Re: Pandemic Awareness/Preparation

indigo, thanks for keeping on top of something that is so important not only to nurses but the public at large
your work is appreciated

Re: Pandemic Awareness/Preparation

on another note the cholera epidemic in zimbawee [sp] the death rate is running about 5%
these people have so much to put up with and this is another hardship

Re: Pandemic Awareness/Preparation

Originally Posted by CHATSDALE

on another note the cholera epidemic in zimbawee [sp] the death rate is running about 5%
these people have so much to put up with and this is another hardship

Yes, a humanitarian crisis because of contaminated food and water.

Re: Pandemic Awareness/Preparation

Bird flu scare: Chandigarh keeps a watch on winged visitors

http://timesofindia.indiatimes.com/C...ow/3992997.cms

http://en.wikipedia.org/wiki/Chandigarh

This beautiful area in northern India is on alert. Better to be prepared than surprised.

Originally Posted by timesofindia.indiatimes.com

CHANDIGARH: As this city plays host to around 15,000 migratory birds which are here for the winter, the administration is watching out for signs of danger - in the form of bird flu that hit some Indian states last year.

"The common symptoms are that the bird starts to stay at secluded places away from the flock, it stops flying, there is an unusual bending of the neck, secretion from eyes and it does not eat anything."

Grebes, geese, shelducks, marsh ducks, diving ducks, rails, coots, stilts, hill kingfisher, mallard, pintail, Siberian ducks, pochards, cranes, storks and sandpipers are some of the migratory birds that come visiting the city every year. They come from Siberia, Central Asia, China, Afghanistan and the upper Himalayas.

A recent joint study by US and Japanese scientists found strong genetic evidence that wild migratory birds are the most important carriers of avian influenza viruses from continent to continent.

Rohit Ruhella, an environmentalist based here, said: "Infected birds carry influenza virus in their saliva, nasal secretions and excretions. Other birds get infected when they come in contact with these contaminated secretions or excretions or with the surfaces that are contaminated.

"Scientists all over the world are convinced that migratory birds are carrying the H5N1 virus in its highly pathogenic form. They carry it over long distances, and many times spread the virus among poultry birds that come in their way."

Most of the migratory birds here, around 14,000, have made their winter homes in Chandigarh's famous Sukhna Lake and the 190-odd ponds and swamps around, which together form the Sukhna Wildlife Sanctuary, declared a protected national wetland.

Re: Pandemic Awareness/Preparation

Indonesia

This case is not confirmed, and even if positive might never be due to the ongoing
censorship in Indonesia.

http://www.recombinomics.com/News/01...ster_2009.html

Originally Posted by www.recombinomics.com

...The mother (43F) was transferred to an infectious disease hospital after failing to respond to treatment. She died within hours of admittance. The comment by the attending physician is likely based on a infleunza A positive rapid test, but there has been no official confirmation. This is a common pattern for H5N1 cases and clusters in Indonesia.

Moreover, three family members also had symptoms, but recovered. The likelihood that they will test positive is near zero. Indonesia has had a case fatality rate near 80%, which it has had since 2005. The high rate is due in part to testing / reporting issues. The MOH has already commented on a lowering of cases due to Tamiflu treatment. However, Tamiflu treatment should lower the case fatality rate, not the number of confirmed cases unless there was frequent human to human transmission, treatment generated a false negative, or both. Since there are dozens of examples of both, including the cluster described above, the artificial lowing of confirmed cases and clusters, the true extent of human H5N1 in Indonesia remains unclear.

China


http://crofsblogs.typepad.com/h5n1/2...-province.html

Originally Posted by crofsblogs.typepad.com

The Centre for Health Protection (CHP) of the Department of Health received notification from Ministry of Health (MoH) tonight (January 17) concerning a confirmed human case of avian influenza H5N1.

A CHP spokesman said the patient was a two-year-old. She developed symptoms on January 7 in Hunan and was brought to Shanxi for medical treatment on January 11. She is now in critical condition.

Laboratory tests on the patient's specimen by Chinese Centre for Diseases Control and Prevention yielded positive to H5N1.

http://www.recombinomics.com/News/01..._Concerns.html

Originally Posted by www.recombinomics.com

She was infected right after the patient in Beijing died, who was infected a couple weeks after the outbreaks Jiangsu. All three incidents (see updated map) involved H5N1 confirmed hosts in the absence of dead poultry.

The outbreaks in Jiangsu were detected during routine surveillance. As noted in the OIE report, there were no dead birds.

Clade 7 is cause for concern because it has caused at least one human case previously and was in asymptomatic birds in Jiangsu. Moreover, it has caused problems previously in vaccinated flocks. The genetic differences between clade 7 and clade 1 or 2 can produce vaccine mismatches which generate asymptomatic birds which shed H5N1 that can infect other birds and humans. This creates conditions for silent transmission in birds and cases that have no clear linkage to dying poultry.

