Pandemic News/Awareness.

indigo girl · Jun 4, 2007

UNICEF puts workers on avian flu alert:

http://www.flutrackers.com/forum/showpost.php?p=84115&postcount=1

As UNICEF's focus is forwarding the rights of children, a World Health Organisation (WHO) study revealed that youth will be the most vulnerable in the event of the spread of the human pandemic influenza. Apparently 90 per cent of people who have been diagnosed with H5N1 avian flu are under the age of 40.

indigo girl · Jun 6, 2007

Vietnam grapples with H5N1 crisis:

http://afludiary.blogspot.com/2007/06/vietnam-grapples-with-h5n1-crisis.html

A few short months ago Vietnam was the poster child for the successful fight against bird flu. Once the most severely hit country in the world, they had reportedly eliminated human infections for more than a year, and were down to sporadic outbreaks in poultry.
Starting in February, we began to see new outbreaks, followed by a period of quiescence. Over the past six weeks, those outbreaks increased dramatically, and we have two confirmed human cases, and two . . . possibly four . . . suspected cases.

Vietnam steps up human surveillance:

http://afludiary.blogspot.com/2007/06/vietnam-steps-up-human-surveillance.html

The Health Ministry on Monday ordered local authorities in nine bird flu-struck localities to strictly monitor all people showing possible symptoms of the virus.
In an urgent message to the nine localities - out of the country's total 15 provinces and cities that have confirmed outbreaks of the disease since early May - the ministry ordered local authorities to isolate those affected by the deadly H5N1 virus.
Grassroots health agencies have been asked to monitor all those who show symptoms relating to bird flu symptoms such as high fever, cough and difficulty breathing. These patients are to be checked in to local hospitals immediately, not left at home.

indigo girl · Jun 6, 2007

Indonesian reseachers warn that H5N1 may be becoming more transmissible:

We have been watching for these changes for some time now. This is exactly why it is important for all affected countries to share viral samples.

http://www.flutrackers.com/forum/showpost.php?p=84395&postcount=6

A microbiologist at the bird flu commission said the suspicions were based on preliminary findings of molecular genetic tests conducted at laboratories in Indonesia.
"Virus samples from poultry cases have increasingly shown a similarity in their amino acid structure to virus samples extracted from humans," Wayan Teguh Wibawan told Reuters.
"This makes it easier for the virus to attach to human receptors," he said, referring to receptor cells lining the human throat and lungs.
For the H5N1 virus to pass easily from bird to human, it would have to be able to readily attach itself to these special cells.
For the moment, because H5N1 is a bird virus, it has evolved to easily attach to these receptors in poultry. Humans have a different type of receptor site, making it harder for people to become infected.
Wayan said he had spotted "gradual changes" in the virus sample he receives every month...
Lo Wing-lok, an infectious disease expert in Hong Kong, said changes such as these demonstrated how important it was for Jakarta to share virus samples.
"If there is such a change, it would not only mean that the virus can jump more easily from bird to man, but from human to human, too."

indigo girl · Jun 7, 2007

More suspect human cases in Vietnam?

http://afludiary.blogspot.com/2007/06/vietnam-more-suspect-infections.html

Three Vietnamese people have been hospitalized for being suspected of having contracted bird flu, local newspaper Labor reported Thursday.
Specimens of the people, admitted to the Tropical Disease Hospital in Hanoi capital on June 5, are being tested for bird flu virus strain H5N1, the paper quoted the hospital director Nguyen Duc Hien as saying.

