Pandemic News/Awareness - Thread 3

India - A Situation Out of Control?

All eyes are on India, that hugh country trying to deal with a terrible situation.

http://www.recombinomics.com/News/01160801/H5N1_Birbhum_Suspect_2.html

http://www.saharasamay.com/samayhtml/articles.aspx?newsid=93170

http://www.recombinomics.com/News/01200801/H5N1_Calcutta_North.html

http://afludiary.blogspot.com/2008/01/india-sunday-morning-roundup.html

http://afludiary.blogspot.com/

While the incidence of human infections remains low, the number of people who live in countries that have experienced bird flu outbreaks is very high.

In fact, more than half the world lives in countries that have detected bird flu.

That's right, more than half.

The CDC is warning people who plan to travel to certain Asian countries during the upcoming Lunar New Year's Celebration of steps to take to avoid Bird Flu...

Indonesia

http://afludiary.blogspot.com/2008/01/indonesia-confirms-120th-human.html

Indonesia has confirmed the 120th human case of H5N1.

This latest patient has been hospitalized since January 14th, and his condition appears to be deteriorating. He is reportedly in intensive care with severe pneumonia.

Turkey

Poultry deaths have been occurring here, and it has been confirmed that it is HPAI

(highly pathogenic avian influenza) H5N1 that has killed them. Turkey has

experienced human cases in the past 2 years. They will not hesitate to do

whatever it takes to try to control this outbreak.

http://afludiary.blogspot.com/2008/01/turkish-outbreak-is-reportedly-h5n1.html

http://crofsblogs.typepad.com/h5n1/2008/01/turkey-b2b-h5n1.html

India

India is in turmoil. It is not surprising that they would begin having suspected

human cases, and in fact that is what has happened. They remain suspect

cases until proven otherwise. Many diseases can look like bird flu.

http://afludiary.blogspot.com/2008/01/india-faces-bird-flu-disaster.html

INDIA'S worst ever outbreak of the virulent H5N1 strain of bird flu could turn into a disaster, an official warned, as five people were reportedly quarantined with symptoms of the virus.

Eight districts in the eastern state of West Bengal have been hit by the virus, with dead birds being sold to locals who are said to be "feasting" on cheap chicken.

The state's animal resources minister, Anisur Rahaman, said authorities were "determined to cull all poultry in the districts in three or four days, otherwise the state will face a disaster".

More than 100,000 bird deaths have been reported, and teams are racing to cull two million chickens and ducks.

The Times of India reported five people in West Bengal have been quarantined with "clinical symptoms" of avian flu - including fever, coughing, sore throats and muscle aches - after handling affected poultry.

If the tests are positive for H5N1, this will be the first case of human infection in India, home to 1.1 billion people and hit by bird flu among poultry three times since 2006.

Indian Smugglers Spreading H5N1 Across the Country

Would people really do this? Incredibly, yes they would:

http://crofsblogs.typepad.com/h5n1/2008/01/bengal-intercep.html

Not willing to incur any financial loss because of the outbreak of bird flu, well-networked cartels in West Bengal are smuggling out chicken and poultry products from affected areas, even sending consignments to neighbouring states to minimise the loss.

This could be one of the reasons why the deadly virus has spread so fast — from one district in the beginning to almost eight districts now.

Two lorries full of poultry birds and four lorries carrying eggs were intercepted at the Birbhum-Murshidabad border on Tuesday. These were being smuggled out of the Rampurhat area in Birbhum where the virus was first detected and where culling operations are on.

With permission from Effect Measure:

WHO releases information on viral sharing and disposition

A report late last night by Helen Branswell alerted me to a tabulation from a new tracking system WHO is putting into place to answer demands from a number of member states in the developing world that there be more transparency in how isolates of avian influenza (bird flu) submitted to WHO are used and by whom. About a third of confirmed cases have been registered in Indonesia, although that country has provided less than a quarter of the isolates, a reflection of the refusal by the country's health minister, Dr. Siti Fadilah Supari, to provide any more specimens until matters of vaccine rights have been settled...

