H5N1, Bird Flu Updates

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    Tracking Bird Flu Cases

    Bird flu deserves its own thread for tracking suspected and confirmed cases. It's not the pandemic virus, but it is still an ongoing and significant threat because of its virulence. As Margaret Chan, the Director General of the WHO says, we do not know how H5N1 will react under pressure from the pandemic virus, H1N1. All of the countries with endemic H5N1 are also reporting cases of swine flu. As everyone should know by now, the new concern revolves around what will happen if the two viruses co-infect the same host. Flu viruses exchange genetic material with each other all of the time. Right now we have a pandemic virus that is very transmissible, but does not kill the majority of people infected. Bird flu, on the other hand has a case fatality ratio (CFR) of around 60%.

    In the past year, something different began to happen in Egypt. We started seeing many cases of young toddlers infected with mild cases of bird flu there. But, we also saw some older children and adults that had fatal cases. No one has yet explained why the disease began to change in Egypt. Just prior to the beginning of the swine flu cases appearing in the US and Mexico, the WHO was going to send in a team to Egypt to investigate why this was so. And, then the swine flu pandemic began in earnest, leaving this question unanswered. Why this situation has changed in Egypt but not in Indonesia, is most likely very important information.

    Egypt continues to try to isolate swine flu cases. At some point, they won't be able to contain that virus, and will have to bow to the inevitable. Nobody knows what will happen then, but the Egyptians are clearly concerned. Remember, this is the country that slaughtered its entire pig population a few months ago to international dismay. Maybe they were right to do so, as we are now finding swine flu in pigs in Canada, Argentina and Australia. Pigs, the perfect mixing vessels for influenzas, may have been harboring the current swine flu for years undetected because they are almost never tested in most countries unless they are sick. This lack of disease surveillance is now being compensated for by a heightened awareness and increased testing of pig herds in many countries.

    With all of that being said, here is a translation regarding a new case of bird flu, H5N1 in another child in Egypt. They do not state the child's age in this article, and some translations are saying that this is a male child. They would have isolated her anyway with bird flu, but with swine flu also in Egypt, they are likely to be very worried. Descriptions of these cases almost always mention dead birds being found in the same location. That of course, is going to be helpful in determing which flu they are dealing with at least for now, but maybe not later...

    Egypt - Case #82


    Quote from www.flutrackers.com

    D. Abdel-Rahman Shahin, official spokesman of the Ministry of Health

    The Ministry of Health on Sunday, a new human case of bird flu, a girl from a province of Kafr el-Sheikh for a total of 82 case of injuries so far.

    A statement by the Ministry of Health said on Sunday that the new situation of the girl child is Muhammad Mustafa Ahmed Rania from the village of "Sidi Ghazi," the Department of Kafr El-Sheikh governorate of Kafr el-Sheikh.

    The statement pointed out that the disease developed symptoms on July 24 of this hospital was incorporated in fevers of Kafr el-Sheikh on July 25 with a high temperature, running nose and cough after exposure to dead household birds, suspected of being infected with bird flu.

    He also pointed out that the statement was given the drug "Tamiflu" as soon as the suspicion of being infected with the disease and her condition is stable and satisfactory communications are being carried out and procedures for the transfer to the hospital in the capital Cairo for the completion of treatment.
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    Scott McPherson is the Chief Information Officer [CIO] of the Florida House of Representatives. He is commenting on information received from ProMed of a suspected bird flu fatality in Indonesia.

    Indonesia has the distinction of having the most deaths caused by the H5N1, bird flu virus of any other country in the world. The case fatality ratio from bird flu in Indonesia is at around 80%. Unlike in Egypt, not many survive bird flu in Indonesia, no matter what their age is.

    The beautiful island of Bali in Indonesia, is a vacation destination for many. These travelers have brought the swine flu virus into this bird flu endemic country. As mentioned in the post above on the bird flu case in Egypt, there is great concern that these two viruses might recombine or reassort to cause a more transmissible and more virulent new virus.

    Here is a brief description of ProMed for those not familiar with this organization:

    Quote from www.cdc.gov

    The online program to monitor emerging diseases (ProMED-mail) was established in 1994 with the support and encouragement of the Federation of American Scientists and SatelLife. The principal intent of ProMED-mail is to assist local, national, and international organizations in disseminating, as rapidly as possible, reports of outbreaks of infectious diseases wherever they occur; these reports are taken from sources such as media reports, online summaries, local observers, official reports, and others. Subscribers are encouraged to contribute reports and to participate in the dialogue.

