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Biosecurity BriefingVietnam to Test H5N1 Vaccine in Humans, New Warnings of H5N1’s Pandemic Potential in Indonesia By Jennifer Nuzzo, March 21, 2008 On March 18, 2008, Reuters reported that Vietnam will begin human trials of an H5N1 avian influenza vaccine next month.1 According to the article, the trials, which will be conducted at the Military Medical Academy in Hanoi, have been approved by Vietnam’s Health Ministry but approval from the Ministry of Defense is also needed before the trials can begin. An unidentified official told Reuters that the trials will be conducted on a voluntary basis using students and employees of the academy.1 Vietnam has reported 6 human cases of H5N1 infection this year, of which five have been fatal. The article notes that the test vaccine will be manufactured by Vabiotech, a company run by the National Institute of Hygiene and Epidemiology. If the trials are successful, the company will be able to produce “six million doses per year for application on both humans and poultry.”1 World Health Organization (WHO) officials in Vietnam told Reuters that while they have not been “directly involved” in the country’s H5N1 vaccine development efforts, they understand that “the Ministry of Health has rigorous guidelines for quality control.”1 In related news, the United Nations’ (UN) Food and Agriculture Organization (FAO) are warning that the H5N1 virus that has been infecting birds and people in Indonesia could “mutate and cause a human influenza pandemic.”2 According to a second Reuters article, H5N1 has affected 31 of Indonesia’s 33 provinces. The FAO points out that despite “major control efforts, Indonesia has failed to contain the spread of bird flu in poultry.” FAO Chief Veterinary Officer Joseph Domenech told Reuters that he is “deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic....We have also observed that new H5N1 avian influenza virus strains have recently emerged, creating the possibility that vaccines currently in use may not be fully protecting poultry against the disease.”2 According to Domencech, a “highly decentralized administration, under-resourced national veterinary services, thin international and national financial and human resources for control campaigns are among the major problems that Indonesia has to deal with in fighting the virus spread.”2 FAO issued its warnings the same week that Indonesia’s Ministry of Health reported that a teenager may have been simultaneously infected with seasonal influenza and H5N1 avian influenza strains. As reported by CIDRAP News, this case represents the first report of "a human with both influenza A/H5N1 and H3N2 co-infection.”3 Co-infection with human and avian influenza is one condition that scientists have feared could give rise to a pandemic influenza strain. The co-infection case was presented on March 17, 2008, at the International Conference on Emerging Infectious Diseases. In the information presented by Indonesia's Center for Biomedical and Pharmaceutical Research and Development, the patient was a “16-year-old girl who was tested for flu in Jakarta in April 2007 under a flu-surveillance system established in 2005 by the Indonesian Ministry of Health.”3 The girl experienced mild flu symptoms, and nose and throat swabs taken on the 6th day of her symptoms tested positive for both a seasonal influenza virus (H3N2) and H5N1 avian influenza virus. Serological samples also taken on the 6th day were mixed: one test (antibody titers) provided weak evidence of H5N1 infection, but was negative for H3N2; another test (convalescent sera) gave a strong indication of H3N2 infection (but was negative for H5N1).3 According to the CIDRAP article, the test results were “confirmed by the Eijkman Institute for Molecular Biology in Jakarta, an arm of the Indonesian Ministry of Research and Technology.” The article also points out that the testing was done “within the period when the Indonesian government was not sharing flu isolates with the international laboratory system maintained by the World Health Organization.”3 References
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