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.
A top official, who wanted his name not to be mentioned, told ‘The News’ on Thursday that the NIH has advised hospitals to be ready for any untoward situation and ensure all necessary measures including facilities for effective management and care of expected bird flu victims.
“Adequate stock of Tamiflu, ventilators, nursing and personal protective equipment should be ensured,” adds the letter. Tami flu can reduce severity and duration of illness caused by avian influenza.
H2H means human to human transmission. I think that the Reveres
wrote this before it was clear that the first Pakistani cases occurred
in October.
The following is with permission from Effect Measure:
China, Pakistan and what's expected
Category: Bird flu * China * Pandemic preparedness * Public health preparedness
Posted on: December 14, 2007 7:32 AM, by revere
China tries to close the door on a possible H2H while Pakistan opens the door to human bird flu cases on the Indian sub-continent. First China. Two recent cases, a fatal case of a 24 year old male followed after a period of some days by the infection of his father raised the issue whether the son passed the H5N1 infection to the father. No one wants this to be the case and the Chinese, who are hosting the summer Olympics in Beijing have a lot at stake. The spin on this, though, is incomprehensible:
China's health authorities said here on Monday that no human-to-human transmission had been confirmed in the two human cases of bird flu and the means of transmission in these cases, involving two family members in the Nanjing area, remained unknown.
"The virus in the first case originated with poultry and has not mutated. It has no biological features for human-to-human transmission," Mao Qun'an, spokesman of the Ministry of Health, said, citing laboratory results.
But Mao said there were several possibilities for transmission in the second human case, which involved the father of the man in first case.
"Neither of the three possibilities has been confirmed and in-depth investigation is still being conducted," Mao said. (CXinhua News Agency)
Chinese authorities have said there was no contact with sick poultry in either case or any reported poultry outbreaks anywhere in the vicinity. The claim is being made that some kind of analysis (sequence?) of the son's virus showed it was from poultry. Except they don't know any poultry source and in fact we don't know what makes the virus transmissible (or not). But if they can tell from looking at the virus, than why is the father's case still under investigation? Why not just look at the virus? If they can tell the son got it from poultry, presumably they can tell if the father did, too. Spin.
Now, Pakistan. There have been infected poultry on the Indian subcontinent but never reported human cases. Now Pakistan is not only reporting two cases and they are yet another family cluster (there have been almost three dozen so far):
For the first time in the history of Pakistan, Bird Flu influenza has been confirmed among human beings after two brothers died at a local hospital in Peshawar.
According to spokesman of Health Ministry, two brothers Muhammad Ilyas and Tariq working in a poultry farm in Mansera suffered flu, few days back that later turned to be critical in the form of Bird Flu influenza (H5N1).
They were admitted to a local hospital in Peshawar where on Monday they died. (Onlinenews via ProMed; see also comments at Flu Wiki Forum)
Both brothers worked on a chicken farm in Mansera, so it is more than conceivable they both both got it from a common poultry source, although it has not been reported there was any H5N1 outbreak on the farm. The news report says the diagnosis was on the basis of blood samples sent for "formal testing in Laboratory" but we aren't aware of any confirmation of the diagnosis from a laboratory with expertise in this area. Maybe it will come.
It's flu season again and avian influenza is influenza. Expect to see more cases in poultry, humans and who knows what else. That's the expected part. The unexpected part is the thing that worries everyone. The unexpected part we are all expecting, that is. If you know what I mean.