Of 734 viruses currently stored in WHO labs, 171 were provided by Indonesia, the country which for the past year has been at the centre of a standoff over access to viruses.

China, thought to be the birthplace of the H5N1 virus, has provided 22 viruses to the WHO network, 20 in 2006 and two in 2007. Its special administrative region, Hong Kong, has provided another four, according to the report posted on the WHO's avian influenza web site. (Helen Branswell, Toronto Sun)

It is important to note that usually what is submitted to WHO, through its reference laboratories, is a clinical specimen. The tabulation shows there were 8,763 specimens submitted from humans or animals but viruses were only able to be cultured from 734, less than 10%:

Of those, the WHO recommended 13 be made into seed viruses for vaccine development. Those viruses came from China (2), Indonesia (1), Vietnam (3), Cambodia (1), Turkey (1), Hong Kong (4) and Mongolia (1).

Eight of those have been made into vaccine seed strains using reverse genetics, a patented technique in which the virus is modified in order to allow it to grow in hens' eggs. (Unmodified H5N1 viruses kill eggs.)

A total of 292 institutions - likely companies and university-based researchers - have taken possession of the vaccine seed strains made with reverse genetics. Another 46 have taken possession of unmodified H5N1 viruses provided by labs in the WHO network. (Helen Branswell, Toronto Sun)

In terms of specimens submitted, Indonesia looks better, having sent WHO almost half the total specimens (4774), but only 171 grew virus in culture. It isn't clear what the criteria were for which specimens to send, so this may be a reflection of less selectivity on Indonesia's part compared to other countries. At the beginning of last year (end of January, 2007) Siti Supari raised her concerns about sharing virus. For 2007 Indonesia sent only 65 specimens (compared to 368 in 2006), 62 to WHO reference laboratories at CDC and 3 to Japan. 13 of the CDC specimens grew H5N1 but none of the Japanese specimens. As Branswell notes in her excellent article, all of the 14 countries who reported human cases by the end of 2007 have submitted specimens as well as many others who have had poultry outbreaks.

Having viral isolates is an important piece of the global pandemic influenza surveillance system. It not only allows monitoring of genetic changes that may or may not be of epidemiological significance, but it also allows diagnostic testing to be kept up to date as primers used for PCR testing undergo changes. Unfortunately the broken intellectual property system and the often rapacious and reckless behavior of large vaccine and drug makers has produced a Gordian knot that so far has not found its Alexander. The result is this logjam in viral surveillance...

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.

From the WHO:

http://www.who.int/csr/disease/avian_influenza/TrackingHistoryH5N1_20080121.pdf

India Admits Falling Behind in Bird Flu Battle

http://uk.news.yahoo.com/

(hat tip flutrackers/dutchy)

"We don't have the infrastructure to battle this epidemic. Bird flu is spreading to new areas. Thousands of chickens are dropping dead every day," he told AFP.

"We've asked neighbouring states to send at least 1,000 veterinary and human doctors," said Rahaman. "We've urged the federal government to send expert teams and doctors to assess the situation and help the culling teams."

The previous target of culling two million birds had been raised to 2.2 million "in the next seven days as the disease has spread to two more districts," he said. Nearly 400,000 birds have already been killed.

India has so far not had any human cases of bird flu but Rahaman said he feared the disease would spread to humans with hundreds of people reporting flu symptoms in the state of 80 million.

"Naked children are playing with chickens in courtyards in affected villages. Chickens are roaming in the kitchen while women are cooking. It's a very worrisome situation," he said.

http://afludiary.blogspot.com/

I guess I have to ask just what is the rest of the world going to do about this?

It is not just India's problem. H5N1 does not respect boundaries and is not

likely to stay confined to West Bengal. Can we ask if the WHO is on the ground

in India yet? Hello, Dr. Chan?

Officials in the Indian state of West Bengal say that the bird flu epidemic has spread to two more of the state's 19 districts, taking the total to nine.

