Comparative efficacy of different adjuvant containing inactivated vaccines against low-pathogenicity Avian Influenza H9N2 virus

Background: Outbreaks of low-pathogenic Avian Influenza virus H9N2 (AIV-H9N2) occurred in poultry industry in Pakistan in 1998 and caused serious economic losses. Since then, many of the AIV-H9N2 vaccines have been introduced to Pakistani market to control the virus, however, it is still circulating all over the country. Therefore, the purpose of the study was to prepare and evaluate different adjuvant containing vaccines using local isolate of AIV-H9N2 in broiler birds.Methods: Three vaccines; Alum precipitated (AP-AIV), Aluminum hydroxide gel (AH-AIV) and Oil based (OB-AIV) were prepared in the laboratory and injected into broiler birds at 7th and 14th day of age. There were four groups of birds including one control group. To evaluate the serological response of the birds to vaccines, serum antibody titers were measured using haemagglutination inhibition test (HI). Vaccinated and control birds were challenged with AIV-H9N2 and virus shedding was determined from trachea and cloacal swabs by HI.Results: Out of the three prepared OB-AIV with hydrophile lypophile balance (HLB) values 5.37, 8.01 and 9.01, the vaccine with HLB value of 8.01 was the most stable. Each of the adjuvant containing vaccine was effective in inducing high HI antibody titers. However, OB-AIV was found to be the most effective in inducing a significantly higher (P<0.05) HI titer as compared to that of AP-AIV and AH-AIV each. No significant difference was observed between the HI titers induced by AP-AIV and AH-AIV. All the vaccines also showed effective protection against AIV-H9N2 challenge in vaccinated birds.Conclusion: In conclusion, this study reports the successful preparation and evaluation of adjuvant containing inactivated AIV-H9N2 vaccines. OB-AIV formulation was found to be most effective to control the H9N2 virus infections in broiler birds.

Risk Factors for Avian Influenza H9 Infection of Chickens in Live Bird Retail Stalls of Lahore District, Pakistan 2009-2010

Abstract This study was conducted to identify risk factors associated with AIV infections in live bird retail stalls (LBRS) in Lahore District, Pakistan. A cross-sectional survey of LBRS was conducted from December 2009-February 2010 using two-stage cluster sampling based on probability proportional to size. A total of 280 oropharyngeal swab sample pools were collected from 1400 birds in 8 clusters and tested by qRT-PCR for the matrix (M) gene of type A influenza virus and HA gene subtypes H9, H5 and H7. Thirty-four (34) samples were positive for the M gene, of which 28 were also positive for H9. No sample was found positive for H5 or H7. Data for 36 potential risk factors, collected by questionnaire, were analyzed by survey-weighted logistic regression and prevalence odds ratios (OR) for associated risk factors were calculated. A final multivariable model identified three risk factors for H9 infection in LRBS, namely obtaining birds from mixed sources (OR 2.28, CI95%: 1.4–3.7), keeping birds outside cages (OR 3.10, CI95%: 1.4–7.0) and keeping chicken breeds other than broilers (OR 6.27, CI95%: 1.7–23.2). Sourcing birds from dealers/wholesalers, keeping birds inside cages and avoiding mixing different breeds in cages could reduce the risk of H9 infections in LRBS

Reassortant Avian Influenza A(H9N2) viruses in chickens in retail poultry shops, Pakistan, 2009-2010

Phylogenetic analysis of influenza viruses collected during December 2009–February 2010 from chickens in live poultry retail shops in Lahore, Pakistan, showed influenza A(H9N2) lineage polymerase and nonstructural genes generate through inter- and intrasubtypic reassortments. Many amino acid signatures observed were characteristic of human isolates; hence, their circulation could enhance inter- or intrasubtypic reassortment

A case-control study to identify risk factors associated with avian influenza subtype H9N2 on commercial poultry farms in Pakistan

