Re: Pandemic Awareness/Preparation

Concerns of Increased H5N1 Transmission Efficiency in China

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

This is what worries me. H274Y is a piece of genetic material that would indicate that a flu virus is resistant to Tamiflu. Tamiflu is our main defense against bird flu. H5N1 (avian influenza) is usually not resistant to bird flu but, it could become resistant if patients are infected with both the seasonal flu (H1N1) and H5N1.

Originally Posted by www.recombinomics.com

The latest series of confirmed H5N1 cases in China indicate the H5N1 has achieved more efficient transmission to humans. Two of the cases are linked to contacts who had bird flu symptoms. In Beijing, a nurse recovered and test results have not been released. In Hunan, the mother of the confirmed case (2F) died of pneumonia when the daughter developed symptoms. Thus, in both clusters the index case died, but the contact survived. This was also reported in the cluster in northern Vietnam. The index case (13F) died of pneumonia, which her sister (8F) and neighbor (5M) survived. The survival of these cluster members is consistent with human to human transmission, which involves a low viral load, leading to milder cases.


Milder cases in China and Vietnam (see updated map) remain a concern. In China, all seven recent confirmed cases were admitted in critical condition. One is recovering, one is stable, and the other five are dead. This high case fatality rate suggests milder cases are not being detected / reported.



On the reporting front, the only H5N1 in poultry has been two outbreaks in Jiangsu in asymptomatic birds. Although some of the recent human cases have been linked to poultry exposure, there has been an absence of linkages to dead, dying, or H5N1 confirmed poultry.



This lack of poultry links raises concerns that the poultry is asymptomatically infected, which can be due to a vaccine mismatch.



Clade 7 has a large number of receptor binding domain changes flanking position 190, which is also true for the Tamiflu resistant H1N1 seasonal flu, which has spread throughout the northern hemisphere.



The co-circulation of clade 7 H5N1 and clade 2B H1N1 which has H274Y is an additional cause for concern, with regard to Tamiflu resistance on N and exchanges of receptor binding domain changes on H.



More information on the H5N1 clade linked to human cases in China and Vietnam would be useful as would release of H5N1 sequences from the recent cases in both countries.

Re: Pandemic Awareness/Preparation

http://www.cidrap.umn.edu/cidrap/con...2609birds.html

It's looking like H5N2, not H5N1. This outbreak is actually closer to the US border than I had thought, like 10,000 yards or so.

Originally Posted by www.cidrap.umn.edu

Canada's National Centre for Foreign Animal Diseases in Winnipeg, Man., confirmed that the virus was an H5, the OIE report said. It said gene sequencing showed that the virus was 99% similar to an H5N2 virus recovered from a green-winged teal in California in 2007.

The CFIA said all birds on the farm would be euthanized and disposed of and that the agency would oversee cleaning and disinfection of the barns, vehicles, equipment, and tools.

Re: Pandemic Awareness/Preparation

http://www.dailykos.com/storyonly/20...455/949/688579

From An Interview with One of the Reveres on Public Health and Pandemic Preparedness

Originally Posted by scienceblogs.com

In epidemiology an effect is the endpoint of a causal mechanism. An effect measure is an estimate of the influence of a particular factor on a population's health. The Editors of Effect Measure are senior public health scientists and practitioners. Their names would be immediately recognizable to many in the public health community. They prefer to keep their online and public lives separate to allow maximum freedom of expression. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

The health of our citizens is dependent upon our public health infrastructure. We take it for granted that everything will always work the way it is supposed to, that it will always be there to protect us. Most of us never think about how the economic decisions being made by government can impact our health in the future.

I like to think of the Reveres as watch dogs, warning us about how the consequences of bad decisions can come back to haunt us as they suggest in this link about what is happening in the state of Utah.

http://scienceblogs.com/effectmeasur..._to_deep_s.php

Originally Posted by scienceblogs.com

Utah could become the only state in the country without a state health department.
Republican lawmakers are considering handing the duties of the health department -- from tracking and responding to communicable diseases and trying to reduce obesity and cancer rates to inspecting child care facilities -- to other agencies.

Not unexpectedly, this interview is largely about our public health infrastructure because our population's ability to survive a widespread disease outbreak is dependent upon this.

Originally Posted by www.dailykos.com

DemFromCT: We started Flu Wiki together with the late Melanie Mattson in 2005. Are we any better prepared now for a pandemic than we were then?

Let me take this in two parts: the public response and the government/public health response. As far as the public and the news media goes, there's a lot of "flu fatigue" out there and with all that's going on it's more and more difficult to get their attention except with scare headlines. But I'm going to surprise a lot of people and say I think in terms of public awareness, the short answer is "yes," we are better off.