indigo girl · Jun 7, 2007

The Kind That Binds - Avian Flu Diary

An easy to understand discussion about the claim by Indonesian researchers that H5N1 may be becoming more transmissible:

http://afludiary.blogspot.com/2007/06/kind-that-binds.html

indigo girl · Jun 8, 2007

Deadly flu virus mutating rapidly: WHO

http://www.flutrackers.com/forum/showpost.php?p=84761&postcount=1

Dr Shigeru Omi, WHO Regional Director for the Western Pacific, told ministers and senior delegates from the 21 nations the virus was rapidly evolving.
"The virus is already entrenched, embedded in this part of the world and ... it has been very, very unstable and changeable," Dr Omi said after the meeting.
"If we put (these two points) together it's a very clear indication that we have to remain vigilant."
The Indonesian strain has infected 309 people since 2003, killing 188, but Dr Omi warned that what was once two distinct grades had now spilt into four sub-groups.
"And I would not be surprised if we end up with more sub-classes in the years to come," he said.
Current mutations have not necessarily increased the likelihood of human-to-human transmission, but it proved the virus was "risky".
"The longer the virus lasts, the more chance such a mutation will occur," Dr Omi said. "It's simple mathematics."

indigo girl · Jun 8, 2007

Alarming news from southern Egypt:

http://www.flutrackers.com/forum/showpost.php?p=84850&postcount=1

You have to understand that the previous cases in southern Egypt were mild cases, and all of those children survived. This 10 year old girl is said to be in very critical condition, so something has changed but not for the better.

indigo girl · Jun 8, 2007

The Editors of Effect Measure are senior public health scientists and practitioners. 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.

China shares its bird flu questions
We've written here about China's failure to share viral isolates, but we hope we've also made clear that many Chinese scientists have been forthcoming in sharing much other scientific information with colleagues in other countries about their experience with bird flu. A good example of interesting and valuable information has just appeared (published Ahead of Print in CDC's journal Emerging Infectious Diseases). The paper has details on six H5N1 cases that occurred in China between October 2005 and October 2006. The cases were all in urban areas and had no known exposure to sick poultry or poultry that died from illness. They were among a total of 20 H5N1 cases in China reported in that period.
The Chinese investigators, with the collaboration of a scientist from the US CDC, interviewed patients and/or their relatives, reviewed medical records examined households and venues visited by patients in the two weeks prior to the onset of their illnesses (all but one of the cases died). A standardized survey instrument was used to collect the data from the patients or next or families:
Particular attention was paid to potential exposures such as contact with well-appearing, sick, or dead poultry; visits to poultry markets; or contact with persons with febrile respiratory symptoms in the 2 weeks before onset. A rural case was 1 that occurred in a village resident; an urban case was 1 that occurred in a city resident. (Yu et al., Emerging Infectious Diseases)
A Chinese city is considerably more populous than the average European or American city. The patients came from 6 different cities in 5 different provinces and the average population of the 6 was 8.3 million people. All patients were adults, ranging in age from 21 to 41, median 30 years old. None of the patients had contact with anyone with fever and respiratory disease. 136 close contacts of the patients, 389 healthcare workers and 115 people working in the poultry markets visited by the patients were under medical observation for 2 weeks. Five febrile illnesses developed in contacts but none were serious and none had evidence of H5N1 infection by RT-PCR of respiratory secretions or paired acute and convalescent serum samples. And 5 of the 6 had no direct contact with poultry. But there was some poultry association with all of them:
One patient prepared freshly slaughtered chicken that she purchased for cooking at a live (wet) poultry market. No patients kept poultry or other animals at home, and no poultry or poultry outbreaks were identified in their neighborhoods. Five patients had visited wet poultry markets within a week of illness onset, and all had visited a wet market during the 2 weeks before their illness. Three patients visited wet markets at least once a day before illness onset. Only 1 patient (case-patient 5) had any travel history in the 2 weeks before illness onset. That patient had visited his parents' home in a rural area, where healthy backyard poultry were kept outside the house, and he had visited a wet market in the same area 2 weeks before illness onset.
The data suggest visits to wet poultry markets are a risk factor for urban cases in China, although not the only one:
None of the 6 case-patients had known direct contact with poultry that were sick or died of illness. Two patients (case-patients 1 and 3) had no identified potential exposures except for visiting a wet poultry market during the week before illness onset. Four other case-patients visited wet markets, although other exposures could have potentially led to virus transmission. Case-patient 2 was an egg seller and could have also been infected by contact with fecally contaminated eggs. In 2005, influenza A (H5N1) virus was isolated from eggs brought to China by travelers from Vietnam (11). Case-patient 4 could potentially have been exposed to the virus through preparation of freshly slaughtered chickens purchased at a wet market. Case-patient 5 could have been exposed to the virus by visiting his parents' home, which had healthy backyard poultry outside, or by transporting eggs. Case-patient 6 could have been exposed to the virus at home, when his wife prepared a freshly slaughtered chicken purchased from a wet market. No epidemiologic evidence suggested human-to-human transmission of influenza A (H5N1) associated with the urban patients.
This isn't a large sample and we don't know is how many other people, of the same age and sex, selected at random in these cities, would have given similar histories (making this comparison is called case-control design in epidemiology). Clearly more needs to be done and these observations raise many other questions.
But the big one for us is this: if wet poultry markets is the true risk factor (and it may be), then of all the people visiting or working in wet markets, why these people?

