Pandemic News/Awareness - Thread 2

Vietnam, new outbreaks of H5N1:

http://crofsblogs.typepad.com/h5n1/2007/07/b2b-h5n1-back-i.html

A group of H5N1-infected ducks has brought the bird flu back to Vietnam's southernmost province of Ca Mau, said the Animal Health Department Saturday.

The outbreak in Dam Doi District's Tan Trung commune wiped Ca Mau's name off the list of bird flu-free provinces.

Indonesia

A six year old boy has died of avian flu infection and multi-organ failure.

He is the 81 death and the 102 victim in that country. His family

did not keep poultry. The cause of his infection is not known. It is so

easy to assume that these cases are poultry related, but many are not.

The visit to the zoo is a possible cause.

The CFR in Indonesia is now around 80%.

http://www.curevents.com/vb/showpost.php?p=759329&postcount=16

http://www.curevents.com/vb/showpost.php?p=759331&postcount=17

Germany

House to house searches in a modern country? Yes, that is what is happening.

This is no different from what happened in Jakarta, Indonesia when residents of

that city were forced to turn in their birds to be culled. They hid them. You

have to wonder what the German citizens are doing.

http://crofsblogs.typepad.com/h5n1/2007/07/bird-flu-on-a-e.html

German officials have culled as many as 1,000 domestic birds following the discovery of the deadly H5N1 bird-flu virus in a dead goose in the village of Wickersdorf in eastern Germany.

The cull includes nine villages and is part of a quarantine process encompassing a 13-kilometre radius of the initial bird flu site.

Health officials have accused residents in the area of keeping hundreds of birds in defiance of laws, which has meant authorities have been forced to carry out house to house searches.

This is what happens to countries that announce the presence of avian flu

in any domestic birds. Sometimes even if it is in wildbird populations, other

countries announce sanctions hence the reluctance to pursue a diagnosis in

countries dependent upon foreign trade in animal products.

http://today.reuters.co.uk/news/CrisesArticle.aspx?rpc=401&storyId=T40548

Japan's farm ministry has suspended imports of live day-old chicks, poultry meat and eggs for use in processing from Germany after a pet goose there tested positive for a lethal strain of avian flu, a ministry official said on Monday.

Virginia takes steps to halt spread of bird flu:

http://afludiary.blogspot.com/2007/07/virginia-takes-steps-to-halt-spread-of.html

Effective immediately, Dr. Richard Wilkes, State Veterinarian with the Virginia Department of Agriculture and Consumer Services, has canceled all public sales, shows, and exhibitions of live poultry throughout Virginia and has prohibited land application of poultry litter, manure or bedding in 17 Virginia counties.

Nearby West Virginia has now cancelled all poultry shows to prevent bird

flu from being spread to that state:

http://afludiary.blogspot.com/2007/07/ripple-effect-w-va-cancels-poultry.html

West Virginia's annual poultry festival has been canceled and all poultry shows and sales are on hold because of avian influenza concerns.

The five-day festival in Moorefield was to start July 23rd, but the discovery of avian influenza in a turkey flock in Virginia prompted officials today to cancel the event.

State Poultry Association Executive Secretary Emily Funk says Moorefield will still hold its annual carnival.

Area poultry farmers are being encouraged not to attend the carnival as a precaution. Funk says avian influenza can be easily spread and poultry farmers try to limit access to each other when a positive finding is made.

Is that vigorous denial that this virus is not highly pathogenic based on actual science? No, according to virologist, Dr. Henry Niman of Recombinomics. But, since the birds did not die from the virus, when poultry usually do, it probably is indeed a low path virus. At least we all hope so.

http://www.flutrackers.com/forum/showpost.php?p=90538&postcount=11

This is interesting considering what is going on in Virginia and West Virginia

with their low pathogenic H5 virus scare. Finding a low path bird flu is still

a very serious event, and they will spare no expense to try to eradicate the

virus because of the risk that it could evolve into a highly pathogenic virus,

and possibly infect the human population.