China has not filed any OIE reports since the Jiangsu outbreak in December, suggesting H5N1 was not detected in poultry culled in the Beijing area. Detecting H5N1 in asymptomatic birds is difficult, so the absence of H5N1 positive birds does not necessarily signal the absence of H5N1.

The widespread detection of H5N1 in China in the absence of dead or dying poultry is cause for concern.

Re: Pandemic Awareness/Preparation

http://news.aol.com/health/article/g.../278541?cid=14

Thought you might find this interesting.

Re: Pandemic Awareness/Preparation

Originally Posted by gentlegiver

http://news.aol.com/health/article/g.../278541?cid=14

Thought you might find this interesting.

Absolutely, good catch, gentlegiver. Thanks for sharing the information.

This new case is of concern because there was no indication of any contact with sick birds. This could be indicative that H5N1 is spreading "silently" in infected but asymptomatic birds.

Here is what virologist, Dr. Henry Niman has to say about this. He notes a report made to OIE, [the animal version of the WHO] about the culling of asymptomatic poultry. The report does not say that there any fatal cases in those birds, indicating that they were only culled because they were positive for the virus not because they were sick. Then gravely ill humans cases started occurring, and an HCW started showing symptoms, (probably infected by the first patient, the 19 year old female in Beijing).

It used to be that when poultry start dying, people had a good indication that a danger was present. But, there was no clear signal this time, and that is very alarming. Sick birds in China are not serving the role of sentinels to detect the virus.

http://www.recombinomics.com/News/01...de7_China.html

Originally Posted by www.recombinomics.com

...comments are from the OIE report submitted by China for the two H5N1 outbreaks in Jiangsu, China (see updated map). Although 376,998 birds were culled, there were no fatalities listed in the December 26 report because the birds were asymptomatically infected. This raised concerns that similar infections at other farms led to the silent spread of clade 7, which was the clade in Jiangsu...

The Jiangsu outbreak was followed by the confirmed case (19F) in Beijing, who had purchased and gutted ducks in Hebei and developed symptoms on Dec 24. It is unlikely that these birds had symptoms, and a survey of birds near Beijing failed to identify dead or dying poultry. However, a health care worker in Beijing did develop symptoms, raising concerns of increased efficiency of transmission to humans.

The Beijing case(s) were followed by the fatality in Shandong (27F), who developed symptoms on January 5. The possible exposure has not been disclosed.

These two cases were followed by the case (2F) in Hunan, who is in critical condition in Shanxi. Surveys of markets in Hunan and Shanxi failed to identify dead or dying poultry.

Thus, there has been no linkage of any of the three confirmed H5N1 to dead or dying poultry. However, vaccination of poultry with a poorly matched vaccine would yield asymptomatic birds shedding H5N1 virus, which would facilitate spread in immunized birds that could lead to fatal human infections.

Re: Pandemic Awareness/Preparation

Another Death in China

http://crofsblogs.typepad.com/h5n1/2...from-h5n1.html

http://www.transworldnews.com/NewsSt...id=73643&cat=0

Originally Posted by crofsblogs.typepad.com

A 16-year-old male student died of bird flu in central China's Hunan Province Tuesday morning, the third death caused by avian influenza in the country in the new year, provincial health authorities reported.

The student, surnamed Wu, died at about 8:10 a.m. in Huaihua City, said an official from the Hunan provincial health bureau.

Mother of Sick Child May Have Died from Bird Flu

http://www.recombinomics.com/News/01...nxi_H2H2H.html

I wondered why they would take this sick toddler from Hunan Province all the way to Shanxi Province. When her mother died of pneumonia, possibly caused by bird flu, her maternal grandparents came and got her. Hospitalized in critical condition, her name is Peng.

Originally Posted by www.recombinomics.com

[COLOR="Her mother last December 21 ~ 26 have a history of exposure to live birds, December 28, 29 there was a slight fever, due to severe pneumonia in January 2009 death of 6 ~ 7.

The above translation includes the disease onset date for the index case in the Hunan / Shanxi cluster. The 2 year old daughter developed symptoms on January 7, when her mother died, signaling transmission of H5N1 from mother to daughter. The daughter was then taken to Shanxi, where she was hospitalized.

Re: Pandemic Awareness/Preparation

All Eyes on China as Bird Flu Continues Its Comeback

http://www.scottmcpherson.net/journa...-comeback.html

Scott McPherson is the CIO (Chief Information Officer of the Florida House of Representatives). He also blogs on bird flu when he has something to say on the topic. He's been busy typing away for the last two days on the situation in China and Indonesia.