They say that the spread of the H5N1 virus means that even more chicken and duck will have to be killed than was originally estimated.

On Monday officials said that around 2m birds would need to be culled - a figure that will now rise.

Health experts have warned that the outbreak could get out of control.

H5N1 in poultry in India spiraling out of control; BBC boots on the ground

http://www.scottmcpherson.net/

Specifically, the area is West Bengal, a state located along the nation’s border with Bangladesh. It is some 33,000 square miles, just larger in area than South Carolina. When you combine affected areas of adjacent Bangladesh, the region is about the same size and shape as Maine. It has the third-best economy in India, and is home to more than 80,000,000 people, or roughly 8% of the nation’s population. Its capital is Kolkata, or what we used to call Calcutta.

So what is going on in West Bengal? Chaos. Tens of thousands of chickens have literally dropped dead in the past month. Thousands of dead, diseased fowl litter the streets of rural villages in West Bengal. It is the worst outbreak of H5N1 in India’s history, a fact confirmed by the WHO...

India: Portrait of a culler

http://crofsblogs.typepad.com/

Saha takes off his Chinese-made yellow gloves, now turned dark and sticky with blood. Then the mask slips.

“Yes I do feel bad at times. After all, one is snuffing out a life every few seconds. But you don’t stop to think about all this while on the job,” the young father in his thirties says.

The first day was particularly bad. “I handle cows, I had never done anything like this,” the livestock development assistant with the animal resource development (ARD) department said.

“I felt sick inside my stomach. The Tamiflu we have to take as a precaution against bird flu makes it worse by causing nausea.”

Vietnam

http://afludiary.blogspot.com/

A man in northern Vietnam died of bird flu last week, marking the country's first human case to be reported this year, health officials said Wednesday.

Health officials in Tuyen Quang Province said the 32-year-old man died last Friday, two days after being rushed to a special hospital in Hanoi that handles bird flu cases...

Bangkok International Conference on Avian Influenza 2008 : Integration from Knowledge to Control

http://afludiary.blogspot.com/2008/01/bangkok-conference-opens.html

Turkey

From Turkey where "everything is under control" and this family is

probably being given Tamiflu:

http://www.todayszaman.com/tz-web/detaylar.do?load=detay&link=132320

...Zonguldak Governor Yavuz Erkmen said the necessary measures had been taken to contain a potential pandemic, and pointed to wild ducks as the source of the disease. "After a series of analyses, we found out that the disease broke out after a family ate a wild duck and gave the leftovers to their chickens. The H5N1 virus in the duck, which spread among the chickens, is the cause of the bird flu case in our province," he said.

Officials from the Ministry of Agriculture and Rural Affairs stated on Monday that several dead chickens found in Zonguldak's Saz village during a routine inspection conducted on Jan. 19 tested positive for the bird flu virus. The village was immediately put under quarantine, and teams from the local government started culling poultry in the village.

"Some 600 chickens, ducks and turkeys have been culled so far. Members of the family who consumed the wild duck in question are currently receiving medical care. Everything is under control; thus, there is nothing to fear," stated Erkmen.

Southern India

If these reports are correct, then H5N1 has extended its range to Southern India:

http://afludiary.blogspot.com/2008/01/unassuming-headline-out-of-india.html

About 2,000 dead broilers were found floating in a highly decomposed

state in a pool at Vellakaradu near Devadanapatti in Theni district causing

panic and the villagers fear that the birds might have died due to avian flu.

The water in the pool is stagnant and dirty. Dead fowls were found floating

in the pool and the whole area was reeking with the stench of rotten flesh.

Many people in the area do not know how the birds landed in the pool.

But they suspect that the fowls may have died of bird flu.

They also feel that the poultry farm owners in the area may have disposed

the birds to avoid being questioned by authorities.

Goat Deaths In West Bengal Raise Concerns

http://afludiary.blogspot.com

H5N1 has been found in other mammals but never before have goats

been infected. Whatever is causing the pneumonia must be contagious

since so many animals have died. Just a coincidence that the chickens

are dying of bird flu at the same time? Interesting but disturbing...