Those poultry factory farms, assure us that their biosecurity measures are sufficient, but yet they still have avian influenza outbreaks periodically. No one can figure out exactly why. Maybe it's because there are vectors that they have never considered before, maybe something as omnipresent as the common housefly. Imagine that. The list of creatures capable of being infected with

these avian viruses keeps growing. And, the truth is that we really do not know

everything that there is to know about how these viruses are transmitted.

http://afludiary.blogspot.com/2007/07/house-flies-as-vectors.html

Recent North American research has made the startling conclusion that several insects, particularly Musca domestica or the common housefly, are capable of carrying and transmitting the New Castle Disease Virus as well its more deadly, highly pathogenic strain, H5N1, which is transmittable from animals to humans. British scientist, Terry Mabbett, reporting in a recent issue of Poultry International, says the new research findings must come as a big wake up call for the world’s poultry industry. ]

"That the avian influenza (AI) virus can be spread by winged insects as well as wild birds underlines the need for efficient fly control on poultry farms along with other strict biosecurity measures," he says.

Below is a commentary on the reassurances of the Va. Dept of Agriculture

and Consumer Services with regards to the finding of bird flu in turkeys there.

We could call this:

Virginia reacts to low path bird flu by not being completely honest with the public.

http://crofsblogs.typepad.com/h5n1/2007/07/virginia-reacts.html

The antibodies discovered in the turkey flock match those in a mild strain of avian influenza, but a U.S. Department of Agriculture laboratory is conducting tests to determine whether the antibodies are for low or the more severe high pathogenicity.

So, they are not done testing yet. Apparently they are basing their diagnosis of this being a low pathogenic virus on the fact that the turkeys did appear ill then. Well, that's scientific. And, do we even know which H5 virus this is yet?

Elaine Lidholm, a spokeswoman for the Virginia Department of Agriculture and Consumer Services is doing a fine job.

Again this is what it takes to get a definitive diagnosis, not just a

pronouncement, and a wave of hands.

The local labs that perform initial testing for avian influenza in live or dead birds take samples from feces or from throat swabs and then use a rapid test PCR (polymerase chain reaction) to look for H5 or H7 or N1 viruses. Within three to six hours they can detect these viruses, but cannot tell for certain whether they are the highly pathogenic variety. The PCR tests are fairly sensitive and can pick up both low volumes of virus, as well as inactive viruses.

Isolation of the virus (step two confirmation) is performed only at the USDA's National Veterinary Services Lab in Ames, Iowa. It is Biosecure Level 3. It injects the viral samples into embryonted chicken eggs and within seven to ten days can "grow" the virus if it was in large enough quantities and was active. Analysis from the virus cultures (if they were successful in the isolation process) can specifically determine the virus strain (eg H5N1), but only subsequent viral sequencing can spot the poly basic amino acids at the HA clevage site which would represent the high path variety virus.

Having said that, to Dr. Niman's point, one really has to want to find these viruses. It takes diligence because the process is not all that simple and subject to a lot of problems along the way. I would be concerned that an agency whose primary job is to protect the beef and poultry industry might lack a certain level of independence necessary to seek out and find a virus that could cause significant economic disruption to the very food industry that it supports. To my point, please note the following excerpt from the USDA's strategic plans:

"USDA has created a strategic plan to implement its vision. The framework of this plan depends on these key activities: expanding markets for agricultural products and support international economic development, further developing alternative markets for agricultural products and activities, providing financing needed to help expand job opportunities and improve housing, utilities and infrastructure in rural America..."

The Czech Republic

More cases of bird flu found, subtype H5. Does this sound familiar?

http://afludiary.blogspot.com/2007/07/czechs-find-h5-at-two-more-farms.html

PRAGUE, July 11 (Reuters) - Vets found an unidentified type of H5 bird flu virus at two Czech farms with 71,000 poultry, bringing the number of outbreaks at farms to four, the State Veterinary Authority (SVS) said on Wednesday.

