Pandemic News/Awareness - Thread 3

Vietnam: Civets Die of H5N1

You might recall that civet cats were implicated in spreading the SARS virus

a few years ago in China. This report says that some of them have been

infected with H5N1. This virus seems to have a large host range. The

point of concern about this is that the diet of the civet does not explain how

they got infected. A common water supply with infected birds, or the worms

fed to them were from soil contaminated with droppings from infected birds

perhaps?

It might be important to know just how they got sick considering that we still do

not know how some of the people are getting infected either.

http://crofsblogs.typepad.com/h5n1/2008/03/vietnam-civets.html

Bird flu killed four civets in a Vietnamese national park, the second time the

rare type of mammal was reported to have died there of the H5N1 virus since

2005, a park official said on Tuesday.

Civets eat pork, worms and fruit, but not poultry.

India - West Bengal Night Raids

Like almost every other country where people have had to give up their

poultry for a cull, their owners are hiding them. This even happened in

Germany last year. So, the govt has resorted to sneaky night raids:

http://afludiary.blogspot.com/2008/03/working-on-their-night-moves.html

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/mar1008flureax.html

Hectic season exposes gaps in flu preparedness

Friday's announcement by the Centers for Disease Control and Prevention (CDC) that influenza appears to be slowing down has left medical personnel relieved for the imminent end of a harsh flu season.

But it has also left them worried over weaknesses that the season exposed in public health's ability to anticipate flu's behavior, and over doubts raised among their patients by the flu vaccine's diminished effectiveness.

In four weeks, we went from a ho-hum flu season to ridiculous overcrowding," said Dr. Maurice Ramirez, an emergency physician who works in several institutions in north Florida. "We have had so many people that we have them, not in beds in the hallway, but in chairs with a number taped to the wall over their heads."

Troublingly, many of the flu patients coming to the healthcare system received flu shots. Their illnesses represent a mismatch between the strains that were chosen for the vaccine a year ago and the strains that actually caused illness this season, a development the CDC acknowledged in early February. The mismatch has been significant: Last Friday, the CDC said that the rates of match between the current flu vaccine and flu isolates analyzed so far this winter were 77%, 14%, and 7% for the three flu strains.

Hong Kong Schools Closing After Student Deaths Occur

It is not clear what the situation is in Hong Kong. Some children have

died of influenza which was said NOT to be H5N1. Later some news reports

were calling it bird flu. Bird flu seems unlikely given the problem with

the mismatch of this year's seasonal flu vaccine. Seasonal flu can kill,

and the Brisbane strain has done so in the U.S. as well as in Australia.

http://afludiary.blogspot.com/2008/03/more-on-hong-kong-flu-fears.html

http://afludiary.blogspot.com/2008/03/hong-kong-orders-all-schools-to-close.html

HONG KONG (AP)-Hong Kong's government has ordered all

kindergartens and primary schools to close for two weeks amid

a flu outbreak.

The government has also asked one of its top scientists to study

three child deaths over the past week.

When Zhong speaks, we'd better listen

Zhong Nanshan is Director of the Guangzhou Institute of Respiratory Diseases.

http://tinyurl.com/2bqahl

Zhong has issued a stern warning to the Chinese people in particular (and

to the world in general) that H5N1 is mutating (again) at a time when

traditional, seasonal influenza is about to reach a peak this month in China.

His concern is straightforward: These may be the most favorable pandemic

conditions in southern China since the original Hong Kong outbreak of human

H5N1 in 1997.

...When avian flu is around and human flu appears, this will raise the

chances of avian flu turning into a human flu...

Experts are worried about seasonal flu, because it could get mixed up with

a deadly novel strain, such as the H5N1 bird flu virus. Such a hybrid would

not only become easily transmissible between people, but packed with great

killing power.

Don't Smuggle Me...I Could Be Sick!

Photo of sign viewed at US Customs very recently (hat tip Curevents/Potemkin).