Hundreds of goats have died of an unknown disease over the past four

days in Birbhum's Rampurhat block II.

Mohid had called in a local vet, who could only say the animal was

suffering from high fever but could not pinpoint a disease. Though he

prescribed medicines, those have not worked.

Mohid, who has already lost 35 chickens to bird flu, is now scared about

his livestock. He said that several neighbours had lost their goats as well

to the mystery ailment.

His neighbour Seikh Kalim has buried seven goats over the past two days.

They were suffering from a similar disease. In their case, too, drugs

prescribed refused to work. The animals had fever and their throats

started swelling before they fell unconscious and died within minutes.

At Dakhalbati, more than 60 goats have died so far.

Thailand

Authorities suspected the presence of H5N1 virus at a farm in Nakhon Sawan's Chumsaeng district after thousands of chickens were found dead. A lab test conducted in Phitsanulok confirmed the chickens had died of the bird flu virus.

http://crofsblogs.typepad.com/h5n1/2008/01/b2b-h5n1-breaks.html

http://crofsblogs.typepad.com/h5n1/2008/01/more-on-the-tha.html

Indonesian Fatality

This young man was only thirty. No history of contact with birds:

http://afludiary.blogspot.com/2008/01/indonesia-reports-98th-fatality.html

A 30-year-old Indonesian man from the outskirts of Jakarta died of avian influenza on Thursday, putting the total fatalities to 98 out of 120 contracted people in the country, Indonesian health ministry said here.

With permission from Effect Measure:

It's Not All Bad News

There's more bird flu than we thought. That's good news.

Category: Bird flu • Clinical • Epidemiology • Surveillance

You'd think finding that there were some bird flu infections that went undetected would be bad news but it is actually good news. Not tremendous good news but better than no news, and that's unusual in the bird flu world. For some time the absence of mild or inapparent infections has been worrying. It means that the current case fatality ratio of over 60% is the real CFR, not one based on just the most serious cases coming to the attention of the surveillance system. Now scientists gathered in Bangkok at one of the many gatherings of those studying the disease have heard some new data involving 674 people in two Cambodian villages exposed to influenza H5N1 ("bird flu") by infected poultry in their households. Seven children were found to have been infected using a test of their blood for antibodies. Seven is 1% of these exposed people, so it is still consistent with low transmissibility to humans. But scant data from previous investigations of health care workers or villagers in infected areas had not turned up evidence of mild infection, so this is good news. Not all H5N1 cases are serious or fatal disease.

The data were collected in early 2006 in southern Cambodia. Two cases were registered in Cambodia in early 2006, one in April 2006 and one in March 2006. Both were children and both died. Although the locations are different, if we count them both, this suggests that for two clinical cases there were seven mild cases, which means that the case fatality ratio might be considerably lower than the current 100% for the country to 50%. To be more optimistic, one might compare the 2 deaths in 2006 to the seven mild cases for a 22% CFR.

The missed cases were all young, between the ages of 4 and 18 (median age 12). This was much younger than the entire sample of 674 (median age 27).

Results of the Cambodian study support findings from a decade ago in Hong Kong, where human H5N1 cases were first reported in 18 people, six of whom died. Survival rates were higher among children, many of whom weren't severely affected, Peiris said in an interview in Bangkok yesterday.

"Most of the children diagnosed in Hong Kong in 1997 had a very mild course of infection, they basically had a mild flu- like illness and they recovered," he said. "I don't think there is any evidence to say the situation has changed." (Jason Gale, Bloomberg)

We noted in a recent post that a review of the existing cases also shows that the age 10 - 19 children have the highest case fatality, so we should perhaps not read much into the fact that children also have more mild infection. They may just have more infection, both mild and severe. The reasons children are more often among the infected is not known, although that hasn't stopped speculation. We won't go there.

But we think this is good news -- sort of. Or to put it another way, the news could be worse. A lot worse.

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.