    With a minimum amount of funding, volunteer moderators, and a bulk mailer in Newfoundland, ProMED-mail grew from 40 subscribers in 1994 to its present number of over 20,000 in more than 160 countries; there are no subscription fees. Since 1999, ProMED-mail has been administered by the International Society for Infectious Diseases, with servers and software furnished by Oracle, Inc. The e-mail service provider is located in the Harvard School of Public Health.
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    Quote from afludiary.blogspot.com

    The Ministry of Health of Egypt has reported 2 new confirmed human case of avian influenza A(H5N1).
    The first case is an 8 year-old female from Kfr Elsheikh district, Kfr Elsheikh Governorate. Her symptoms started on 24 July 2009. She was admitted to Kfr Elsheikh fever hospital on 25 July, where she received oseltamivir treatment. The patient is in a stable condition.

    The second case is an 18 month-old male from Shebin Elkom district, Menofyia Governorate. His symptoms started on 28 July 2009. He was admitted to Shebin Elkom fever hospital on 29 July 2009, where he received oseltamivir treatment, and is in a stable condition.

    Investigations into the source of infection indicated that both cases had close contact with dead and/or sick poultry.
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    Report: H5N1 Kills Wild Birds In Mongolia


    Wild aquatic birds are the natural hosts of H5N1. It is always a concern therefore, when we read of numbers of these birds dying from bird flu because it could indicate a more virulent strain, and subsequent infections of domestic poultry and humans in areas that these migrant bird populations that are still well enough to fly, might visit.

    Quote from afludiary.blogspot.com

    An official with Mongolia's Emergency Situations Ministry has confirmed to Xinhua on 11 Aug 2009 that avian influenza recently occurred in Arkhangai Province.

    Mongolian disease control and prevention agencies found 56 dead swans, wild geese, and other kinds of birds in the area around Shelechagan [transliteration] Lake in Tsetserleg District of Arkhangai Province and after testing samples, confirmed that the birds had died of avian influenza virus. For the moment, it has been confirmed that the virus is H5 subtype.
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    Egypt - Case #84


    It remains an unexplained mystery as to why toddlers are the group being diagnosed with bird flu this past year or so, and also why they are surviving while adult cases did not.

    Quote from afludiary.blogspot.com

    Today we learn (hat tip Dutchy on Flutrackers) of another child in Egypt diagnosed with the H5N1 virus. This is their 84th known human infection. Nearly all of the victims this year have been toddlers, under the age of 5.

    For reasons that are not yet clear, the mortality rate in Egypt has dropped dramatically this year, with 90% of those infected recovering. Whether this is due to better (or perhaps, earlier) treatment, or due to a milder form of the virus in Egypt, isn't known.

    While seemingly good news, a less virulent virus is believed to be more easily transmitted in a community, since the victims are less ill and more likely to come in contact with others.

    With the pandemic H1N1 virus also circulating, there are concerns over the possible reassortment of these two viruses (see FAO: Concerns Novel H1N1 May Spread In Poultry), particularly in places like Egypt, Indonesia, and China.
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    Denpasar, Bali


    If this patient also has bird flu, I doubt that the Indonesians will ever admit it. They have been censoring information on bird flu deaths for almost two years now, and Bali is a tourist destination.

    Indonesia has the highest number of bird flu deaths in the world with a case fatality ratio of over 80% if infected. A co-infection of bird flu and swine flu is big news, and worrisome information if true. It seems inevitable that this will happen at some point, and does not necessariy mean anything except that it gives bird flu an opportunity to pick up the ability ease of transmissibilty from swine flu which is very contagious. Bird flu is not easily transmissible human to human thus far, therefore co-infections are going to be watched with some alarm if we even hear about them, that is. Egypt and Indonesia are the countries most infected with H5N1, and the news from there is being searched carefully for this type of information daily.

    Quote from www.flutrackers.com
    Ken Wirasandhi, a spokesman from the hospital, said Friday that Ni Wayan Siti of Tampaksiring, Gianyar, died on Thursday night. Ken said the patient, who had tested positive for the H1N1 infection, had also had pneumonia.