I wanted to keep the pressure on government to play an appropriate and meaningful role and I thought that placing the burden on individuals to protect themselves and their families was the wrong message. I am optimistic the new administration will be more receptive to the task of rebuilding public health infrastructure, both its human capital and its material substance, and will revive the idea of fulfilling the mission of public health. If this happens and combining it with a new spirit of public service I think there is less risk of letting government off the hook by pushing individuals and communities to take up the burden. But there is still a long way to go. Preparedness advocates are still a marginalized minority in their communities and often feel extremely frustrated at their inability to convince others of the potential danger.

As far as government response, however, I am not confident we are better off. There has been a lot of planning on paper, but like a military plan that never survives the first engagement with the enemy, the pandemic plans on paper will be out the window in the first week of a catastrophic disease outbreak. This always happens, but it will be more severe today than four years ago because of the deterioration of local and state public health and its distorted priorities during the Bush years. There has been a lot of stockpiling of antivirals (Tamiflu and Relenza), but whether they will work for bird flu or whether the virus will quickly develop resistance we don't know, although the signs are that this could be a big problem. There is as yet no vaccine matched to a pandemic strain because we don't know what that strain will be, and in any event the time to produce a vaccine is long enough so that we will have to endure at least one wave of a pandemic and after even after that, if a vaccine can be produced there will not be enough to go around or adequate ability to distribute it. That's a consequence of the lousy shape our health care and public health systems are in. And they continue to get worse.

DemFromCT: We have often talked about ‘rebuilding public health infrastructure’. Last week we discussed one aspect of that (the lab capability). What else does ‘rebuilding public health infrastructure’ mean?

Over at Effect Measure we've been saying for years that the best way to prepare for an influenza pandemic is not with antivirals or vaccines (although both have important uses) but by strengthening the public health and social service infrastructure to make it robust and resilient. Our view is that preventing a pandemic is technically difficult or impossible so the main task is to prepare to manage the consequences. The consequences of a large proportion of our population being sick or dying extends to almost every part of our society.

A state public health laboratory is not part of the public health infrastructure but most of us consider the laboratory system to be an essential element of infrastructure. Similarly for our disease surveillance system, which provides us with the "situational awareness" we need to make decisions about disease outbreaks or resource allocation. It's public health infrastructure.

Then there are things of ambiguous status. What about the vaccine production system? A no-brainer you’d say? I had a long discussion about this with a like-minded colleague over the lunch table but we couldn’t agree. He is an economist who doesn’t consider the vaccine system to be part of infrastructure, whereas I argued it was. I'm less sure about the nation's drug manufacturing capacity.

Re: Pandemic Awareness/Preparation

Indonesia - Dead housemaid tests positive for bird flu

http://www.flutrackers.com/forum/sho...&postcount=511

Originally Posted by www.flutrackers.com

"Initially, we did not know but remained suspicious of the patient's symptoms. After her death, the hospital's medical team sent a sample of her blood to the Health Ministry and the laboratory test result *confirmed* she was infected with the H5N1 virus," he told The Jakarta Post.

Urip said the hospital's medical team had doubted she was infected with the disease after learning the patient was not exposed to poultry at her work place or in her home village in Lumajang.

"This case has received a serious level of attention from the medical team because it is a new phenomenon," Urip said.

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

Originally Posted by www.recombinomics.com

The absence of a poultry link is cause for concern. The level of H5N1 in poultry in Indonesia is high, but the lack of OIE reports since 2006 from Indonesia limits specifics.

Similarly, the delays in reporting confirmed cases by Indonesia and WHO complicates analysis in humans. The WHO has not issued a situation update for confirmed cases, and since Indonesia has imposed a news blackout on cases, the updates lag disease onset dates by weeks or months.

The latest lab confirmation of a patient without known poultry exposure suggests the undercount in Indonesia is markedly higher than reported confirmed or suspect cases.

Re: Pandemic Awareness/Preparation

http://www.ahc.umn.edu/mnpanflu/faq/home.html#1

Originally Posted by www.ahc.umn.edu

Originally Posted by www.ahc.umn.edu

What is a severe influenza pandemic?

What makes a pandemic severe, as opposed to mild or moderate, is the rate of deaths and other serious complications from the disease. The more people die or develop serious complications, the more severe it is. Severe pandemic influenza occurs on a scale that distinguishes it from other public health disasters in terms of its global nature and duration. It is experienced over years, not days, weeks or months, and threatens core public health, social and economic infrastructures. Unlike a mild pandemic, a severe pandemic has the potential to disrupt normal health care and business operations and therefore interfere with the distribution of essential goods and services globally. Unlike other disasters, states and communities cannot count on receiving federal assistance in a severe pandemic. For purposes of this project, we assumed that a severe pandemic could resemble the one that occurred in 1918–19.

