Month: November 2020

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Tamiflu-resistant H5N1 strain surfaces in Egypt

November 18, 2020 | lpjxbyhj | No Comments

first_imgJan 18, 2007 (CIDRAP News) – Two patients who recently died of H5N1 avian influenza in Egypt had a strain of the virus that was moderately resistant to oseltamivir (Tamiflu), the World Health Organization (WHO) announced today, but the finding has not prompted new health advisories.News of the drug-resistant strain came as Egypt’s health ministry announced a new human H5N1 case, involving a 27-year-old woman from the town of Beni Suef, about 62 miles south of Cairo. The report was carried today by IRIN, a United Nations news and information service.Oseltamivir is recommended by the WHO as the first-line drug for H5N1 patients. The patients who had resistant infections were a 16-year-old girl and her 26-year-old uncle, who lived in the same house in Egypt’s Gharbiyah province, in the Nile delta 50 miles northwest of Cairo. They got sick in December; the man was hospitalized on the 17th, followed by his niece 2 days later, the WHO said. Both received 2 tablets of oseltamivir on Dec 21 and were transferred to a referral hospital on Dec 23, the same day samples were taken.The girl died Dec 25 and her uncle died Dec 28. They were part of a possible family cluster; H5N1 avian influenza was also confirmed in a 30-year-old woman in the household, said to be the man’s sister, who died, though few details are available about her. The WHO said the patients reportedly had contact with sick ducks. The two cases boosted Egypt’s avian flu total to 18 cases and 10 fatalities, all of which occurred in 2006.Genetic sequencing was done at US Naval Medical Research Unit 3 in Cairo and at WHO collaborating centers in Atlanta and London, the WHO said. Tests suggested that the virus had “moderately reduced susceptibility” to osteltamivir. The same type of mutation was previously identified in a Vietnamese case in 2005, the WHO said.But in contrast to the Egyptian cases, the virus in the Vietnamese case appeared to be highly resistant to oseltamivir. The case, reported in December 2005 in the New England Journal of Medicine (NEJM), involved a 13-year-old girl who was started on oseltamivir the day she was hospitalized, receiving the recommended dose of 75 mg twice a day for 5 days.The girl was one of 8 patients whose cases were analyzed after they were treated for H5N1 infection in Ho Chi Minh City in 2004 and 2005. Researchers sequenced the H5N1 virus’s neuraminidase gene to look for resistance, signaled by the substitution of tyrosine for histidine at amino acid position 274. The mutation was found in the 13-year-old girl, who died of severe pneumonia on her seventh day in the hospital.The viral load in her throat was higher by the time of her death than it was earlier, which, with other laboratory evidence, suggested that drug resistance contributed to treatment failure and ultimately death, the NEJM report noted.The mutation was also found in an 18-year-old girl, but the researchers said the relationship between the viral resistance and her death was less clear.Fred Hayden, a WHO avian flu and antiviral expert, told the Associated Press (AP) today the drug-resistant strains in the Egyptian patients likely developed after they were treated with oseltamivir. He said a more worrying scenario would be if oseltamivir-resistant strains were circulating in birds.The mutations in Egypt are different from the ones in Vietnam, Hayden told the AP. The Vietnamese strains were definitely resistant to oseltamivir, but the Egyptian ones were only shown to be less susceptible to the drug.There is no evidence that oseltamivir-resistant strains are spreading in Egypt or elsewhere, the WHO said. The agency said it is not changing its antiviral treatment recommendations, because the clinical level of resistance of the mutations is not yet well established.Public health implications of the findings are limited because the mutation is not associated with any known changes in transmissibility of the virus between humans, the WHO said, adding that it would not be raising the pandemic alert level.Because of concerns about drug-resistant strains, avian flu experts have suggested that a higher dosage, longer treatment course, or combination therapy with other antiviral drugs may be needed to ensure the effectiveness of oseltamivir.Terence Hurley, a US spokesperson for Roche, the maker of Tamiflu, told CIDRAP News by e-mail that studies are being conducted to gauge the optimal oseltamivir regimens for use in H5N1 flu cases. “These activities are based upon laboratory data and from information from patients infected with H5N1 who have been treated with Tamiflu,” he said.Roche is collaborating with the US National Institutes of Health on clinical studies to determine the efficacy of oseltamivir in the treatment of severe influenza, including H5N1, Hurley reported. “The NIH study is comparing standard doses of Tamiflu versus double doses for the treatment of people infected with avian influenza and other severe influenza infections in the Far East,” he wrote. “Results of the study will be reported as soon as they are available.”The Egyptian woman reported today as a new H5N1 patient was admitted to a hospital Jan 11 after having given birth on Jan 2, IRIN reported. She initially denied contact with poultry, but WHO spokesman Hassan el-Bushra told IRIN that ducks and pigeons were found in her home and chickens had died nearby.If her case is confirmed by the WHO, it will be Egypt’s 19th.See also:Jan 18 WHO reportDec 27 WHO reportDec 22, 2005 CIDRAP News article “Tamiflu resistance in avian flu victims sparks concern”De Jong MD, Thanh TT, Khanh TH, et al. Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med 2005 Dec 22;353(25):2667-72 [Full text]last_img read more