    Siti was eight months pregnant when she was admitted to the hospital on Saturday last week. She had a miscarriage three days later.

    The hospital also suspected that Siti was infected with bird flu, but had yet to receive test results to confirm it.

    Separately, chief of the Bali Health Agency I Nyoman Sutedja, said Siti's death was the first H1N1-related death on the resort island. So far, 83 people, 42 of them foreigners, have been treated for the H1N1 virus infection.


    The following link is referring to the same case, and there is confirmed bird flu in poultry nearby... Impossible to say what really happened. She could have had both influenzas. Because of the fetal demise though, my guess is now that bird flu is involved. We have been seeing with most of the swine cases in this thread that the baby almost always survives because an emergency C-section is done which delivers the baby safely. Fetal demise is more frequent with bird flu. Again, if this is bird flu in a human case, I do not expect them to admit this. It's very bad for the tourist business.

    Quote from flutrackers.com
    Avian flu outbreak recorded in Buleleng

    Fri, 09/04/2009 2:27 PM | Bali

    BULELENG: Residents of Tejakula village culled 400 chickens infected with the avian flu, to prevent the disease spreading.

    "Intensive culling must be carried out in two affected villages in the regency," said Bali Husbandry Agency head I.B. Alit.

    He added avian flu was still present on the island, mostly among domesticated fowl.

    Meanwhile, a pregnant woman from Gianyar regency is being treated at Sanglah Hospital for avian flu. Her unborn baby was dead. - JP


    Comment: The last sentence refers to a woman treated in hospital for avian flu. Today it was announced the woman died of swine flu.
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    It is worrisome that the virus has outpaced the avian influenza vaccine because it puts the humans in the area at risk for H5N1 infection. The number of birds involved is very high.

    Indonesia continues its policy of censorship about human cases.

    It is a bad situation all around that swine flu has also been found in Indonesia. We now know that swine flu can infect birds as well as mammals as we just learned about the turkeys infected in Chile in addition to infected pigs in Canada, Argentina and Australia.

    There is concern that the two influenzas will exchange genetic material.

    Quote from crofsblogs.typepad.com
    Indonesia: Bird flu virus attacks vaccinated chickens

    Via Bird Flu Information Corner, a translated report from Pikiran Rakyat: Purwokerto, Central Java ::: Bird flu virus attacks vaccinated chickens. Excerpt:
    Bird flu H5N1 attacked hundred thousands of layer chickens in several farms in Kabupaten Banyumas, Cental Java. Infected chickens had received avian influenza vaccination.
    Bird flu massive attack was distributed evenly in Sumbang, Karanglewes, Kedungbanteng Serat and Cilongok within weeks.
    The story goes on to say that the virus didn't kill the vaccinated chickens, but suppressed egg production.
    Last edit by indigo girl on Sep 10, '09
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    Our Biocontainment Unit has been preparing for H5N1 for 6 years now. Let's hope that the two viruses don't combine RNA!

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    That is a real concern for all of us.
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    "Our Biocontainment Unit has been preparing for H5N1 for 6 years now. Let's hope that the two viruses don't combine RNA"
    That's like reassortment, having the 2 combine genetic material. It may have already happened, indigo girl.


    Who was responsible for this? Why, Baxter, one of the companies now making our "mandatory" vaccines!

    I can see you are passionate on this topic, indigo girl, and I respect that. But I am suggesting that we ALL just calm down, take a deep breath, and THINK about this! The way it's being handled now is so knee-jerk and hasty, it can't HELP but turn out badly. Fear and panic always screws up the thinking process, and what we need now is clear-headed thinking, not blind reactions.
    Our elected officials seem to be drinking the Kool-aid here, and we are seeing things like what is happening in NY and Massachusetts. Knee-jerk responses to the fear-mongering of the CDC and WHO, etc. Just like after 9-11, when our government used the fear of another terrorist attack to take away or revise some of our rights, it's being done again, this time with the fear of pandemic disease.
    The trouble is, after the so-called "emergency" has passed, try getting those rights back again!

    Indigo girl, you are right in that we should be concerned about this, but we have to be very careful how that concern gets expressed in practice. We are at the event horizon of a very slippery slope here...

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