Pandemic News/Awareness.

indigo girl · Jun 12, 2007

Another Egyptian case today, this time a 4 yr old girl. Here is some commentary from Dr. Niman, the virologist at Recombinomics discussing the sequencing of the viral strain from the recent 10 yr old pediatric fatality from Saturday. She was the first child fatality in Egypt, and hopefully the last. Dr. Niman is collaborating with NAMRU-3, the US Naval lab in Cairo where they have access to the viral samples of these cases.

Keep in mind that these flu cases are occurring in a hot country in the summertime.

With regards to the sequences from the 10 yr old, Dr. Niman is saying in a discussion over at flutrackers, that N98D is indicative of mammalian changes that this avian flu virus continues to make. N98D was present in the Spanish Flu in 1918. It is a mammalian marker. H5N1 continues to evolve.

http://www.recombinomics.com/News/06110701/H5N1_Qena_4F.html

indigo girl · Jun 12, 2007

In Vietnam, a patient recovers from bird flu and goes home. The other case is still hospitalized. They still continue to find infected poultry despite their poultry and duck vaccination programs.

http://crofsblogs.typepad.com/h5n1/2007/06/vietnam_bird_fl_1.html

indigo girl · Jun 12, 2007

I am not sure what this means, and neither is anyone else, but in Indonesia

they are finding that infected poultry are asymptomatic. It used to be that you could be warned by poultry deaths that H5N1 was present, but not now that is not always true.

It is not known whether or not this is indicative of the virus becoming less virulent.

http://crofsblogs.typepad.com/h5n1/2007/06/indonesia_finds.html

http://www.bloomberg.com/apps/news?pid=20601202&sid=afhASkp8W55k&refer=healthcare

Four of every five human H5N1 cases have been fatal in Indonesia. Of 15 cases confirmed there last month, doctors weren't able to identify the cause of infection in eight of them.
If there's virus circulation and the animals appear clinically healthy, then it can be a human health risk because people keep on handling those animals'' without being aware of the risks, said Christianne Bruschke, a veterinarian leading an avian influenza project for the World Organization for Animal Health.
During the past two years, 99 Indonesians are known to have been infected with the virus, 79 of them fatally.

(hat tip flutrackers/AnneZ)

indigo girl · Jun 12, 2007

Illegal meat smuggled into the UK:

http://www.flutrackers.com/forum/showpost.php?p=85641&postcount=1

The Observer has learnt from one senior trading standards officer that poultry smuggled in from Egypt, where avian flu was confirmed last year, is on sale at markets across London. Dr Yunes Teinaz, acting environmental health manager for the London borough of Hackney, said much of the trade was carried out by criminal gangs: 'It's a very big black-market industry with highly lucrative rewards. You just need £400 to buy an old van and you can go around the country distributing illegal meat.'

indigo girl · Jun 12, 2007

Two new cases of avian flu in Vietnam, one of which has already been released from the hospital. That is odd. The other is on a vent.

Both are young women in their twenties.

The whole story in Vietnam is strange. They have much experience in dealing with H5N1 yet it seems not to be controlled there. Supposedly they are vaccinating their birds. Now these human cases have been occurring again as well as many cases in poultry.

It really makes you wonder about countries like Bangaldesh. No human cases reported yet in that country. Why is that? Not that we wish this upon them, but why is it different there?

http://www.flutrackers.com/forum/showpost.php?p=85550&postcount=2

indigo girl · Jun 13, 2007

In Indonesia, another death suspected to be bird flu related:

http://afludiary.blogspot.com/2007/06/another-indonesian-death.html

A 28-year-old man died Tuesday after being treated at a hospital in Indonesia's Riau province with bird flu symptoms and the death toll of the disease could hit 80 in the country if his case is confirmed.

Update

http://afludiary.blogspot.com/2007/06/indonesia-confirms-80th-fatality.html

indigo girl · Jun 13, 2007

Essay from Effect Measure used with permission of the author/authors

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.

Bird flu: soup's still on

Category: Bird flu * Pandemic preparedness * Public health preparedness

Posted on: June 13, 2007 7:29 AM, by revere

Bird flu news tends to be episodic. For long stretches there seems to be little news (unless you deliberately go looking for it; then you find it). Then there are these little spurts as bird flu pops up here and there in the news. Human cases in places where they haven't been for a while tend to be more noticeable. Or suspicion there are cases where they haven't been before. So we have Malaysia quarantines five with suspected bird flu (possible new country for human cases; but suspect cases of febrile illness around poultry outbreaks often turn out "negative," either because they are one of the many other common illnesses or because they are false negatives; if they turn out to be bird flu, I wouldn't be surprised; if they turn out not to be, I wouldn't be surprised); Vietnam reports 2 more human cases of bird flu (more new human cases in a country touted as having successfully controlled bird flu in poultry and in people); Egyptian girl diagnosed with bird flu (another case, the second in two weeks, in the country outside of Asia with the most cases [36], half of them in 2007).