I wonder if a sign could stop anyone from smuggling:

http://tinyurl.com/yskb2p

Posted with permission from Effect Measure where they also are concerned

as to just how these animals became infected:

What's up with H5N1 in civets in Vietnam?

Few of us had heard of palm civets before SARS. Then these small nocturnal animals came under suspicion as the source of the human SARS virus. Civet cats were a wild animal delicacy in the area where SARS broke out and it was discovered that they were infected with the same virus as humans. Did humans give it to the civet or the other way around? Or is there some third source? Bats have been discussed for SARS.

Now Vietnam is reporting, for the second time, the deaths of civets from H5N1:

Four Owston's palm civets, a catlike carnivorous species that the International Union for the Conservation of Nature lists as endangered, died between February 7 and 18 at Cuc Phuong National Park, 120 kilometres south of Hanoi, said Truong Quang Bich, director of the park.

[snip]

Bich said the civets, which were being kept in a semi-wild enclosure at the park's conservation centre, had not been fed poultry but he suspected that infected wild birds might have entered their habitat and spread the disease.

[snip]

Vietnam lists the Owston's palm civet in its Red Book of endangered species, which are illegal to trade or transport.

However, the civets' population is threatened by an illegal trade in body parts for traditional medicine. Civet meat, particularly if caught in the wild, is thought to be an aphrodisiac in some regions. (dpa)

This story claims these are the first mammals other than humans to be infected with H5N1 in Vietnam, but in 2005 three Owlston's palm civets also died of the bird flu virus. The earlier cases were described as being kept in cages, while this describes these as in a semi-wild enclosure in the same national park. It is likely the circumstances were similar. In neither case were the civets said to have been fed poultry of any kind.

So these civet cases raise two issues. The first is the infection of a particular wild mammal. Civets are found across a wide range from the Himalayas and south China to the Philippines, the Malay peninsula and Indonesia. They are said to adapt to new environments easily, living in forests and agricultural areas, often in contact with humans:

While growing up in Indonesia, I would sometimes wake up to a terrible racket in the ceiling, occasionally followed by a sickly-sweet odor reminiscent of a striped skunk. It was the musangs, or common palm civets, having some sort of spat. Once one fell through the ceiling, almost hitting my father, who had gone to investigate. Like pesky squirrels they would sometimes invade our attic.

[snip]

Weighing from 4 to 11 pounds, the palm civet's head and body length is 17 to 28 inches (43.2-71 cm), with a tail length of 16 to 26 inches (40.6-66 cm). Its ears are small and faintly pointed, as is its nose. It has a long and slender body with short legs. They have a coorifice grayish to brown coat with black-tipped guard hairs over all. Three rows of black spots run along each side of its body. The hair around its eyes, cheeks and muzzle is black, with spots of white under each eye and on each side of its nose. The ears, feet and last end of its tail are also black.

Both sexes have well-developed anal scent glands looking somewhat like testes, which gives the musang its species name.

A nocturnal omnivore, the palm civet hunts alone. They are expert climbers and spend most of their lives in trees. They eat small vertebrates, insects, ripe fruits and seeds. They are very fond of palm sap, therefore their common name.

[snip]

Palm civets stake out territories which often overlap during times of adequate food supply. When spending time in one area, musangs will use the same tree to sleep in during the day. Plam civets reproduce throughout the year although it has been recorded that kittens are most often seen from October to December. Kittens are born in a litter of 2 to 5 young. Palm civets become sexually mature at 11 to 12 months. In captivity the common palm civet can live up to 22 years.

The common palm civet disperses seeds of the trees on which it feeds by eating the seed pulp and passing the seeds well away from its parent tree. Although not much is known about the palm civet, it is believed that its nocturnal habit was developed to avoid predators. (Blue Planet Times)

The Owlston's palm civet in Vietnam is not exactly the same as the common palm civet in Indonesia, but as far as I know, no one has looked for H5N1 in the common palm civet in Indonesia, either.

