Pandemic News/Awareness - Thread 2

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What is bird flu and why should I care?

Here is a little history about avian flu from an article written in September 2006, on why you really should care:

http://www.flutrackers.com/forum/showpost.php?p=29081&postcount=1

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.

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Commentary from Effect Measure, with permission, of course:

H5N1 and Chlorination

H5N1 and chlorination

Category: Bird flu

Posted on: September 7, 2007 7:52 AM, by revere

There's a lot to know about influenza that we don't know. Unfortunately a lot

is things you thought we knew but don't. Like whether there is a risk from influenza virus in drinking water. Admittedly this hasn't been at the top of the list for seasonal flu, since the main reservoir for this virus is other people and that's who you catch it from. But with avian viruses there is the problem of aquatic birds (the main reservoir in the wild) shedding virus into ocean littorals and surface waters, including drinking water reservoirs. In addition, agricultural run-off, including fecal waste from large poultry operations, can contaminate surface and groundwaters with virus. So it's something to think about. It would be nice if we knew that current and conventional methods of water treatment inactivated highly pathogenic avian influenza (HPAI). It would be one less thing to worry about. If we knew it. Viruses can vary widely in their sensitivity to chlorine. Unfortuantely until just recently the only data we had was from low pathogenic H5 subtypes (specifically H5N2...) and even that data were scarce (epidemiologists like to use data as a plural, BTW; it's a peccadillo of the profession). Now a paper has come out looking specifically at chlorine inactivation of HPAI H5N1. So what do we know?

The authors (Rice et al. from EPA, University of Georgia and USDA) grew H5N1 (clade 2) in chicken eggs and exposed it to chlorinated buffer for 60 seconds, testing it for ability to infect tissue culture (primary cultures of chicken embryo fibroblasts). The inactivation was carried out at 5o C. Preliminary data indicated that inactivation at room temperature was higher than at colder ones. Many surface waters can be this cold so this is a necessary precaution. The results indicate better than three orders of inactivation (99.9%) after 60 seconds at free chlorine levels typical of US water treatment plants. Reassuring (if not surprising) news.

So this fills in a little more of the picture. However there are other ways to disinfect water (chloramination, ozonation), so these need to be looked at as well, especially as many systems are moving away from straight chlorination to meet new disinfection by-product rules. Chlorine is not only bad for viruses, but can produce by-products that are bad for people too.

Life is complicated.

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.

Here is the study that is being referred to above, and I notice in the

acknowledgements that Rice works for Homeland Security. The safety

of our water supply is being addressed by that agency, and that is probably

a really good thing. Anyone who works in the field of water safety

should be considered critically important to the health of many. It appears

that I am not the only one that thinks so:

http://www.cdc.gov/eid/content/13/10/pdfs/07-0323.pdf?s_cid=eid07_0323_x

Further reports seem to indicate that the Tamiflu Blanket is going to cover the entire island of Tanggamus which as noted in the post above is off of the coast of Sumatra.

http://www.recombinomics.com/News/09060701/Tamiflu_Blanket_Tanggamus.html

A geographic clarification. Tanggamus is a Regency in Lampung Province on the island of Sumatra. Within the Tanggamus Regency there are a number of subdistricts, one which is Cukuh Balak Subdistrict. This subdistrict includes the island of Tabuan off the coast of Sumatra, a small island perhaps 14 square miles with a population of 1000-2000 people.

http://www.flutrackers.com/forum/showpost.php?p=99384&postcount=37

This is where the Tamiflu blanket is apparently being applied.

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Thanks for clarifying, Laidback Al. I find these Indonesian locations to be

quite confusing at times.

So, we are still looking at an entire population of 1000 to 2000 people?

That is a lot of Tamiflu.

And, they are saying typhoid? Treating typhoid with Tamiflu? Of course,

we know that Tamiflu is the tx of choice for flu viruses, and typhoid most

definitely is not in any way related to influenza.

Specializes in Too many to list.

Germany

German authorities order 200,000 birds slaughtered over suspected bird flu infection

http://www.flutrackers.com/forum/showpost.php?p=99559&postcount=79

German authorities said Friday that more than 200,000 ducks would be slaughtered at two farms in Bavaria after tests indicated the presence of the H5N1 strain of bird flu.

The head of Bavaria's state office for health and food safety, Volker Hingst, said the slaughter was "a purely precautionary measure," taken after "laboratory indications of H5N1" were found. The birds were not visibly sick, he said.

