The H5N1 strain of influenza - often referred to as bird flu - is first known to have jumped from chickens to humans in 1997. Since 2004 it has ripped through poultry and wild bird populations across Eurasia, and had a 53% mortality rate in the first 147 people it is known to have infected. Health authorities fear this strain, or its descendent, could cause a lethal new flu pandemic in people with the potential to kill billions.
Flu has been a regular scourge of humanity for thousands of years. Flu viruses each possess a mere 10 genes encoded in RNA. All of the 16 known genetic subgroups originate in water birds, and especially in ducks.The virus is well adapted to their immune systems, and does not usually make them sick. This leaves the animals free to move around and spread the virus - just what it needs to persist.
But sometimes a bird flu virus jumps to an animal whose immune system it is not adapted to.
In Bandung, Indonesia, a doctor was initially suspected of contracting bird flu from personal chickens that had died. Initial PCR tests for H5N1 were negative. The individual was given Tamiflu and is improving. They also are awaiting additional test results.
In Bandung, Indonesia, a doctor was initially suspected of contracting bird flu from personal chickens that had died. Initial PCR tests for H5N1 were negative. The individual was given Tamiflu and is improving. They also are awaiting additional test results.
Aussie mother dies only two days after catching flu
BRISBANE: The influenza outbreak sweeping Australia has now claimed nine victims, including a Queensland woman who died just two days after showing the first symptoms.
Influenza Survey Uncovers Key Differences Between Bird Flu and Human Flu
MEMPHIS, TN -- August 20, 2007 -- Scientists at St. Jude Children's Research Hospital have found key features that distinguish influenza viruses found in birds from those that infect humans. . . .
The researchers . . . identified 32 persistent markers that exist in five bird and human virus proteins: PA, NP, M1, NS1 and PB2. These markers stand out as obvious differences between bird and human viruses, and many appear in regions where host protein and viral replication occur…..
The researchers showed that 13 of the 32 markers identified by their survey had remained stable in these viruses, and, like the other viruses, these markers were distributed among PB2, PA, NP and M1-- the proteins linked to virus replication. "This suggests that these 13 sites are required for pandemic influenza to fully function," Finkelstein said. …
The researchers also showed that the H1N1 virus that caused the 1918 pandemic -- the most deadly pandemic known -- already contained 13 of the 32 markers early in the outbreak; and acquired the other 19 markers within 10 to 20 years, acquiring the preferred human influenza amino acids in stages.
"While we can't directly estimate how long it would take an avian virus such as H5N1 to acquire these traits, we can use these markers to roughly measure the distance between an avian influenza and a pandemic," said Clayton Naeve, PhD, St. Jude Hartwell Center director. . .
Indonesia is finally sending specimens that appears to be complete not just unuseable portions of H5N1 virus to a WHO affiliated lab, the CDC in Atlanta. It's from the woman who died in Bali, and the neighbor child that tested negative.
The US Navy lab, NAMRU-2 is involved in getting the specimens to CDC.
The reasons why they have released these specimens? Read it for yourself.
It is not for humanitarian purposes. Go figure.
First they say that there is a change in the virus, then they say there is not.
We do not know the truth. These are just two speciments after all. But, we sure do wonder why they are so anxious to have a vaccine now and immediately start using it on their population instead of stockpiling it, and saving it for a pandemic if it occurs.
She said the despatch was carried out by the Research and Development Agency of the Health Ministry (Balitbangkes) through the US Naval Medical Research Unit-2/NAMRU-2) office in Jakarta.
The specimen consisted of larynx and nose smears taken from a 29-year old woman identified as NLPS, an inhabitant of Jembrana, Bali who was positively infected with the virus and from a 34-month old child identified as NKP who was at first suspected of being infected but eventually tested negative for the virus.
The tests by the CDC in Atlanta were completed and the results were the same as the findings of the Balitbangkes and the Eijkman Molecular Biology Institute.
Meanwhile, the complete results of the sequencing of the Ribonucleic Acid (RNA) of the specimen would be obtained in the next two or three weeks, head of the Research and Development of the Bio-medics and Pharmacy of Balitbangkes, Endang Tri Sedyaningsih, said.
Lily added the sending of the specimen was aimed to prove that no mutation took place in the virus and to inform people in the world that Bali was still a safe place to visit.