first_img But at last month’s World Health Assembly, the voting gathering of the WHO’s 193 member states, the countries restated their case as an issue of sovereignty. A group of more than 20 countries asserted that they retain rights to isolates from their territories under the 1991 International Convention on Biological Diversity, which protects unique genetic resources. Doris Bucher, PhD, of New York Medical College, who is attending the Toronto meeting, runs the lab that makes most of the seed strains for seasonal flu vaccine production. The strains are distributed to manufacturers for free. Introducing fees or royalties into the virus-sharing system could have a dramatic effect, she said in an interview: “It would slow down the process. It would raise the price of vaccine,” she said. “The need to balance the sharing of viruses through global surveillance and the need to make the access to vaccines and those sorts of technologies broadly available should not come as a surprise,” Dr. Keiji Fukuda of the World Health Organization’s (WHO’s) Global Influenza Programme said in a speech yesterday. “We see there is a need to increase the access of the developing world to vaccine.” Defensibility of property claims unclearIt is not clear whether Indonesia and its partners could assert enforceable property rights over isolates from their territories, according to several intellectual-property experts. May 23 CIDRAP News story “WHO adopts resolution on flu virus sharing” In speeches and interviews here, international public-health figures are stressing their desire to avoid a confrontation. “It does worry me, because it makes the whole thing murkier, and it is difficult enough already,” said Dr. John Wood, a conference speaker and principal scientist at the United Kingdom’s National Institute of Biological Standards and Control. “It could also spread to seasonal [vaccine], I agree.” New twist in an ongoing disputeThe fear of a legal claim that could disrupt flu surveillance and vaccine manufacturing is the latest chapter in a dispute that began late last year when the government of Indonesia withdrew from the 55-year-old system by which flu viruses are shared around the world. Under that system, which was developed for tracking and controlling seasonal flu and has now been extended to flu strains that could spark a pandemic, viruses are isolated in a country and analyzed to increasing levels of sophistication by a national lab, regional lab, and WHO Influenza Collaborating Centers in Tokyo, Melbourne, London, and the US Centers for Disease Control and Prevention in Atlanta. Gene sequences from the analyses are used to identify emerging strains of flu and then passed free of charge to pharmaceutical companies to be commercialized as vaccines. Intellectual property concerns have already touched pandemic-flu vaccine research. The reverse genetics process that mutes H5N1’s highly pathogenic aspects, producing a vaccine seed strain that will reproduce in chicken eggs, is owned by MedImmune Inc. That company has agreed to suspend licensing fees during the pandemic-vaccine research phase and will begin charging only when the vaccines go into commercial production. Indonesia ceased sending isolates to the WHO at the end of 2006 as a protest, triggering intensive international negotiations. Its government and several other Southeast Asian countries, including Thailand, lodged their objections in front of the WHO’s executive board in January, casting the impasse as an issue of human rights and equity. And in a resolution passed by the WHA after almost a week of negotiation, the group asked for international reconsideration of the virus-sharing system, increased investment in developing-world research, and a guarantee of “fair and equitable [vaccine] distribution” as the price of continuing to send isolates to the WHO. “We have some hard things to deal with,” Fukuda said in an interview. “We do not know whether we will face a pandemic in a short time or a long time. Given that kind of uncertainty . . . I think there is a real practical want on the part of all of the parties involved not to have a long discussion and to come up with practical solutions.” Since then, the WHO has promised to create a stockpile of pandemic vaccines for developing-world use, given contracts to support flu manufacturing in countries that lack the capacity, and set up meetings in August and November to continue to negotiate virus-sharing. Indonesia has meanwhile released only a few isolates. “There has to have been an ‘act of man’ to have changed the thing found in nature,” he said. “To be patentable, it has to be new, it has to be useful and it has to be something that didn’t exist before.” Under US law and the voluntary International Patent Cooperation Treaty, natural organisms such as wild-type viruses cannot be patented, said Gerry Norton, PhD, a flu virologist who heads the intellectual-property group at the Philadelphia law firm Fox Rothschild. Jun 19, 2007 – TORONTO (CIDRAP News) – The continuing debate over developing countries’ ability to afford pandemic-influenza vaccines has produced a disturbing complication: the possibility that Indonesia and