ECDC risk assessment on novel influenza A virus in China

03 Apr 2013 http://www.ecdc.europa.eu/en/press/news/Lists/News/ECDC_DispForm.aspx?List=32e43ee8%2De230%2D4424%2Da783%2D85742124029a&ID=876&RootFolder=%2Fen%2Fpress%2Fnews%2FLists%2FNews 파일 : http://www.ecdc.europa.eu/en/publications/Publications/AH7N9-China-rapid-risk-assessment.pdf

ECDC On 31 March 2013, the Chinese authorities announced the identification of a novel influenza A virus, A(H7H9), in three seriously ill people from two provinces presenting with respiratory infections. So far, no epidemiological link has been identified between those three patients. When testing for the influenza virus, the Chinese Center for Disease Control and Prevention identified genes from both A(H7N9) and A(H9N2) viruses, thus indicating a novel reassortant avian influenza A virus. In its initial assessment of the situation, the ECDC rapid risk assessment concludes that the risk of the spread of the virus in Europe can be considered low at this stage. However, individual patients coming from China cannot be ruled out. It is thus important to further investigate the source of infection and the mode of transmission to develop ECDC’s assessment further. This event stresses the importance of considering the possibility of zoonotic influenza due to novel influenza A viruses in persons presenting with severe acute respiratory disease. Especially when patients have recently been in countries where animal influenza A viruses circulate and these viruses have recently caused severe respiratory disease in humans. This includes China. ECDC is working closely with WHO and the European Commission and will continue to monitor the situation.  ECDC Rapid Risk Assessment Severe respiratory disease associated with a novel influenza A virus, A(H7N9) China, 2 April 2013 Related links: Weekly influenza surveillance overview, week 11/2013 Risk assessment: Seasonal influenza 2012/13 in Europe (EU/EEA countries) View influenza surveillance maps Learn more about influenza on ECDC website Influenza;Avian Influenza;Influenza; =====================

Pathogenesis and transmissibility of highly (H7N1) and low (H7N9) pathogenic avian influenza virus infection in red-legged partridge (Alectoris rufa).

미국의사협회지 (JAMA) 2012년 7월 11일자에 신증플루(H1N1) 예방접종 후 말초신경 장애를 초래하는 희귀질환인 길렝-바레 증후군이 발생할 수 있다는 보고가 실렸습니다.

캐나다 퀘백주에서 신종플루 백신을 접종받은 440만 명 중에서 25명에서  길렝-바레 증후군이 발생했으며… 100만 명 당 2명 꼴로 이 증상이 나타나는 것으로 추정됩니다.

그렇지만 연구진은 백신접종을 받지 않은 58명에게서도 길렝-바레 증후군이 나타났으며…
백신접종을 받지 않았을 경우의 위험이 길렝-바레 증후군이 발생할 위험보다 크기 때문에
백신접종을 받는 것을 권장하고 있습니다.



H1N1 vaccine may be linked to rare nerve disorder

By Christopher Wanjek

Published July 10, 2012 LiveScience
http://www.foxnews.com/health/2012/07/10/h1n1-vaccine-may-be-linked-to-rare-nerve-disorder/

The H1N1 (swine) flu vaccine was associated with a small but significant risk for developing a rare nervous disorder called Guillain–Barré syndrome (GBS), say doctors in a report detailed in the July 11 issue of  the Journal of the American Medical Association (JAMA).

The study, conducted in Quebec rekindles the still-controversial connection between Guillain–Barré syndrome (GBS) and the 1976 swine flu outbreak, which halted that year’s flu vaccination program in the United States. It also raises questions about vaccines for flu strains originating in swine.

This latest analysis, led by Philippe De Wals of Laval University, Quebec City, Canada, followed 4.4 million residents vaccinated against the H1N1 “swine flu” in late 2009. Over the next six months, 25 people who received the vaccine developed GBS. Across the Quebec province, however, another 58 people who were not vaccinated also developed GBS.

De Wals said that, regarding the entire population, the number of GBS cases attributed to the swine flu vaccine was about 2 per 1 million doses, but that the benefits of immunization outweigh the risks.