What kinds of resources might be scarce during a severe pandemic, and what resources are discussed in this project?

Food, medicines and supplies of all types could be scarce at times during a severe pandemic. During the peaks of a severe pandemic as many as 40% of the workforce could be absent due to illness, death, caretaking duties at home or fear. Large workforce shortages could result in interrupted services, manufacturing, and distribution chains for many resources. Health care resources are likely to be in particularly short supply, because demand will be very high.

This project recommends how to ration five kinds of health-related resources as examples of those that will be scarce: antiviral medications (both for treatment and prevention), N95 respirators, surgical masks, pandemic vaccine and mechanical ventilators.

What is the Minnesota Pandemic Ethics Project?

The project’s goal is to propose ethical frameworks and procedures for rationing scarce health resources in Minnesota during a severe influenza pandemic. The frameworks recommend how to decide in what order different groups of Minnesotans should be prioritized to receive resources. There are also recommendations about how to implement the ethical guidance provided by the frameworks. The preliminary recommendations have been developed by a broad-based panel and work groups of more than 100 Minnesotans. An important part of this project is to gather public input so that the final recommendations include broader perspectives.



Why your comments matter

The Minnesota Department of Health will use the project's recommendations as part of its pandemic planning process. A severe pandemic would affect everyone, and it is very important that rationing decisions reflect Minnesotans’ values and input. We want to hear from persons from all walks of life. We also are interested in hearing from non-Minnesotans because responding to a pandemic involves close collaboration with others, including other states and countries.

Re: Pandemic Awareness/Preparation

Another Chinese Victim

http://news.xinhuanet.com/english/20...t_10741532.htm

With contact with sick fowl, it is not so unexpected for this farmer to become ill. It is just surprising that more people that work with poultry do not become infected. And it is when the birds do not appear sick, but the people become ill, that it becomes alarming.

Originally Posted by news.xinhuanet.com

A 21-year-old female farmer was confirmed infected with bird flu in central China's Hunan Province, said the provincial health bureau on Saturday.

Shu was transferred to a hospital in Changsha, capital of the province, on Thursday. So far she has been in a stable condition and become better.

An investigation found that Shu had contact with fowls that died of disease before becoming sick.

Hunan has launched an emergency response against the virus. Those who had close contact with the patient are under medical observation, but none of them has been found ill so far.

Two Suspicious Deaths in Indonesia

http://afludiary.blogspot.com/2009/0...us-deaths.html

Treating contacts with Tamiflu, indicates that the doctors suspected bird flu and treated prophylactically. Indonesia has not added these deaths to their mounting number of cases.

Originally Posted by afludiary.blogspot.com

...it appears that two patients - sisters - died last week from that area after being admitted to Persahabatan Hospital, in East Jakarta.

Both were `strongly suspected' of being infected with the bird flu virus. Health officials, according to the second article, are taking blood samples in the area.

Contacts of the victims were provided with Tamiflu.

If any results of these tests are known, they haven't been disclosed by the Ministry of Health.

Re: Pandemic Awareness/Preparation

Update Needed on the Bird Flu Outbreak in Canada

It's beyond strange that there still has been no real identification of the avian flu virus that caused the outbreak at Abbotsford in British Colombia. We last heard Canada's National Centre for Foreign Animal Diseases in Winnipeg reporting that this was an H5 virus, 99% similiar to an H5N2 virus recovered from a green-winged teal in California in 2007.

It is important for governments to have a certain level of transparency about the cause of such events. The OIE report was filed on 1/23/09, and it's now 2/03/09, and they still have not announced the serotype of that virus. So, is it H5N2 or maybe a low pathogenic H5N1?

This is rather uncomfortably reminiscent of the handling of another bird flu event that occurred in Canada a few years ago where there was no definitive result given then either.

http://www.flutrackers.com/forum/sho...3&postcount=58

Originally Posted by www.flutrackers.com

There is little reason to aggressively test. The best example for North America was the H5 positive dead geese on Prince Edward Island. All real data STRONGLY suggested the H5 positive geese died from Qinghai H5N1, yet Canada managed to "control" damage, so no OIE report was filed and no country banned Canadian exports.

http:////www.flutrackers.com/forum/s...8&postcount=11

Originally Posted by www.flutrackers.com

...one really has to want to find these viruses. It takes diligence because the process is not all that simple and subject to a lot of problems along the way. I would be concerned that an agency whose primary job is to protect the beef and poultry industry might lack a certain level of independence necessary to seek out and find a virus that could cause significant economic disruption to the very food industry that it supports.

http://www.flutrackers.com/forum/sho...&postcount=107

Originally Posted by www.flutrackers.com

It's beginning to sound like the dog ate the homework AGAIN!