And of course -- of course -- Indonesia:

An Indonesian expert from the Research Center for Biotechnology of Gadjah Mada University, Widya Asmara, said that there had been indication that the viruses had geographically changed.

"It is urgent to conduct more researches to prove the change," he told Xinhua.

If the change is significant, it will be necessary to develop anew strain of vaccine, he added.

"There are some indications that some strains of the viruses have changed in some regions," he said.

Another Indonesian expert, Ngurah Mahabarata, said that the highly pathogenic H5N1 virus so far had spread before it could control properly.

"When the virus has a chance to infect poultry, it has a chance to develop and at the same time it changes its structure," he said.

John Weaver, from the avian influenza control program of the United Nations in Indonesia warned of the risk when the virus changes.

"We have to be aware that there is always a risk that the field virus is becoming more different," he said. (XinhuaNet)

Indonesia and other countries are hoping poultry vaccination will stop the disease without mass culling. It might. But it might also just provide enough protection that the birds don't get sick but still become asymptomatically infected, still shedding virus that could infect people. Asymptomatic infection of poultry has been reported from China and now the Indonesians are also saying they have found it:

Indonesia has found traces of H5N1 bird flu in apparently healthy-looking poultry, making it tougher to detect the disease in the country hardest hit by the virus, officials said on Monday.

Sick or dead chickens are used as a sign of H5N1 infection, but the appearance of "asymptomatic" chickens means humans could become more easily infected with bird flu. Indonesia has the world's highest death toll from the disease, killing 79 people.

"The poultry death rate is not so high, but there is a trend that chicken or poultry are infected by the virus but they don't die. So, the H5N1 virus is not fatal to poultry," Musny Suatmodjo, director of animal health at the agriculture ministry, told a news conference. (Reuters)

Presence of sick or dead poultry is a signal to clinicians they should do diagnostic work-ups for H5N1 infection in people with flu-like symptoms nearby. If some people are becoming infected from shedding but asymptomatic poultry, it could mean cases are being missed because of the absence of a sufficient diagnostic index of suspicion.

There is as yet no evidence bird flu is boiling over in the epidemiologic cauldron that is the millions of infected birds living cheek by jowl with millions of people. But for sure it isn't fading away. It is bubbling away.

indigo girl · Jun 14, 2007

Vietnam

There are now 17 provinces where H5N1 has been found. I think that we can expect that number to increase:

http://www.flutrackers.com/forum/showpost.php?p=85985&postcount=39

The US and Vietnam have announced a 5 year cooperative plan to combat

avian flu and pandemic influenza:

http://crofsblogs.typepad.com/h5n1/2007/06/vietnam_us_laun.html

indigo girl · Jun 15, 2007

Nothing in the following information is encouraging news:

What is really going on in Malaysia?

http://afludiary.blogspot.com/2007/06/malaysia-denies-bird-flu-cause-of.html

The Philippines hoping to prevent avian flu from entering via human travelers, but what about the nonhuman ones?

http://afludiary.blogspot.com/2007/06/manila-airport-steps-up-bird-flu.html

Bangaladesh, it just keeps happening:

http://crofsblogs.typepad.com/h5n1/2007/06/bangladesh_figh.html

Myanmar (Burma) H5N1 continuing to spread:

http://crofsblogs.typepad.com/h5n1/2007/06/myanmar_calls_o.html

indigo girl · Jun 15, 2007

From Effect Measure with their permission:

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.

Trying to solve the pandemic vaccine problem: too little, too late

Category: Bird flu • Pandemic preparedness • Vaccines

Posted on: June 14, 2007 7:31 AM, by revere

One of the big issues over sharing of viral isolates from Indonesia was the contention, probably well justified, that the poor nations would be last in line for any vaccine that might be available in the event of a pandemic. While a well matched vaccine has to await the emergence of a pandemic strain, there are good reasons to think vaccines made from pre-pandemic strains would provide some cross-protection, and such vaccines are already in production, although in small quantities.