Note: Ducks can carry the virus and not appear ill.

----------------------------------------------------------------------------------------------

Indonesia's Case Fatality Ratios (CFR)

http://crofsblogs.typepad.com/h5n1/2007/09/indonesias-case.html

Most of these have had just a handful of cases, so the numbers of fatalities don't seem significant. But in the top three—West Java, DKI Jakarta, and Banten—the case fatality ratios are striking: In West Java, 23 deaths out of 29 cases (CFR 79.3%); in DKI Jakarta, 22 out of 25 (CFR 88%); in Banten, 12 out of 14 (CFR 85.7%).

These are the areas with the most cases and presumably the most experience in dealing with human H5N1. You would think their medical people would be able to spot cases fast and begin treatment quickly, and thereby bring down the CFR.

Yet the CFR remains high...

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NORTHCOM's First Tri-National Pandemic Influenza Conference

http://www.flutrackers.com/forum/showpost.php?p=99798&postcount=1

[quote name=http://www.blackanthem.com/News/U_S_Military_19/NORTHCOM_hosts_Canada_Mexico_at_

Pandemic_Influenza_Conference9998.shtml]

PETERSON AIR FORCE BASE, Colo. - Representatives from American, Canadian and Mexican military and government agencies came to U.S. Northern Command headquarters here this week to discuss their plans and preparedness for a possible influenza pandemic.

"Pandemic influenza does not respect borders," said Francisco Averhoff, chief of quarantine and border health services at the Centers for Disease Control and Prevention. "It's clear that it's necessary, when

you talk about this disease, that we need to have a continental strategy...

Health officials cannot predict if or when a pandemic influenza will develop, but a particularly dangerous strain of avian flu known as H5N1 is being closely monitored around the world for signs it may be spreading from human to human.

...officials from Canada, Mexico and the United States committed to cooperating with mitigation efforts as much as possible.

...pandemic influenza preparedness has been really unique in the way people are actually proactively trying to deal with these issues before it happens as opposed to reactively."

NORTHCOM's mission is homeland defense and civil support. The command conducts operations to deter, prevent, defeat and mitigate threats and aggression aimed at the United States, its territories and interests within the assigned area of responsibility and provides military assistance to civil authorities.

In the event of a pandemic, NORTHCOM primarily is concerned with continuity of operations and force protection. The command also expects to be asked to provide support to civil authorities.

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Germany

The largest cull of domestic birds ever for that country has just taken

place in Germany. That was 365,000 birds that were killed there.

Now we are finding out some disturbing information about frozen

duck meat being contaminated with H5N1, and that some of this could have

been bought unwittingly by consumers.

Here's the problem. Yes, it is supposed to be safe to eat poultry contaminated

with H5N1 virus including ducks, but if consumers do not know

that there could be a risk in handling that poultry when raw, that is a problem.

It's not like we are talking about salmonella or a common pathogen here.

Is the poultry industry going to EMPHASIZE the necessity of careful and

safe handling of, as well as the disinfection of all surfaces after contact with raw poultry,

or not?

The answer seems to be no. They have an industry to protect, you know.

While most consumers know enough to try and be diligent when handling

raw poultry, sometimes people get careless. Maybe it might not be a

great risk, but can anyone really afford to be careless about this?

Should someone be looking out for the welfare of the public? Is

no one going to mention that people have died from handling infected

poultry? Really, they did.

Commentary from Avian Flu Diary:

http://afludiary.blogspot.com/2007/0...-buy-duck.html

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Bali, Vacation Destination

What is really going on there? We get a glimpse via translations of the

local press. Censorship is a problem in all of Indonesia, and Bali is very dependent on tourism.

http://www.scottmcpherson.net/

Grim Milestone Reached in H5N1 Battle

http://www.scottmcpherson.net/journal/

Last week marked the 200th death worldwide (that we know of) from H5N1 avian influenza, and the 100th case in the nation of Vietnam.

indigo girl, you are correct the other day i saw a guy that worked for the city, who picks up dead animals, picking up with just the type of gloves that you might wear for gardening.

these are not fluid resisdent and he could get blood on hands, might very well wipe across nose after gloves are off

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Indiana

First cases of seasonal flu are occurring already, and no vaccine available yet:

http://www.abc25.com/

(hat tip PFI/anon451)

Doctor Hindahl got sick with the flu early. His symptoms started last week with a sore throat, severe congestion and runny nose. The chills and aches didn't start until the weekend.