other countries affected by H5N1 avian flu will assert legal ownership of the viral isolates on which the vaccines would be based. An ongoing series of international meetings extending into next autumn has been set up in hopes of defusing the situation, Fukuda and other WHO officials said. Developing countries paid little heed to the system for most of its existence because they do not manufacture vaccine and typically do not vaccinate their populations against seasonal flu. However, the Southeast Asian countries where H5N1 is concentrated have a strong interest in protecting their populations against a potential pandemic—but they would be unable to afford the pandemic-flu vaccines that Northern Hemisphere manufacturers might produce. However, the United States is not a signatory to the Convention, indicating that it does not consider its provisions binding. The European Union, where most vaccine manufacturers are based, is a signatory to the treaty but has not ratified it. See also: The prospect of a territorial or intellectual-property claim on the isolates—which are used both to track the movement and evolution of the virus and to develop vaccines against it—is roiling senior members of the international flu community, who are meeting in Toronto this week at the International Conference on Options for the Control of Influenza. About 1,400 experts from 65 countries are attending. Convention on Biological Diversity But the potential effect of Indonesia’s property claim—regardless of the country’s ability to recover in court—is so much wider, and the ripple effect it could trigger so uncertain, that it is provoking significant anxiety in the international flu community. The countries probably can assert a claim to their isolates as real property rather than intellectual property under the Convention on Biological Diversity, said Elizabeth Haanes, PhD, a microbiologist and director in the biotechnology practice of the Washington, DC, law firm Sterne, Kessler, Goldstein & Fox. Article 15 of the Convention specifies that “the authority to determine access to genetic resources rests with the national governments.” “But they could say you can’t export our strains, or they could exert government control over how and when people can handle them within Indonesia—and they could do that by just passing a law, not seeking a patent,” he said. Experts worry about ripple effects”A developing-world country’s remedy, if their resources were used in the commercial development of vaccine, would probably be through the international courts, but that would be very difficult to enforce,” Haanes said. “On the other hand, the countries hold the trump card because they have the viruses—and I think they realize that not sharing this material will be bad for them as well as bad for everyone else. Hopefully, there will be a negotiated settlement.” Moreover, patent laws that protect intellectual property cannot be enforced outside a country’s borders, even if the country subscribes to the patent treaty, said Larry S. Millstein, PhD, a molecular biologist and partner with the Washington-area law firm Holland + Knight. If such a claim were successful—which legal experts say is far from guaranteed—it could both disrupt the fragile and relatively low-profit flu vaccine system and potentially threaten the legal standing of other biological products as well. Feb 6 CIDRAP News story “System for global pandemic vaccine development challenged” If rights were asserted over isolates of potentially pandemic strains, they could equally be sought for the seasonal flu strains used to make millions of doses of vaccine each year.last_img read more

first_imgOct 19, 2007 (CIDRAP News) – Scientists investigating why seasons drive annual influenza epidemics have charted how low humidity and cold temperatures contribute to the spread of the disease in laboratory animals.The research group, from Mt Sinai School of Medicine in New York City, published their findings yesterday in the October issue of Public Library of Science Pathogens (PLoS Pathogens).In the two-pronged study, the researchers first tested aerosol influenza A virus transmission at different relative humidities and temperatures among guinea pigs. Then they assessed whether cold temperatures influenced the immune response of infected animals by extracting RNA from their nasal tissues for polymerase chain reaction (PCR) testing.The researchers used guinea pigs because they learned from a medical journal that guinea pigs kept for research purposes in 1919 at a New Mexico army base died during the 1918 flu pandemic, Peter Palese, a Mt. Sinai virologist and senior author of the study, said in a report today from New Scientist, a British science and technology magazine.”We didn’t know guinea pigs got the flu. They are no longer popular lab animals, and no one had tried them,” he told New Scientist.To tease out the effects of temperature and humidity on virus spread, the group performed 20 trials at different humidities and temperatures, each involving eight animals. For each trial, four guinea pigs were intranasally inoculated with influenza A virus. Then pairs of infected and uninfected animals were housed individually in adjoining cages. Nasal wash samples were collected from the animals about every other day, and serum samples were collected before infection and on day 17 after infection.Five different humidity levels were tested at 20°C: 20%, 35%, 50%, 65%, and 80%. The researchers found that transmission was most efficient at the two lowest