Vaccine risks and benefits

Health experts have long been nervous to speak about risks associated with vaccines. This is because the vaccine benefits are great and the risks are small, with adverse reactions usually occurring in vulnerable populations, such as those with certain allergies or pre-existing nervous system disorders. [5 Dangerous Vaccination Myths]

Flu vaccines, in particular, save millions of lives. Influenza will kill on average about a half-million people worldwide annually, including up to 40,000 in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). Flu pandemics will kill millions.

Sometimes vaccine risks are real and high because of a bad batch of drugs. A prime example is the Cutter Incident in 1955, in which the polio vaccine accidentally contained a live virus that infected 40,000 children, leading to 55 cases of paralysis and five deaths. This nearly destroyed the public’s confidence in vaccines at the dawn of polio eradication.

Sometimes, however, reports of vaccine risks turn out to be false and based on fabricated science, such as the link between the measles, mumps and rubella (MMR) vaccine and autism. Measles and also whooping cough have had resurgences as a result of low vaccination rates brought on by this scare.

Thus, many health experts do not readily concede to vaccine risks when confronted with them. And Guillain–Barré syndrome haunts many like a specter.

Tale of two swine

Guillain–Barré syndrome is a serious peripheral nerve disease that can cause partial paralysis, breathing difficulties and death. Most patients recover after several months to a year, although not always fully. GBS is associated with Campylobacter jejuni,the food-borne bacterium, and several viruses; but for most cases, the immediate cause is not known, according to the CDC. [Top 10 Mysterious Diseases]

During the 1976 swine flu outbreak in the United States, health authorities reported an unusually high number of GBS cases, nearly 1,100 — half of which occurred after immunization against the flu. Panic ensued, and the vaccine program ended by December that year.

Doctors debated the connection then, and it took nearly 30 years before the prestigious U.S.-based Institute of Medicine concluded in 2003 that there was a causal relationship and that one extra person out of a million contracted GBS as a result of the vaccination.

The results of the new Quebec study on the 2009 H1N1 flu strain of swine origin are eerily similar to the conclusions drawn from the dozens of studies on the 1976 swine flu outbreak. Is there something about vaccines for flu strains of swine origin that can trigger GBS?

A much larger study published in February 2011 in the New England Journal of Medicine examined nearly 90 million doses of H1N1 vaccine in China and concluded that the answer was no.  Doctors there found only 11 cases of Guillain–Barré syndrome, which actually is far lower than the natural rate.

So, one debate will continue: whether there is a small but real link between swine flu vaccines and GBS. But few if any reputable doctors will argue that the flu vaccine is dangerous or not worthwhile for most people, from infants to the elderly. In fact, a study published in the same issue of JAMA finds the H1N1 vaccine is safe for pregnant women.

Read more: http://www.foxnews.com/health/2012/07/10/h1n1-vaccine-may-be-linked-to-rare-nerve-disorder/#ixzz20vfrSEOn

=====================

[국내사례] 신종 인플루엔자(H1N1) 예방 접종 후 발생한 길렝 바레 증후군 1례
Journal of The Korean Child Neurology Society 2010 ; 18(1) : 108-111 

INTRODUCTION & CONTENTS

These documents and risk assessments have been collated by the Wildlife Information Network in response to the FMD Outbreak in the UK, 2001 and we wish to thank the authors, publishers and copyright holders for making these documents available to us.

The documents represent a spectrum of information ranging from instructions issued to travellers to detailed risk assessment on the disposal of carcasses. We have also included a number of discussion documents which illustrate the diversity of opinion on the UK 2001 outbreak, and the policies on the use of different control methods, particularly culling and vaccination.

Whilst we do not accept responsibility for the content of these documents, and in some cases may not agree with some of the content, we believe that these documents, particularly when combined with information within the main Wildpro module, provide a good background to the issues and problems associated with this FMD outbreak.