A 1:1 matched case-control study was conducted to identify risk factors for avian influenza subtype H9N2 infection on commercial poultry farms in 16 districts of Punjab, and 1 administrative unit of Pakistan. One hundred and thirty-three laboratory confirmed positive case farms were matched on the date of sample submission with 133 negative control farms. The association between a series of farm-level characteristics and the presence or absence of H9N2 was assessed by univariable analysis. Characteristics associated with H9N2 risk that passed the initial screening were included in a multivariable conditional logistic regression model. Manual and automated approaches were used, which produced similar models. Key risk factors from all approaches included selling of eggs/birds directly to live bird retail stalls, being near case/infected farms, a previous history of infectious bursal disease (IBD) on the farm and having cover on the water storage tanks. The findings of current study are in line with results of many other studies conducted in various countries to identify similar risk factors for AI subtype H9N2 infection. Enhancing protective measures and controlling risks identified in this study could reduce spread of AI subtype H9N2 and other AI viruses between poultry farms in Pakistan

Burden of Influenza in Patients visiting Emergency Department for Treatment of Influenza Like Illness at THQ Hospital Shujabad, Pakistan

Background: Viral infection of the respiratory tract is a common illness syndrome in humans. Human respiratory tract is infected by large number of viruses. Self-constraining infections are caused by most of them e.g. normal chilly and intense bronchitis. Seriousness of illness relies upon specific infection and furthermore on host factors. Flu influences all age gatherings; an extensive number of bleakness and mortality happens in high hazard gathering e.g. elderly patients with chronic disease. Methodology: The research was completed in Shujabad, Multan. A prospective study was conducted for a period of three months in order to define burden of flu among cases of influenza-like illness as they visited emergency department of the THQ Hospital Shujabad, Multan. Data was analyzed by using SPSS software with 95% confidence interval. Chi-square test was used to measure the association of risk factors. CI (cumulative incidence) of disease (influenza) was calculated by standard formula. Results: There were 16332 patients visited emergency department of the hospital for the treatment different health issues. Total numbers of influenza like illness patients enrolled in current study were 244 and cumulative incidence was calculated to be 1.49%. Among these 244 ILI patients, 12 patients were hospitalized in the emergency department for advance respiratory care which was 4.9% of the ILI patients and 3 patients died among the 12 hospitalized patients due to the severe respiratory attack which was (1.2%) of ILI while rest of the patients were discharged as they were stable. All of the 244 ILI patient samples were sent to the laboratory for PCR and results was showing that 35 were influenza positive which was 14.3% of the ILI cases presented in emergency department of the hospital. Conclusion: It was concluded that Influenza virus strains are circulating in general public of the Tehsil Shujabad, District Multan. This study therefore indorses the need for continuous surveillance of influenza as an important public-health issue. It also raises the question of rational vaccination policy for influenza. Finally, there is the question of clinical diagnosis where specific treatment/antiviral treatment is available

Availability of essential medicines in Pakistan—A comprehensive document analysis

INTRODUCTION: Access to essential medicines (EMs) is a basic human right. Non-availability and shortages of EMs are reported for Pakistan but there is insufficient data to define the nature and magnitude of this problem. The current study is designed to systematically analyze the medicines included in the National Essential Medicines List (NEML) for their availability through comprehensive document analysis. METHODS: An expanded list of medicinal items was developed using the NEML of Pakistan (2018) to enlist individual medicines with their specifications. Registration status of the medicines was searched using three publicly accessible information sources; Pharmaguide 25(th) Edition, 2018–19, the on-line Drug Information System, and the Mobile Application Pharmapedia followed by a later 3-step validation of the data. The unregistered EMs were then further categorized into three subgroups in accordance with their possible remedial strategies. FINDINGS: The 19 studied categories comprised 690 EMs and it was found that 179 (26%) of these EMs don not have a registration status. However, it was also identified that the availability of 47 (26.2%) out of 179 unregistered EMs can be enssured by strengthening compounding services, and prioritizing registration of age-appropriate formulations. Availability of another 39 (21.7%) such medicines can be ensured by revising the NEML or the product registrations for the slight differences in their different specifications. The categories showing high proportion of unregistered medicines included anti-Parkinson’s medicines (100%), antidotes and other substances used in poisoning (60%), diuretics (47%), anticonvulsants/antiepileptics (42%), hormones and other endocrine medicines and contraceptives (38%), medicines for mental and behavioral disorders (30%), anti-infectives (27%), medicines for pain and palliative care (26%), medicines for neonatal care (25%), medicines for diseases of joint (25%), gastrointestinal medicines (24%) and cardiovascular medicines (15%). CONCLUSION: The study shows the absence of registration status of a significant number of EMs in Pakistan. This could be major barrier in their access. Strategies are needed to strengthen the processes of their registration on priority basis