humidity levels, at which three or four of the exposed guinea pigs became infected. At 50% relative humidity, only one of the four animals contracted influenza. More were infected in 65% humidity, but no disease transmission was noted at 80% humidity.In the temperature experiments, animals were exposed to 5°C, 20°C, and 30°C at different humidity levels. The investigators found that transmission was more efficient when guinea pigs were kept at 5°C than at 20°C, and at 30°C they detected no disease spread. In addition, the duration of peak viral shedding at 5°C was 40 hours longer than at 20°C.”Our data implicate low relative humidities produced by indoor heating and cold temperatures as features of winter that favor influenza virus spread,” they concluded.In assessing the effect of low temperatures on innate immune response, the authors found that housing animals at 5°C didn’t greatly impair their immune response when compared with that of animals housed at 20°C. This finding runs counter to the conventional wisdom, the authors asserted.Palese, quoted in a report yesterday from the LiveScience news Web site, said, “We’ve always thought the immune system wasn’t as active during the winter, but that doesn’t really seem to be the case.”The researchers said their findings on humidity effects raise several possibilities about influenza transmission mechanisms:Breathing dry air could desiccate the nasal mucosa and reduce ciliary clearance of the virus—though the guinea pigs weren’t exposed to dry air for very long before they became infected.The virus could be more stable at low humidity.At low humidity, water evaporates quickly from bioaerosols, leaving droplet nuclei that remain airborne and increase the opportunity for pathogen transmission.Low temperatures could affect hosts in ways that contribute to the infection mechanism, the report says. For example, cooling the nasal mucosa is thought to increase the viscosity of the mucous lining, which could reduce ciliary clearance of the virus. Also, cooling in the nasal passages may provide a more stable environment for flu viruses.The authors said their findings suggest that controlling indoor temperature and humidity—warmer than 68°F and 50% to 80% relative humidity—might slow influenza virus transmission.Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for infectious Disease Research and Policy, publisher of CIDRAP News, said the seasonality of influenza outbreaks is clearly important. However, he said other factors besides just temperature and humidity must be involved.”Previous pandemic outbreaks were widespread in other seasons of the year,” he told CIDRAP News. For example, he said, the spread of flu in August and September during the 1918 pandemic was especially dramatic.Lowen AC, Mubareka S, Steel, et al. Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathogens 2007 Oct ;3(10):e151 [Full text]last_img read more

first_imgIn the period from January to November 2017, the number of voyages of foreign cruise ships decreased by 16,7%, and the number of passengers on these ships decreased by 13,9% compared to the same period in 2016. The total number of days spent by ships in the same period is lower by 17,7%, according to the Central Bureau of Statistics (CBS).In the period from January to November 2017, 82 foreign cruise ships entered Croatian seaports, which made 677 cruises. There were 936 thousand passengers on these ships, who stayed in Croatia for 1 days. The largest number of voyages was made by ships under the flag of the Bahamas (437 voyages) and Malta (163 voyages), while the largest number of passengers arrived by ships under the flag of Italy (155 thousand passengers), Bahamas (245 thousand passengers) and Panama (193 thousand passengers).Out of a total of 677 trips, most trips were realized in the Dubrovnik-Neretva County (64,1%) and the Split-Dalmatia County (18,6%), which is a total of 82,7%. The remaining 17,3% of trips were made in the following counties: Zadar (6,1%), Istria (4,7%), Šibenik-Knin (3,8%), Primorje-Gorski Kotar (2,5%) and Lika-Croatia. Senjska (0,2%).The port of Dubrovnik had the highest number of visits by foreign cruise ships (530 visits), followed by the ports of Split (223 visits) and Korčula (129 visits).Source: CBSlast_img read more

first_imgThe IPK Travel monitor traditionally presents completely “fresh” research results on the ITB, which have been conducted continuously since 1969.The survey is conducted in 60 countries around the world and includes 500 respondents. Questionnaires are completed in 000 world languages. The questions refer to trips that include at least one night. Coverage by main geo zones is: Europe 50%, USA 95%, Asia 90%.World Travel in 2017The purchasing power of world travelers increased by 2017% in 4, with a total of 1,1 billion people traveling (+ 6,5% compared to 2016), which is 81 million more passengers. In 2017, there were 9 billion more overnight stays than in 2016 (+ 8%). The average number of nights per trip is 7,8. The average consumption per trip was 1.213 euros. In the structure of global GDP, travel occupies 5%.In total, tourist traffic grew by 6,5%. In Asia, the increase in turnover was 5%, in Europe 8%, while US tourism was “dormant”, without growth or decline.According to the reasons for travel, the biggest growth is recorded by “sun and sea” (+ 15%), which is the first motive for travel, followed by cities with an increase of 14% and the village with + 4% while touring trips are down -5%. There were 7% more departures from