Re: Pandemic Awareness/Preparation

Canada - Low Path H5N2

http://www.flutrackers.com/forum/sho...&postcount=111

At last a diagnosis! Canada gets to say it is still free of any highly pathogenic bird flu. A highly pathogenic influenza would have had an even worse adverse economic effect on the region.

This is in contrast to an earlier outbreak that occurred on Prince Edwards Island a few years ago. In that case they said that the specimens were too degraded to be serotyped. Someone sent them too late. They did say that it was an H5 virus, but would not acknowledge the size of the probe insert. Doing so would have given information about the cleavage site of the virus, and that would have indicated if the flu was highly pathogenic. Instead, they claimed "privacy" issues (of geese?). They did however, offer Tamiflu to the folks on the farm.

Just saying, there has to be a certain level of transparency to maintain trust in the accuracy of what they are claiming as truth because this is not just about the economic security of the Canadian agricultural industry anymore.

Originally Posted by www.flutrackers.com

The Canadian Food Inspection Agency reported Tuesday that tests at the National Centre for Foreign Animal Diseases in Winnipeg confirm the H5 bird flu virus detected on the farm is H5N2.

The agency also reiterated that preliminary tests at the outset of its investigation on Jan. 24 indicate this strain of bird flu is of low pathogenicity ("low-path").

It's thus likely that Canada will keep its status as free of "high-path" bird flu, which it's held since April last year after the cleanup of an outbreak of H7N3 on a poultry farm near Regina Beach, Sask.

http://www.flutrackers.com/forum/sho...&postcount=112

Re: Pandemic Awareness/Preparation

France - Low Pathogenic Bird Flu Outbreak

http://crofsblogs.typepad.com/h5n1/2...k-of-h5n3.html

This is the same type of flu (H5N3), a low pathogenic one, as what was just found in Canada, however the French did all of their testing, and reporting of results in only 4 days. Are the Canadians just inept?

This does not bode well for H5N1 surveillance in North America.

Originally Posted by crofsblogs.typepad.com

...the first signs were on January 29, a Thursday, and on Sunday the whole population on the farm was culled. The first positive test results were on January 30, with a follow-up test (also positive) on February 1.

Egyptian Baby Diagnosed with Bird Flu

http://www.flutrackers.com/forum/sho...3&postcount=64

Another baby was found to be infected with H5N1 in Egypt. Fortunately, most of these little kids have been recovering including the recent case in China. It's the teenagers and young adults that die which is reminiscent of 1918.

Originally Posted by www.flutrackers.com

...Egyptian Health Ministry confirmed on Wednesday that a two-year-old baby has been infected with bird flu virus, which brings the number of human case of bird flu to 54 in the populous country. Mahmoud Sobhi Gharib, from the Suez governorate, some 120 km east of Cairo...

Chinese Toddler Recovers

http://crofsblogs.typepad.com/h5n1/2...goes-home.html

Originally Posted by crofsblogs.typepad.com

A 3-year-old girl has become the youngest person ever in China to recover from bird flu infection.
The girl, identified only by her surname Peng, was hospitalized last month in north China's Shanxi Province after being diagnosed with the H5N1 strain of avian influenza.

Re: Pandemic Awareness/Preparation

What Is Going on in China?

http://afludiary.blogspot.com/2009/0...n-poultry.html

Everyone remembers how the Chinese denied the rumors of a new infectious disease in their country. The rumors turned out to be frighteningly true. That was SARS. Again, we are seeing clues that the Chinese are covering up something. Dead birds are washing up in Hong Kong. There are 8 human cases of bird flu that the Chinese are admitting too, but they deny any outbreaks in poultry.

The real reason to be concerned is that what is happening there, easily could fly here.

Originally Posted by afludiary.blogspot.com

China has reported 8 human cases of H5N1 infection over the past month -and they attribute these infections to close contact with infected birds - but at the same time they deny any outbreaks of the virus among poultry.

Additionally, a small number of infected bird carcasses have washed up on the beaches of Lantau Island, near Hong Kong over the past week. Local officials suspect these birds were tossed into the Pearl River, which flows from Guangdong Province.

All of which is pretty strong evidence that the H5N1 virus is circulating, presumably in the domesticated bird population, in mainland China.

But according to China, they aren't seeing any sick or dying chickens.