• Title Page
  
• Introduction & Contents
  
• Strategy for Emergency Vaccination against Foot and Mouth Disease (FMD) Report of the Scientific Committee on Animal Health and Animal Welfare (European Union)
  
• Foot-and–mouth disease in the United Kingdom: problems with the current control policy and the feasibility of alternatives (March 2001) – Dr Keith Sumption
  
• The 2001 Foot and Mouth Outbreak:  Economic Arguments against an Extended Cull (March 2001) – Professor Peter Midmore
  
• Strategic Decisions to Evaluate before Implementing a Vaccine Programme in the Face of a Foot-and-Mouth Disease (FMD) Outbreak -Professor Joe Brownlie
  
• Strategic Foot-and-Mouth Disease in Deer (Cervidae): its implications for the policy of control of the disease in the Netherlands – Dr Paul Sutmoller

Risk Assessment and Miscellaneous Guidance Documents published by the UK Government’s Ministry of Agriculture, Fisheries and Food (MAFF):

• Veterinary Risk Assessment No.1: What is the risk of causing new outbreaks of FMD by moving livestock directly from “Farm A” to “Farm B”?
  
• Veterinary Risk Assessment No.2: slaughter policy on contiguous premises
  
• Veterinary Risk Assessment No.3: Bulk Feed Delivery to Form D premises by lorry
  
• Veterinary Risk Assessment No.4: What is the risk of causing new outbreaks of FMD if footpaths are open to the public?
  
• Veterinary Risk Assessment No.5: What is the risk that Feral Deer on infected premises will cause outbreaks of FMD on other premises?
  
• Veterinary Risk Assessment No.6: What is the risk of causing new outbreaks of FMD by moving sheep directly from “Farm A” (on which animals have been exposed to the risk of infection by proximity to an infected premises, or in some other way) to an alternative place of slaughter, and from there to a further place for disposal?
  
• Veterinary Risk Assessment No.7: What is the risk of feral wild boar becoming infected with FMD and subsequently causing new incidents of FMD in domestic livestock?
  
• Veterinary Risk Assessment No.8: What is the risk of causing new outbreaks of fmd if animals are slaughtered and their meat and waste products are distributed through the normal channels?
  
• Veterinary Risk Assessment No.9: What is the risk of causing new outbreaks of FMD if deer parks are open to the public?
  
• Veterinary Risk Assessment (no number specified): What is the risk of migratory geese spreading foot and mouth disease virus?
  
• Veterinary Risk Assessment No.13: What is the risk of causing new outbreaks of FMD by moving hay and straw onto a farm?
  
• Veterinary Risk Assessment No.18: What is the risk of causing new outbreaks of fmd through collection and transport of bull semen and artificial insemination of cows?
  
• MAFF: Biosecurity – advice for cattle and sheep farmers
  
• MAFF: “Code of practice for hauliers and buyers of milk” and “Manufacturers of air filters or filter systems approved for use on milk tankers operating in a Foot and Mouth Disease infected area”
  
• MAFF: Advice and precautions for zoos, wildlife parks etc
  
• MAFF: Approach to Vaccination of Animals in Zoos
  
• MAFF: Restocking Form A premises: A farmers guide
  
• MAFF: List of susceptible species commonly kept in zoos
  
• MAFF: Guidance on the Storage, Handling and Movement of Animal Manures and Slurries
  
• MAFF: Silage and hay-making, and grassland management, during Foot and Mouth disease restrictions: guidance for farmers
  
• MAFF: Measures to Allow Movement of Big Bale Silage within a Protection Zone
  
• MAFF: Adjusting the pH as a means of disinfection against Foot and Mouth Virus

Guidance Documents published by the UK Government’s Environment Agency:

• Environment Agency: Guidance on ash disposal arising from Pyres and mobile incinerators
  
• Environment Agency: Licensed Landfill Sites that are Suitable for the Disposal of Carcasses
  
• Environment Agency: advice on the use and disposal of disinfectants
  
• Environment Agency: advice on disposal of manure, slurry and dirty water
  
• Environment Agency: Visiting the countryside – how you can help
  
• Environment Agency: Risks From BSE Via Environmental Pathways

International Guidance for Travellers and Visitors:

• USDA: Foot and Mouth Disease Prevention Information For Passengers Traveling To The United States From FMD Infected Regions of the World
  
• CFIA: Foot and Mouth Disease – Information for Travellers
  
• 
  

  AFFA: Advice to travellers from foot and mouth disease countries