I have permission from Effect Measure to post this without a link as sometimes the comments that follow these essays can violate TOS here.

indigo girl · Jun 9, 2007

I just hate it when kids die. I know that they die everyday somewhere on the planet from many causes, some preventable, and some not. Is avian flu preventable? I think that some of these cases could be, through education, and through awareness of the risks of allowing children to be exposed to poultry in a country where the disease is endemic.

Please be advised that this particular case in southern Egypt is significant. It has happened at a time of year that is unusual, and the southern cases were milder. We need to see the sequences to answer some questions of concern. Was this a Tamiflu resistant case like the cases in the north? Were there any other markers indicative of more virulence or more ease of transmissibility?

http://www.flutrackers.com/forum/showpost.php?p=84972&postcount=17

Most of those who have fallen ill in Egypt were reported to have had contact with sick or dead household birds, primarily in northern Egypt where the weather is typically cooler than in the south.
Bird flu experts in Egypt have said they would typically expect fewer human cases of the disease during Egypt's sweltering summer months, and in 2006 there was a summertime lull in human cases between May and October.

indigo girl · Jun 10, 2007

Bangaladesh continuing to have bird flu outbreaks:

http://www.flutrackers.com/forum/showpost.php?p=85158&postcount=1

The infected chickens were found at a farm in Dinajpur district 450 km (280 miles) northwest of the capital Dhaka.
With the latest cull, some 160,000 chickens have now been slaughtered and 1.5 million eggs destroyed on 62 farms in 12 districts since the virus was first detected at six farms at Savar near Dhaka in March.

indigo girl · Jun 10, 2007

From the Dept of HHS blog

SARS and H5N1: The Precautionary Principle

http://blog.pandemicflu.gov/?p=44

indigo girl · Jun 10, 2007

More on the recent pediatric fatality in Egypt, and the possibility that a 25 yr old woman in the same area is also infected:

http://www.flutrackers.com/forum/showpost.php?p=85234&postcount=28

"In terms of diagnosis, she went to four different private physicians before she was finally diagnosed. This issue [bird flu] needs more awareness and attention from doctors in the private sector," said Dr John Jabbour, International Health Regulations Officer and medical officer for Emergency Diseases, World Health Organization (WHO) Cairo.
Jabbour said that it is crucial for people to know the symptoms of bird flu and for doctors to recognise and treat those symptoms as early as possible to avoid any fatality. But bird culling campaigns and fines for having so-called ‘backyard birds’ – domestic poultry – have deterred many people from reporting the potentially deadly illness.
The main problem in Egypt is that people are afraid of the national authorities. They are denying being exposed to H5N1 and backyard birds, which delays the treatment and causes deaths.

This is still a significant case due to the fact that: 1) it is summer in Egypt, and the temperature is over 100 degrees where this child lived, and there were no cases prior to this at this time of year, 2) previous cases in the southern part of the country were mild, 3) this is the first pediatric fatality for Egypt.