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.
i have changed the title of this because the info keeps changing. i will update as this becomes more clear.
two of the brothers died from pneumonia-like symptoms but were buried by family members before health officials could take blood samples to test for the virus.
a third brother who lives in the united states but was visiting manshera at the time also tested positive for bird flu, but survived and has since returned to the us, akhtar told dpa.
the updated media report above adds additional detail and supports multiple h5n1 clusters in pakistan. the initial familial cluster has now expanded to four, with two recovered patients, who are h5n1 positive, and two brothers who have died with avian influenza symptoms. earlier reports indicated these brothers died last month and were linked to an outbreak that was culled in october. the large size of the cluster, couple[d] with lack of poultry exposure by three of the brothers, increases the likelihood of human-to-human transmission.
that outbreak was linked to another cluster, involving a culler, who tested positive, a hospitalized daughter, and a third hospitalized patient. early testing generated four h5n1 positives, suggesting at least one more positive associated with the earlier outbreak.
additional media reports describe two brothers who died this month, who were said to be involved in more recent culling.
these reports are still somewhat contradictory and lack an official confirmation by an outside party. however, the size of the first cluster, couple[d] with media reports of additional clusters and confirmed positive patients, as well as the hospital alert for h5n1 patients in pakistan, remain causes for concern, which is increased by the lack of timely information on human clusters linked to an october outbreak. these delays raise concerns that the number of current human cases is markedly higher than the number being reported.
The Ministry of Health in Myanmar has confirmed the country's first case of human infection with the H5N1 avian influenza virus. The case is a 7-year-old female from Kyaing Tone Township, Shan State (East).
The case was detected through routine surveillance following an outbreak of H5N1 in poultry in the area in mid-November.
She developed symptoms of fever and headache on 21 November 2007 and was hospitalized on 27 November. She has now recovered.
The above comments from a WHO update confirm H5N1 in a recovered patient in Myanmar (Burma). This is the first confirmed case in Myanmarand is the third country this year to confirm H5N1 in a patient, although confirmation in Pakistan is also expected. Earlier this year, H5N1 was confirmed in patients in Nigeria and Laos for the first time.
The Myanmar case may be the Fujian (clade 2.3) strain since the strain was detected in birds last year in Malaysia and Laos.
However, Myanmar's proximity to Bangladesh and India raise the possibility that the infection is due to the Qinghai (clade 2.2), which was involved in the case in Nigeria and is almost certainly linked to the outbreak in Pakistan.
Up to 13,500 ostriches have been culled in an open farm near the Saudi capital, Riyadh, after a new case of high-intensity avian influenza, or bird flu, was discovered, the Ministry of Health said Saturday.
The project consisted of 80 barns holding 13,500 ostriches, a ministry statement said, adding that the birds were culled at the farm in Al-Kharj, 150 km (94 miles) south of Riyadh.
Up to 2,000 eco-tourists and nature lovers were dealt a blow when it was announced the Mai Po natural reserve would be closed for at least the next three weeks in the wake of the avian flu scare.
The AFCD said the closure was a precautionary measure after a gray heron found dead last week in San Tin, less than three kilometers from the reserve, had tested positive for the H5N1 strain of bird flu.
Two domestic chickens in eastern Germany have tested positive for the H5N1 strain of the bird flu virus, regional authorities said Saturday.
The birds were kept with nine other chickens in the Oberhavel region, northwest of Berlin, Brandenburg state's Agriculture Ministry said.
After several of the birds died, the remains of two of them were sent for testing on Friday. A federal lab confirmed that they were infected with the H5N1 strain, the ministry said.
The west African country of Benin Saturday confirmed bird flu outbreaks at two suspect southern sites, where more than 240 chickens were culled and burnt this week.
Agriculture Minister Roger Dovonou said samples from birds had been sent to the World Organization for Animal Health laboratory in Padua, in Italy which had confirmed that they were infected with the deadly H5N1 strain of the virus.
The ministry had reported the country's first suspected cases of bird flu on December 7 in the commercial capital Cotonou and in Adjara, both located in southern coastal tip.
Authorities in Pakistan have announced that country's first reported cases of H5N1 avian flu in a cluster of family members which may have involved human-to-human transmission.
There was some confusion Saturday about how many people had tested positive for the virus, with Pakistan announcing six cases but an official of the World Health Organization suggesting as many as nine people may have tested positive for the virus in that country.