The second question about the Vietnam civets is this: how did they get infected? They weren't fed poultry (as least as far as anyone knows, and this was explicitly considered) nor were they in contact with poultry. It sounds like these animals were semi-confined, so the virus would have to have been brought to them somehow. Wild birds? Possibly, although there is no evidence in this case. Humans? But how? On boots or shoes? Possibly. But this virus has shown transmissibility to mammals to be difficult, and unless it has changed in that respect, doesn't seem so likely. Other civets in the same enclosure were apparently unaffected. Or is their yet another vector. Bats? It might be. Bats are now implicated as an important source in SARS, not palm civets.

This case needs to be examined carefully. It is these often seemingly anomalous instances which are the most informative.

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.

And then there is this to consider also as any possibility of other animals

carrying this disease is worth investigating:

http://www.flutrackers.com/forum/showpost.php?p=141250&postcount=5

Vietnam

http://www.flutrackers.com/forum/showpost.php?p=141456&postcount=7

Not knowing how these animals became infected is a mystery, and because they don't know, the threat to human health is being taken seriously as it should be.

The Health Preventive Department has issued a directive requesting provincial health departments in Ninh Binh and Thanh Hoa to instruct the park to control the number of visitors, nearby residents and animals from entering the infected site.

The agency also announced that all park employees who took care of the afflicted animals are under quarantine and administered Tamiflu doses.

Indonesia

http://afludiary.blogspot.com/2008/03/indonesian-media-2-patients-test.html

The media is reporting that two patients have tested positive out of a

cluster of 10 suspected cases in one village in Sumatra's Lampung Province.

Clusters of patients are cause for concern.

Increased Case Fatality Ratio in Vietnam

http://afludiary.blogspot.com/2008/03/vietnamese-doctor-blames-mutating-virus.html

We know more now about bird flu than we did a few years ago. What we

do not know is why the CFR is increasing. Well, maybe that is not exactly

true. If the viral sequences being hoarded in various labs were released, we

might have a better idea as to why this is happening. You would almost

think that with such a rise in the Case Fatality Ratio, scientists would be willing

to be part of an all out effort like the Manhatten Project to beat this virus, and

share those sequences, wouldn't you? So, if the virus is mutating as Doctor

Nguyen Hong Ha, Vice Head of the National Hospital for Infectious and Tropical

Diseases believes, the sequences will show this.

The CFR (Case Fatality Ratio -% of infected people who die) in 2005 was

reportedly 43%, and in 2006 and 2007 among known cases, the CFR

jumped to 68%.

Worldwide, 23 bird flu victims have been reported this year, and 18 of those

have died. The fate of several more still hang in the balance.

Even assuming all those who are currently hospitalized survive, the CFR

(Case Fatality Rate) among known cases this year would exceed 78%.

Hong Kong

Hong Kong considering flu jabs for children as they discover that the recent deaths

were from seasonal flu. Unfortunately, these strains are not in the current flu

vaccine.

http://crofsblogs.typepad.com/h5n1/2008/03/hong-kong-flu-j.html

Tests showed the H1N1 virus found in the boy is the same as the circulating

H1N1 (Brisbane) strain in Hong Kong, while the H3N2 virus found in the girl

has already been confirmed to have the same genetic makeup as the

circulating H3N2 (Brisbane) strain. Both have been circulating in other

parts of the world in the past few months.

Both Sars and Bird Flu Ruled Out in Children's Deaths in Hong Kong, but

all kinds of wild birds, not just the ducks, or other water birds that you

might expect, have been testing positive there for H5N1, bird flu for quite

some time. The reports keep coming in:

http://www.scottmcpherson.net/journal/2008/3/14/sars-bird-flu-ruled-out-in-hong-kong-deaths.html

Hong Kong is not completely out of hot water, however. Yet another bird -- this time, a peregrine falcon -- has tested positive for H5N1, making it the second such case in a month... Wild birds in HK are now routinely testing positive for H5N1, and five such positive tests have happened since January.