Europe to the world and 8% more tourists came to Europe. Europe as a geo zone is still the strongest emitting destination. By countries, the largest emitting destination is China, followed by the USA, Germany, Great Britain, France, Canada, the Netherlands, Italy, Switzerland, Russia.Top destinationsEurope is the first top destination in the world with 8% growth in arrivals, followed by Asia with 6% growth. By countries, the first destination is Spain, followed by the USA, Germany, France, Italy, China, Great Britain, Mexico, Austria, Canada.Passenger satisfactionThe average rating of overall passenger satisfaction is 2,7 (on a scale where 1 is best and 5 worst), good but not perfect. The best rated are landscapes, nature (2,5) and sightseeing, as well as the offer of cultural content (2,7). Beaches (3,2), wellness (3,4), summer sports facilities (3,5), winter sports facilities (3,9) were generally rated worse. Overall satisfaction with the accommodation was rated 2,6, service also 2,6, while cuisine and gastronomy were rated 2,8. The state of “overtourism” was examined for the first time. 37% of respondents said that this phenomenon is a problem, while 63% of respondents do not feel the problems of “overtourism”. When asked if there are too many tourists in the destination, 24% of respondents answered positively and 76% negatively. The total impact of “overtourism” on travel planning according to this research is 9%. Asia has the most problems in this regard. Big cities are also more affected by this problem. The biggest problem of “overtourism” is felt in Mexico city, followed by Shanghai, Venice, Amsterdam, Florence, Barcelona. This problem is felt only in some destinations. Many problems related to the term “overtourism” can be solved by better destination management. This problem is first of all felt by the locals.Regarding the impact of terror on travel, 37% of respondents stated that they are afraid of terror, while 63% of passengers are not afraid. 24% of respondents will choose only safe destinations for travel. The safest country in the perception of travelers is Switzerland, followed by Canada, then Austria, Finland, Norway, Denmark, Austria, Sweden, Portugal, the Netherlands. Slightly less safe are Greece, China, Italy, Belgium, Thailand, Dubai, India, Spain, Germany. Medium safe countries are South Africa, Great Britain, Mexico, Russia. Insecure countries are France, Saudi Arabia, USA, Morocco, Jordan. Tunisia, Egypt, Israel and Turkey are considered very insecure.… The bad news is that Croatia is not on the list of safe countries. The good news is that she is not even among the insecure. According to the respondents, Tunisia, Egypt, Israel, Turkey are among the most insecure countries. , 2016% are the consequences of health problems. On business trips, trauma caused by various forms of crime reached a high percentage of 5%. As the safest travel regions, the Caribbean ranks first, followed by North America, Asia, Europe, Central America, the Middle East and finally Africa.Tourist growth forecasts in 2018Tourism turnover in Europe should grow at a rate of 4%, in Asia 6%, North America 4%, South America 7%. Globally, tourist traffic is projected to grow by 5%. A link to the detailed report with a short comment will be posted as soon as it is available.Published by: Nedo Pinezićlast_img read more

first_imgIn its hotels and camps in Novigrad, as well as in hotels in Orebić and Korčula, Aminess employs 650 employees in the high season, including temporary and indefinite employees, trainees, pupils and students. The high level of quality of working conditions in Aminess is also evidenced by the Employer Partner certificate awarded by the company specialized in consulting in the field of human resources SELECTIO, of which Aminess has been the holder since 2017. This year, we are looking for 100 new employees, mostly in the kitchen, restaurant and household departments, but we are also looking for employees for the reception, horticulture, maintenance, animation and sports departments. “At Aminess, we nurture friendly relations with employees, and their work is continuously monitored by mentors, managers and facility directors. Every year we work on improving working conditions and increasing income, and with numerous trainings, we try to approach each employee individually and prepare a plan for personal development and advancement in accordance with the interests and achieved results. In participating in fairs like this, we see an excellent opportunity for further growth of the company through the experiences of new employees and the promotion of the tourism and hospitality industry and related occupations.” said Sanja Žužić, head of human resources at Aminess hotels and camps.center_img Aminess hotels and camps will present all the advantages of working in the company and at the fair Job Days in Tourism, at the Gripe Sports Center in Split, and you can see open job vacancies in Aminess hotels and camps HERE The company provides food and accommodation to all seasonal employees in the destinations in which it operates. Regardless of the employment status, all employees are provided with a wide range of training, development program for trainees and future managers, as well as talent development through experience in various jobs and through mentoring. Also, in hotels and camps, professional internships are conducted for students of tourism and hospitality high schools, and Aminess currently provides scholarships to 11 students.last_img read more