Originally Posted by www.scottmcpherson.net

You have four infections -- and three deaths -- occurring all over the Chinese mainland. Not confined to one singular province, and not necesarily accompanied by any known die-off of poultry. And to top it all off, the mother of the 2-year-old just died of "pneumonia." Sounds like the authorities need to go back and test for H5N1 on the dead mother, if they can.

And not to say "I told you so," but even York Chow, Hong Kong's Secretary for Food and Health, is saying he is deeply concerned about a possible change in the virus that is making detection in poultry extremely difficult. As you know, I speculated in such a change in my recent blog In Like a Lion. York's call for investigation into possible viral mutation is echoed by Chinese viral researcher and hero Guan Yi and by the Jiangsu Department of Agriculture and Forestry. So you have two Chinese provinces officially declaring there may be something to this viral mutation stuff.

Context is important here. Note that the Chinese New Year officially begins January 26th. This event causes travel for hundreds of millions of Chinese, as they migrate back home or to relatives. The highlight is the Reunion Dinner, held on New Year's Eve. From Wikipedia:

A reunion dinner is held on New Year's Eve where members of the family, near and far away, get together for the celebration. The venue will usually be in or near the home of the most senior member of the family. The New Year's Eve dinner is very sumptuous and traditionally includes chicken and fish.

OK, let's put it all together. We have at least four H5N1 human cases across China, all orccurring within the past month. Three of the cases have been fatal, meaning this strain of H5N1 packs the same degree of lethality as before. These cases are scattered all over mainland China, especially in the central and north/northeast regions. People are going home, usually to the home of the most senior person, and my guess is that most senior person is in rural China. And they eat chicken, of course, meaning rural chicken, recently slaughtered in a backyard or a wet market.

Could Asymptomatic Chickens Force Phase 4?

http://www.who.int/csr/disease/avian.../en/index.html

The WHO currently has us at a pandemic threat level of phase 3.

Originally Posted by www.who.int

Experts at WHO and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three pandemics occurred. WHO uses a series of six phases of pandemic alert as a system for informing the world of the seriousness of the threat and of the need to launch progressively more intense preparedness activities.

The designation of phases, including decisions on when to move from one phase to another, is made by the Director-General of WHO.

http://www.scottmcpherson.net/journa...e-phase-4.html

Originally Posted by www.scottmcpherson.net

...what if, suddenly, we have lost our most important sentinels in the fight against pandemic H5N1? What if the virus has not changed, but the conditions for infection have? I am saying that if it is true that we have asymptomatic fowl in China and in other parts of Asia, and possibly Egypt, and as a result it is becoming easier for humans to get infected simply because fowl are not doing their duty and dying to warn us, then perhaps it is time to reassess that threat level once again.

When you lose a major source of intelligence when fighting a deadly foe, what do you do? When intelligence experts lose their eyes and ears, they ratchet up the threat level to compensate while they regroup and re-establish their eyes and ears.

Perhaps it is time for the WHO to do the same. If theories hold true, and there is H5N1 present in China and elsewhere that produces asymptomatic, virus-shedding H5N1 avian flu in birds, then we have indeed lost our eyes and ears within the most populous nation on the Earth, the font of all known infectious respiratory diseases. Any prudent homeland security expert would exercise great caution and would raise the threat level.

Re: Pandemic Awareness/Preparation

Another Area of India Infected - Sikkim

http://afludiary.blogspot.com/2009/0...itive-for.html

Originally Posted by afludiary.blogspot.com

Bordered by Nepal to its west, Bhutan to the East, West Bengal on the south, and with China on its northern border, the tiny Indian State of Sikkim is pretty much dead center in a bird flu hot-spot.

West Bengal, Assam, and most recently Nepal have all reported bird flu outbreaks over the past 30 days.

Therefore it is not terribly surprising that they have now detected the H5N1 virus among poultry in that state, and a call has gone out to begin culling.

Indonesia

http://www.google.com/hostednews/ap/...i-cCwD95RFGB80

Better late than never, the Indonesians are releasing information on two recent deaths from bird flu that occurred there.

Originally Posted by www.google.com

Two Indonesians have died of bird flu, apparently after contact with sick chickens, raising the country's death toll to 115, the Health Ministry said Wednesday.

A ministry statement said a 6-year-old girl in Bekasi, West Java, died on Jan. 2. She got sick after buying a chicken with her parents at a market and was hospitalized for a week.

A 29-year-old woman died on Dec. 16 in Tangerang just outside the capital, Jakarta. She developed flu-like symptoms after visiting a market and died in a hospital five days later.

Bird flu remains hard for people to catch, but health experts worry it could mutate into a form that passes easily between humans, possibly triggering a pandemic that could kill millions worldwide.

Indonesia is considered a potential hotspot for such a mutation, but the country's health minister has refused to share virus samples with the WHO for more than two years.