The SVS said it knew the virus found at the two new farms was of the H5 strain, but had not confirmed it was the H5N1 form, which can be fatal to humans.

For how long is a patient recovering from influenza, infectious?

New studies are showing that it's much longer than we thought.

Here is some commentary from two different sites. Draw your

own conclusions.

First from Avian Flu Diary:

http://afludiary.blogspot.com/2007/07/gift-that-keeps-on-giving.html

Next, with permission from the editors of Effect Measure:

How long do we shed flu virus?

Category: Bird flu • biology

Posted on: July 10, 2007 7:11 AM, by revere

CDC recommends (MMWR Recomm Rep. 2005 Jul 29;54(RR-8):1-40) hospitalized patients with influenza A be placed under standard and droplet isolation precautions for 5 days after the onset of their symptoms. This is based on studies of volunteers who received live attenuated flu vaccine drops in their noses. After 7 days only 1 of 18 were shedding virus. One might wonder if attenuated flu vaccine in healthy volunteers is the best way to estimate the length of viral shedding. A new paper of viral shedding in hospitalized elderly patients at the Mayo Clinic suggests it isn't. Sensitive methods for detecting virus were used in 41 patients who met the criteria for the study and over half were found to be shedding virus beyond 7 days.

This finding raises the concern that hospitalized patients who are older and/or have chronic illnesses could shed influenza A virus beyond the 5- to 7-day period that has traditionally been considered to be the time of infectivity. A period of droplet isolation precautions limited to 5 days after symptom onset, as is currently recommended by the Centers for Disease Control and Prevention to control influenza in acute care settings,10 could be insufficient for such patients, and prolonging isolation measures for the entire duration of the hospital stay might be more prudent to prevent outbreaks in hospitals during the influenza season.

[snip]

Some limitations of our study need to be recognized. First, our patient population was clearly a selected group of mostly older patients with chronic medical conditions. Sicker patients with prolonged hospital stays were more likely to be recruited into the study, compared with those who were dismissed sooner because of milder disease or fewer complications. However, we believe that the results of our study are applicable to similar patients hospitalized with influenza A. It is unclear if these results are generalizable to all adults with influenza, particularly younger, otherwise healthy adults treated in the outpatient setting. Second, regardless of the source of the initial diagnostic specimen, all follow-up specimens were throat swab samples. It has been suggested that the sensitivity of throat swab samples for influenza diagnosis might be low, and if some throat swab specimens gave false-negative results, we could have underestimated the duration of viral shedding in those cases. Third, we were able to detect viral shedding for longer durations by PCR, compared with the durations we could detect by culture. It is possible that PCR could amplify inactive viral RNA, but it is also possible that culture results could be false-negative because of a lower level of virus excretion or virus inactivation during transportation. Because we did not obtain specimens from other patients and healthcare personnel to monitor for transmission of infectious viruses, it is unclear whether the fact that influenza A could be detected by PCR meant that the patient was infective. Finally, our determination of the total duration of viral shedding and our comparisons of hospitalized patients with and without prolonged viral shedding are subject to bias. Patients were not followed up after discharge from the hospital, and the final duration of viral shedding was unknown for several patients; in many cases, a single negative sample was used to identify the end of viral shedding, which could lead to underestimation of duration if those samples had false-negative results. Small numbers of subjects also precluded adjustment for potential confounders, such as age or comorbid conditions. Future studies should attempt to follow up all patients until the end of viral shedding to minimize bias. Surveillance of contacts should also be attempted to help assess whether prolonged shedding is associated with continued infectivity. (Leekha et al., Infect Control Hosp Epidemiol 2007;28:000)

I have included the long list of limitations and caveats to emphasize the difficulty in studying this problem. Things that seem easy to study are not. After reading it you will have to decide for yourself what the implications are for homecare of family.