Meanwhile, U.S. health officials have confirmed they conducted H5N1 testing on a man who had recently visited Pakistan and was complaining of mild respiratory symptoms. The man is believed to be another brother from the affected family.
A spokesperson for the U.S. Centers for Disease Control confirmed Saturday that the CDC sent its plane to Albany last Saturday to collect specimens taken from the man, who lives in Nassau County.
A lab team from the U.S. Naval Medical Research Unit [NAMRU3] in Cairo is travelling to Pakistan to conduct confirmatory testing. And WHO is sending a team of two doctors with experience treating H5N1 patients as well as an epidemiologist to help with the investigation of cases.
We also don't know how many people have been infected, although the numbers released so far indicate less than a dozen. And we don't know if this outbreak involved H2H (human to human) transmission, although it does appear likely.
What we do know is that the WHO was officially notified on the 12th of December, several weeks after this outbreak began. If this had been the start of a pandemic, a delay such as this would have been disastrous.
Any chance to contain a pandemic is predicated on the WHO getting on scene in the first two weeks, and instituting a tamiflu blanket. Even then, the odds are long. But if an outbreak is allowed to fester, hidden from view, for weeks or a month or more, then any opportunity to stop it is lost.
H5N1: Another Country (Or Two) Heard From
DemFromCT is a pulmonary doc practicing in Connecticut.
The idea that someone could be exposed to H5N1 in Southeast Asia and then fly to NY is completely plausible, and likely just happened. Some heads-up thinking by the local doc [and the patient] got the testing done in a timely manner, but had the testing been positive (and it could easily have been), there'd be quite a few headlines about this issue.
No headlines today? Well, let's use that as a teachable moment to cover two frequent criticisms of flu blogging: hype and fear-mongering.
Now, for all the concerns and accusations of media hype, there really is a paucity of news about H5N1 (Daily Kos excepted) and not a surfeit...
As for fear-mongering, as long as H5N1 remains in the environment, it will remain a threat to humans. And as long as that's so, we will report and write about it.This isn't fear-mongering (a term bandied about by folks who don't like to read about these things, for whatever reason), it's education. It is also prudent awareness of a candidate (H5N1) for a natural disaster (flu pandemic) that's as inevitable as the next "storm of the century", and as difficult to predict (both in timing and intensity). Hopefully, that will lead to some preparation steps (see below). And do note that the NYer tested above informed his doctor of his risk factors and got tested. Without that education (from news and elsewhere), you can't expect that level of public cooperation.
...during a visit to the hospital (KTH) on Sunday, a number of doctors and health workers complained to this correspondent that there was a mechanism to keep them safe from the virus but the ventilator of the isolation room where the patient had been kept was open and the virus could spread around in the entire hospital through air.
After culling 13,500 ostriches on Saturday, another three barns of birds have been found to be infected with the H5N1 virus. Another 22,000 birds are to be culled.
Meanwhile, the consumption of Ostrich meat has been banned, and shops and restaurants are being raided to prevent further sale of potentially infected meat.
Infected birds were discovered at a small farm near Milakowo in the northern region of Ostrada, PAP quoted veterinary service spokesman Adam Wojtaszek as saying.
Infected poultry had also been discovered last week in two other small farms in the same region. Five other outbreaks of the strain, which can also be fatal to humans, have been discovered since the beginning of this month at larger chicken and turkey farms in central and northern Poland. Polish authorities have slapped security zones around the affected farms.
Last week, a stork and two buzzards being cared for at a bird sanctuary in Poland's northwestern lake region of Mazuria were also found to have died from H5N1...Poland's Agriculture Minister Marek Sawicki has warned that the outbreak must be brought under control because it could cause major economic problems given that the affected areas have a high concentration of poultry farms.
indigo girl
5,173 Posts
Egypt
On Tuesday, the Egyptian govt issued this warning:
http://birdflu.sis.gov.eg/html/flu01021276.htm