Hong Kong on "Full Alert"

The food has to come into the city from outside suppliers. They have to be the alert

at all times that their suppliers are not in any of the affected areas. What a way to have to live...

http://crofsblogs.typepad.com/h5n1/2008/03/thong-kong-is-o.html

The Food and Health Bureau earlier confirmed there are no chicken farms that supply Hong Kong within a 13-kilometer radius of a market in Foshan where 2,000 chickens were culled.

Thirteen farms in Foshan outside the radius and nine in Guangzhou supply poultry to Hong Kong.

Vietnamese child dies from bird flu

I don't get it...

This eleven year old boy is the only one in his family, apparently that got sick.

Yet, they are trying to say that it is from a meal that the whole family ate.

There is some missing piece of information in these cases. This does not

make any sense.

The disease is endemic in their environment so how is it that he is the only one

that is dead?

http://news.xinhuanet.com/english/2008-03/17/content_7807393.htm

http://crofsblogs.typepad.com/h5n1/2008/03/still-more-b2b.html

The institute's tests showed that specimens from the boy named Do Van Huong from Thanh Liem district was infected with bird flu virus strain H5N1, the news agency quoted Nguyen Lap Quyet, director of the Ha Nam Health Department, as saying.

The boy fell ill on March 5, and was admitted to the Ha Nam General Hospital in the province on March 8, and the National Hospital of Pediatrics in Hanoi on March 11.

In late February, 10 out of a chicken flock raised by the boy's family fell ill and died gradually. Then, the his family slaughtered some healthy chickens of the flock for meal.

Avian, human flu coinfection reported in Indonesian teen

This report describes a situation of some concern. Here we have a person

that might have been infected with H5N1 as well as an ordinary seasonal flu

virus, and it is not clear as to whether or not that this actually did happen

though it is certainly well within the realm of possibility.

Here's the concern. H5N1 so far has not yet "learned" how to easily transmit

to humans. It is expected that at some point, it will pick up the ability to do so

from infecting a person that has been co-infected with a seasonal flu virus.

Seasonal flu viruses, as everyone knows are very easily transmitted to other

people while at this time H5N1 is not.

Given the amount of seasonal flu that is happening right now in the northern

hemisphere, it would seem that this is a likely scenario for such places as

China or Vietnam where H5N1 outbreaks are occurring frequently in poultry

and have occurred in humans. Co-infections probably have happened already,

but we just have not been aware of them.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar1708coinfect.html

Throat and nasal-swab samples that were taken on the 6th day of her symptoms tested positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for both avian influenza H5N1 and the seasonal flu strain H3N2 at the Indonesian National Institute of Health Research and Development. Serology test results were less clear. Antibody titers from serum samples taken the 6th day provided a weak indication of H5N1 infection (titer of 1:10) but were negative for H3N2; convalescent sera, on the other hand, gave a strong indication of H3N2 infection (titer of 1:640) but were negative for H5N1.

Facts Are Stubborn Things

http://www.scottmcpherson.net/journal/2008/3/18/facts-are-stubborn-things.html

Scott McPherson is the Chief Information Officer [CIO] for the Florida

House of Representatives. His language can be very colorful at times.

I hope that no one will be offended by some slightly off color imagery in his

commentary because what he is saying about the Indonesian girl who died

coinfected with both bird flu [H5N1] and seasonal flu [H3N2] is important.

It seems very likely that he is correct in that other coinfections surely must

have occurred already, but his other observations are even more interesting,

and are well worth the read.

We must assume that the Indonesians believe that statistically, coinfection has happened multiple times across the nation. The fact this happened once --almost a year ago -- cannot be chalked up merely to dumb luck. It probably means they realize that they cannot conduct accurate surveillance over a wide enough area to be effective.