Two other points in this paper deserve some comment. Neither a history of vaccination nor the use of antivirals were said to make a difference in whether a person was a "prolonged shedder" or not. The vaccination results might be interpreted as a decline in immune response previously observed amongst the elderly. The results on antivirals are harder to interpret than for vaccination. Which antiviral was used (M2 or neuraminidase inhibitor) was not specified. Examination of Table 4 shows evidence of an effect on shedding beyond 7 days and decreased length of shedding but the differences didn't reach the point where a chance difference could be considered unlikely (i.e., the results weren't "statistically significant"). Lack of statistical significance does not mean the results are due to chance. It only means chance could not be ruled out. The data in the paper suggest an effect on shedding of antiviral therapy, which would be consistent with a number of other papers in the published literature.

Once again, something we thought we knew about influenza must be modified. While this is an "merely" adjustment in a quantitative estimate, it is of some practical significance.

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.

Germany

Wild birds deaths continuing. This is very, very sad, not to mention worrisome:

http://www.recombinomics.com/News/07120702/H5N1_Germany_240.html

The number of species confirmed in the current outbreak in Germany is now up to eight, as are the number of locations.

The latest report provides confirmation of media reports on the large number of deaths. The continuing discovery of new fatal infections, including additional locations, provides compelling evidence for endemic H5N1 in Europe, and highlights the need for increased surveillance in Germany and neighboring countries.

http://www.flutrackers.com/forum/showpost.php?p=91159&postcount=14

An essay from Effect Measure reproduced with the 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.

Where in the world is the H5N1 virus?

Category: Bird flu

Posted on: July 13, 2007 7:34 AM, by revere

The bird flu stories from Indonesia have a sameness to them so it is sometimes hard to remember these are real people. Someone's little girl or boy, sister, brother, father, cousin, best friend. They are just another "6-year-old boy died of bird flu at the weekend, a health official said on Thursday." I'm not blaming anyone of heartlessness. This is a normal way to react. It is also normal to think you know how the disease is transmitted and if you see a circumstance remotely like your pre-conceived notion, you stop searching for other causes. But in the case of the 6 year old just mentioned, the "usual cause," contact with sick poultry isn't in evidence.

The boy, from the city of Cilegon in Banten province, suffered from high fever and breathing difficulties before he died of multi-organ failure on Sunday.

Contact with infected fowl is the most common way for humans to contract the H5N1 virus, but so far no clear link in this case has been established, officials said.

It is always a concern when the cause of a human infection cannot be traced as it makes infection control more difficult.

Runizar Ruesin, the head of the health ministry's bird flu centre, said that at least 20 of chickens near the boy's school had died suddenly.

"But we are still investigating whether he had a contact with sick or dead chickens in the neighbourhood," the official said.

A spokeswoman at the Jakarta hospital where the boy was treated said that along with some chickens dying near the boy's school there were also water fowl in the school area.

"There are a lot of water fowl roaming near the boy's school although they probably didn't get into the school," said Tuty Hendrarwardati, a spokeswoman for the Sulianti Saroso hospital. (Reuters)

Maybe they'll find a connection. Then they'll be satisfied. But it is true that a fairly large proportion of cases in southeast Asia and in Indonesia do not give good histories of contact with sick birds, although often there is mention of birds or sick poultry somewhere in the area. That seems to be good enough to assign birds as the source. In this case those birds seem to be hard to find. There are none within 300 meters of the boy's house. So the next stop is the zoo:

Sardikin Giriputro, deputy director of Jakarta's Sulianti Saroso hospital, where the boy died, said Tuesday that the boy had visited relatives who lived near a zoo elsewhere in Banten province four days before he fell sick. (The Standard)

Since zoo animals have become infected in Thailand, it's a thought. But there is also a mention the boy had a fever before going to visit his relatives. So the zoo remains just a thought.

Here's another one. Maybe it's not true that almost all cases are from infected birds. Maybe there are other reservoirs in the environment, animate or inanimate. There is some equivocal data from feral cats. What else? There has been very little systematic surveillance of wildlife other than birds for infection with this virus.

Maybe it's time to do it. Just a thought.