The choke point is the clearly inadequate global production capacity for influenza vaccine. Even if there were a vaccine that was sufficiently protective, it wouldn't be possible to ramp up production sufficient to meet global needs in a pandemic. As a result of promises and some general agreements made in the wake of the contentious World Health Assembly recently, some vaccine manufacturers are "voluntarily" pledging to contribute to WHO tens of millions of doses of their pre-pandemic H5N1 vaccines. WHO, in turn, would use them judiciously where the need was greatest and earliest. Most experts believe this will be in the developing world. If something started in a rich nation, WHO might or might not make some of the stockpile available. However much stockpile there is, that is.

Because the pledges, while not insignificant, will take years to be fulfilled:

The British firm GlaxoSmithKline said it will contribute enough vaccine for 25 million people to WHO over three years. French drug maker Sanofi-Aventis, American firm Baxter International Inc., and Omnivest of Hungary also said they were willing to make some of their H5N1 vaccine available.

[snip]

More work is needed to clarify under what conditions the stockpile will be used, said the agency, which intends to use the supply to try to stamp out cases at the source of a pandemic, and to help developing countries protect health-care workers, police and military during a pandemic. (Helen Branswell, Canadian Press)

Vaccine manufacturers have to do this. The demands of Indonesia would have scuttled a well established system of influenza virus surveillance, a system that made it possible to manufacture a flu vaccine prior to the flu season, not after it was over. But the amount being made available and the time frame for fulfilling the pledge suggest this isn't going to save poor countries in a pandemic. The only solution -- and it is more a mid or long term one -- is to use better and faster technologies for making vaccines. In addition, if the object is to prepare for a possible pandemic, there will have to be some kind of system for scaling up quickly to meet a sudden demand that isn't there prior to a pandemic. The only other alternative would be to routinely and vastly overproduce and destroy much of the inventory each year.

There is a lot of activity on the vaccine technology front, but little solution to the surge capacity problem. If we started now it would be a race between the virus and vaccine development.

But we haven't started.

TrudyRN · Jun 15, 2007

I think that they need to tell people the truth. We are adults. We can handle it. CDC is expecting a panflu to happen. They must have known what was going on in England because it was reported on Thursday. CDC press conference was on Friday. I know that CDC is aware of the current case fatality ratio in Indonesia and Egypt. Don't tell us 2% when it is not even close to that!
This is what I would tell people. Prep for your family for at least 12 weeks.
If you can do more, do it. Don't forget masks and gloves for use at home.
You may need them.
As nurses, ask your facilities about their panflu policy, and check on the PPE situation. Make up your mind about what your plan is going to be. Do not assume that they will take care of you. Be proactive. Your safety and your life that may be at stake. It certainly was during the SARS epidemic.
Did nursing learn nothing from that?
Where are our nursing leaders when we need them? We need direction and we need education. We need a place at the planning table. We will be directly involved in patient care. We will be at risk. Who is going to speak for us?

I think you are an excellent leader, Indigo Girl. I know I am going to start gathering in the canned goods and dried meats, the bottled water, some gloves, masks, towels, linens, newspaper, meds, and so on, plus lots of books to read, crossword puzzles to do, etc., for all the housebound time we might have to deal with. Batteries, a generator and fuel for it, just anything I can think of to deal with this.

I do think our government and the other big country governments (Israel and Britain) know all about this, I think they have planned it, they will use it to kill off a bunch of us commoners, and it will all be for their own perceived good. Most of us are expendable to them. There are quotes in the media from the likes of Prince Philip that call us "uselsss eaters" and was it Kerry who said we'd end up in combat if we're dumb or something like that. Sorry to wax political on a Nursing board and not trying to offend or hurt anyone - just stating my view. Of course, Nursing is political. Everything is political. We see it daily when our bosses won't staff properly, when pensions are eradicated, when foreign nurses are brought in rather than American nurses being treated rightly so we will work here in America. This is just one more step on the road to the New World Order. It is all planned, we probably can't stop it. Do a search and you'll see. It's not just my imagination. We will have to fight back to survive so I really appreciate this thread, Indigo Girl. I'm going to forward it to my DON and see what we are doing to prepare our facility. If it gets totally horrible, nurses might have to bring their loved ones to work and care for them there, as we won't want to totally abandon our patients either.

Ayrman · Jun 15, 2007

Prepping is always a good idea. When an event such as pandemic influenza looms on the horizon it tends to take on a sense of urgency. Even when no such event is in sight it makes sense. Ask the Katrina folks if they wish they and their facilities had been a bit more foresighted.

Natural epidemics are a historical reality. Influenza alone makes the rounds about 3 times every 100 years, as it has for at least the past 1,000 years that history can document for us. There is nothing conspiratorial about this one, it is merely a natural event that is coming with all the force and speed of a juggernaut - slowly but inevitably and irresistably.

Ayrman