Thank you, Laidback AL. I thought that this was interesting from your link:
"Influenza mutates rapidly, so that any marker that is not the same in bird flu but remains stable in human flu is likely to be important," said David Finkelstein, PhD, research associate at the St. Jude Hartwell Center for Bioinformatics and Biotechnology. "If human specific markers start accumulating in bird flu viruses that infect humans, that suggests that the bird flu may be adapting to humans and could spread."
The researchers also found that various strains of the H5N1 that have infected humans are more likely to contain human markers than are H5N1 strains that have not infected humans. Only occasionally have H5N1 samples obtained from human patients shown any of these markers, and no H5N1 strain has permanently acquired any of them.
The investigators cautioned that there is no proof yet that the human markers in H5N1 and other avian influenza viruses directly contribute to the ability of these viruses to cause pandemics among humans; and H5N1 is not any more adapted to humans today than in the past. However, the fact that the bird viruses accumulate and retain these markers after infecting humans suggests that these changes are important. Therefore, scientists should monitor avian influenza viruses to see if they are acquiring human markers.
A British company is recruiting farmers to cultivate opium to meet the growing demand for diamorphine in hospitals across the country...
In Britain, 3,000 hectares (7,400 acres) of land has already been planted in the hope of making Britain self-sufficient in diamorphine and guaranteeing a supply should a flu pandemic put an impossible strain on drug manufacturers.
Mr Mercer said that problems had arisen in recent years regarding diamorphine production in Britain because of a squeeze on manufacturing capacity associated with concerns about an outbreak of pandemic flu. The same manufacturing plants that are used to make ampoules of diamorphine have been prioritised for producing flu vaccines.
From the editors of Effect Measure with 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.
Flu in Australia: no tears
Category: Bird flu * Health care * Infectious disease * Public health preparedness
Posted on: August 20, 2007 7:22 AM, by revere
This is about the particularly severe flu season being endured by our friends in Australia. Southern hemisphere, so the flu season is in full swing there, the reverse of the northern hemisphere. But "full swing" doesn't quite describe it, so I'm going to do this one in two parts ((all links from Flu Wiki Front Page, news for August 18). The great epidemiologist Irving Selikoff once described statistics as people with the tears wiped away. So the first post today will be statistics, or the equivalent, without the tears . Later today I'll do the other part:
As the flu epidemic continues to cripple the state's health system, an entire Sydney [Australia] emergency department has been shut down because the private hospital's operators failed to maintain staff levels.
Private patients in The Hills district are now being shunted into the overloaded public system, which is already buckling under more than 3000 extra suspected flu cases flooding emergency departments in the past week alone.
The crisis comes as yet another person, a South Australian health worker, has died after being infected with the killer influenza A virus sweeping the country.
The Daily Telegraph can also reveal that a Sydney doctor is in intensive care at North Shore Private Hospital after catching influenza A.
Adding even further to the health system's woes, there has been an outbreak of a superbug at Bankstown Hospital's intensive care unit.
The Hills Private Hospital is now being investigated by the State Government to determine if it has breached its licence by failing to keep its emergency department open amid one of the worst flu epidemics in more than 20 years.
Documents obtained by The Daily Telegraph reveal that the hospital asked ambulances to bypass its emergency department on Monday because they did not have enough staff. (Daily Telegraph)
My first reaction is that if Australia's city emergency departments don't divert because of overcrowding until things reach this level, they are in much better shape than US EDs, where diversion even in summer months is common. Here are some more "statistics":
The Royal Children's Hospital in Melbourne is seeing an extra 100 patients a day as parents worry about a potentially fatal strain of influenza.
The deaths of five young children across Australia have been linked to the virus and the hospital says it is treating more cases of influenza than in previous years. (Australia Broadcasting) (
Bad, but nothing special:
Australia's Chief Medical Officer, John Horvath says the country is experiencing a worse than normal influenza season with 3091 cases reported to authorities so far. That compares with 1213 cases last year.
But experts say the strains are no more threatening than in years gone by and that people with a healthy immune system will mostly recover naturally.
Most fatalities are the result of complications like a secondary infection such as Pneumonia. Most at risk are the elderly, the very young or people with chronic illness. (Sky News)
Keep in mind this isn't pandemic flu in the sense it is a novel strain to which the population has little existing experience and immunity. This is the currently circulating influenza A/H3N2 and some H1N1. But "ordinary" flu is still nasty. This is a small taste of what even a mild pandemic flu would bring. Looked at one way, this is a really bad flu season. Looked at another way, it's just seasonal flu.
