia's group recommends having enough on hand to treat 50 percent.
The U.S. government has also contracted with Sanofi-Aventis and Chiron Corp. to make H5N1 flu vaccines, but the contracts provide for only 2 million doses and the vaccines are still experimental.
The U.S. Government Accountability Office also criticized the U.S. lack of preparation.
Marcia Crosse, Director of Health Care for the GAO, said in prepared testimony that the United States needs to address regulatory, privacy, and procedural issues surrounding measures to control the spread of disease, especially across borders.
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