"My test for Influenza A was positive yesterday (Sunday). I know of a least one other patient tested positive for influenza B and that was done three weeks ago," says Hindahl.

Dr. Hindahl says it's extremely rare to see Influenza this early. The infection usually doesn't come until late fall early winter. That's why the vaccine for it isn't available until October.

Update on The Congo

It is officially, Ebola HF.

http://www.flutrackers.com/

The U.S. Centers for Disease Control and Prevention in Atlanta and another lab in Gabon confirmed the disease as a hemorrhagic fever, and specifically as Ebola, Health Minister Makwenge Kaput said on national television.

More than 160 people have died of the illness in the affected region since late August and nearly 400 have been infected, said Jean-Constatin Kanow, the chief medical inspector for the province.

He said the infections were mostly in two areas, Mweka and Luebo, and the majority of the deaths ocurred at the beginning of the outbreak.

"The number of sick continues to climb, but the deaths are decreasing because they are being taken care of by medical teams on the ground," Kanow said.

But, what about the early reports that said that chickens and pigs died first? Did they have Ebola also?

I suppose that it could be possible that the animal deaths could be unrelated to the deaths of the people.

And Ebola does occur in other mammals other than people and apes according to this report from Promed

that I cannot link to:

Archive Number 20061119.3308

Published Date 19-NOV-2006

Subject PRO/AH> Ebola hemorrhagic fever - Gabon/Congo Rep: prediction

More on Ebola:

http://www.flutrackers.com/

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Pacific Health Officials Confront Avian Flu Fears:

http://www.voanews.com/english/2007-09-12-voa16.cfm?rss=health

(hat tip PFI/pixie)

... Members of the WHO's western Pacific region are in South Korea to discuss ways to combat bird flu.

World Health Organization Director for Communicable Diseases Tee Ahsian gave delegates a grim status report on avian flu.

"In the western Pacific region, the avian influenza situation remains serious and the human influenza pandemic threat shows no sign of abating," Ahsian said. "... The virus has become formally entrenched in many parts of Asia and much capacity-building work to address the challenges lies ahead."

New Zealand Health Minister Pete Hodgson says infrastructure issues will be critical.

"If you have got a very well planned health system and your communications system falls over, or your electricity system falls over, or your finance system falls over, or cops do not turn up out of their barracks when they need to - then more people will die, basically," Hodgson said.

WHO spokesman, Peter Cordingley, says the world is still not prepared.

"There will never, ever, ever be enough Tamiflu if there's a pandemic ... so, all countries know they have to have their own priorities about who will get it in a pandemic situation, and there is going to have to be some tough decisions," Cordingley said.

Specializes in Too many to list.

Pandemic Information from Chief Information Officers Council

http://bpr.state.fl.us/pandemic/

Scott McPherson is CIO for the Florida House of Representatives.

This is a very useful site with links to many sources of information on H5N1

and other avian influenza viruses.

Specializes in Too many to list.

The Economic Costs of a Flu Pandemic

Not what we usely concern our thoughts about when discussing

disease outbreaks, but surely there would be severe economic impact.

These analysts believe that this would be the case.

http://www.kiplinger.com/businessresource/

(hat tip PFI/pixie)

... health experts say the United States must bank on being hit by a severe flu in coming years that could sicken roughly 90 million people and kill 2.25 million.

Such a wrenching human cost will lead to financial losses so crushing that they could push the United States into a recession...

...industries "that require a high degree of social interaction, such as entertainment and tourism, would likely experience the greatest decline in demand."

In today's global economy, almost every aspect of commerce relies directly or indirectly on an interconnected worldwide network of workers, products and services. A major shock to this network could have serious negative consequences on trade and commerce throughout the world.

According to analyses by three major financial and economic research institutions, during a severe pandemic flu outbreak, the U.S. gross domestic product (GDP) could drop between 4.25% and 6%. A "severe" outbreak is based on the 1918 pandemic, when 30% of the population became ill and 2.5% of those who became ill died. In modern times, this would translate into approximately 90 million Americans becoming ill and roughly 2.25 million deaths. An outbreak of this severity would almost certainly lead to a major economic recession.

The 1918 pandemic case fatality ratio (CFR) was something like 2%. If H5N1 ever becomes more transmissible, as some scientists are indicating that it might, then these figures would all have to be adjusted accordingly. The current CFR of

H5N1 is 62%, (higher in some countries, such as Indonesia).

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