In the next post we'll look at it still another way: we won't wipe the tears away.
From Effect Measure with permission of the editors:
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.
Flu in Australia: tears and all
Category: Bird flu • Health care • Infectious disease • Pandemic preparedness • Public health preparedness
Posted on: August 20, 2007 4:30 PM, by revere
As promised, here is a second post on the situation in Australia, currently struggling through a very bad flu season. In the first post I quoted the late epidemiologist Irving Selikoff who referred to statistics as "people with the tears wiped away." Statistical summaries are the stock in trade of the public health profession but it is important to keep reminding ourselves of the ocean of tears we wipe away when we quote them.
So it's back to Australia:
He kissed her goodnight and she softly whispered: "I love you" so as not to wake their two young sons, fast asleep in her arms.
It was the last intimate moment shared by Caboolture couple Deborah Miller and Ross Colburn, who had been teenage sweethearts.
Within hours, the 33-year-old mother would be dead from the flu.
When Ross, 34, left on Saturday last weekend for his afternoon shift as a Queensland Rail city train guard, Deborah waved goodbye from the couch and continued watching a movie with their sons Dylan, 6, and Jamie, 3.
She had spent the day doing laundry and playing with the boys, coping with what they thought was just a cold she had developed two days before.
"I got home late from work that night and checked on her and she was sleeping all right," Ross said.
"She woke up and gave me a kiss and said she loved me and went back to sleep. Early Sunday morning she woke me up and I rushed her to the hospital.
"I had to wake the boys up and they were upset and getting in the way of the doctors, so I took them home.
"I got a call from the hospital and rushed back, but it was too late. She was only sick for two days and then she was gone."
Deborah is the ninth person to die from the killer flu that has swept the nation this winter.
[snip]
The terrifying speed at which Deborah's life was lost shattered her family and friends.
"Everyone is shocked," fellow playgroup mother Leonie Robinson, 36, said.
"She was so down-to-earth and caring, and would never say 'No' to anybody. And she just loved her boys."'
Deborah's death has left two young boys struggling to understand where their mother has gone.
"Jamie has asked a few times, 'Where is Mum?' " Mr Colburn said. "He knows she is not coming back, but I don't know if he fully understands.
"Dylan knows. He cries at times, and says it's unfair his mum has gone.
"Being a mum was the most important thing to her. She was so special, and spent all her time looking after our boys." (Courier and Mail)
It's not hard to find the tears in this story. Maybe you are looking through them.
We know that historically pandemics occur every 30 to 50 years or so. What we do
not know is which virus, and how virulent it will be. Much attention has been focused
on H5N1 which has infected about 300 people world wide with a Case Fatality Rate
(CFR) of about 60%.
H5N1 is not the only virus out there capable of causing a pandemic situation. And, then there is the very real possibility that a highly virulent virus such as H5N1 could intermix with a more transmissible virus such as a seasonal flu or another virus such as the one discussed in the commentary by Scott McPherson. He explains this far better than I could ever do.
Thanks for the link, Laidback Al. That document is 14 pages long plus references,
and should be easily understood by most of us.
Someone in reference to an earlier panflu thread, or maybe it was a PM, asked why steroids were not recommended for treatment of H5N1 infection. This document does a good job of explaining the problems associated with the use of high dose corticosteroids in these patients. There is also some mention of low dose Methylprednisone therapy and associated outcomes.
The information on special considerations, such as cases in pregnant women is
important. Everyone should know by now that pregnant women had a high fatality rate in 1918. This appears to be true also with H5N1.
This document draws on the expertise of clinicians in the affected countries where
H5N1 humans cases have occurred. Where applicable, the experience of treating other types of ARDS has been referenced.
This is the most up to date information we have on the treatment of avian flu cases. There is still much that we do not know about the treatment of these patients, but this will be what we will be seeing for those cases that make it into our hospitals.
Laidback Al
266 Posts
A second test on the doctor is also negative, butthe individual will not be allowed to go home until seven days have past (period of incubation?)
http://www.flutrackers.com/forum/showpost.php?p=96635&postcount=137