Pandemic News/Awareness - Thread 3

Indonesia: A new death confirmed, a new death suspected

http://crofsblogs.typepad.com/h5n1/2008/05/indonesia-a-new.html

Case Fatality Ratio (CFR) in Indonesia is over 80%. Here are two recent

victims from the same family though amazingly, the boy was never tested

for bird flu. He had the same s/s as his sister. Why they didn't test him

is a mystery.

Istiqomah, 16, died four days after being admitted to the Persahabatan Hospital in the Indonesian capital on May 8 with laboratory test later confirming she had the avian flu virus.

She had been treated at the isolated room exclusively for bird flu patients but doctors failed to save her life, reported leading news website Detikcom.

Ten days before her death, brother Ahmad Rizki, 15, died after a brief treatment at another hospital with symptoms similar to bird flu.

Another Case, Same Family

http://www.recombinomics.com/News/05140806/H5N1_Jakarta_Cluster_H2H2H.html

The above translation describes the hospitalization of a third sibling in Jakarta.

The hospitalization of the third brother along with disease onset dates suggests H2H2H transmission, which is among the longest transmission chain reported to date.

http://www.flutrackers.com/forum/showpost.php?p=156750&postcount=149

A pandemic requires SUSTAINED transmission, so the longer the transmission chain, the more likely a pandemic will develop.

One or two more sequential transmissions would set a record for confirmed H5N1 (assuming these infections are confirmed, which in Indonesia is a major assumption).

India

http://www.thepoultrysite.com/poultrynews/14901/bird-flu-update-in-india

West Bengal

According to the report culling operations started on 10.5.2008. 125 Cullers/Veterinary staff are under medical observation and continue to be on chemoprophylaxis with oseltamivir.

Tripura

151 Animal Health Workers are under medical supervision and are under chemoprophylaxis. There is no suspect case of human avian influenza.

Nepal - Too Close to India for Comfort

West Bengal in India is still struggling with H5N1 infected poultry outbreaks.

Jhapa, Nepal is right over the border, not that that would be any kind of a

barrier to curb the spread of the virus because it is just that close...

http://afludiary.blogspot.com/2008/05/nepal-watches-india-bird-flu-worries.html

Jhapa lies in the easternmost district of Nepal and is bordered by the Indian state of Bihar in the south and east, and the Indian state of West Bengal in the east

While the full link below may be difficult for some to follow, the quote is

easily understood.

Public health has become so political. Information gets withheld for many

reasons. Scientists hoard research results. Govt entities hide the facts for

economic or other reasons, and cooperate with each other apparently in

doing so according to the quotes below, as the CDC has done for South Korea.

The WHO can not release data unless the host govt supplying that data agrees.

It gets so complicated trying to discern the truth. That is where flu forums and

independent bloggers become important. The translators around the world

reporting on those flu forums provide an immeasurable service to all of us.

They dig for the facts, and frequently find them. Scientists such as Dr. Henry

Niman give value added comments with his analysis of how H5N1 is changing.

We are blessed to have access to their information.

http://www.flutrackers.com/forum/showpost.php?p=156564&postcount=65

Media reports in South Korea also suggest that the US CDC has confirmed

H5N1 in patient(s) in South Korea, as had been previously seen in the soldier

that was H5 positive. Korea claimed the soldier was H5N1 “negative” because

they couldn’t confirm the N1. However, they did not deny confirmation of H5,

which meets the WHO definition of a confirmed case. It seems that the con-

firmation by the CDC is being withheld, and a Friday meeting is planed to

discuss the development.

These developments may be related to recent WHO comments on sharing of

research results. The withholding of this information remains hazardous to the

world’s health.

More in the link below on the lack of transparency in reporting results which

reminds me. Amongst the results that I would like to see released are those

of a young girl from Danbury, Ct. Her name was Jessie. She was a 16 yr

old lacrosse player. She had been diagnosed with influenza A and started on

Tamiflu very quickly. She was in 2 different hospitals in Connecticut before

being airlifted to Boston where she died of multi-organ failure. The ID docs in

Boston asked her parents if she had been exposed to birds, and of course,

she had been exposed to Canadian Geese feces since she was a lacrosse

player. How is it possible that none of the 3 hospitals would not have sent

specimens to the CDC? Would you believe that? I know that I can not.

Here is a post from the Preparedness Thread, quoting those epidemiologists

at Effect Measure about the hoarding of vital information that is ongoing:

https://allnurses.com/forums/f8/disaster-pandemic-preparedness-205024-33.html#post2843210

South Korean - The Spin Goes On

http://tinyurl.com/4ab9sa

Twisting the facts to make the information more palatable?

The strain of avian influenza that broke out in South Korea this year is a type

that has not caused any human infections worldwide, as opposed to the kind

found in Southeast Asia, the quarantine service said Friday.

The strain of bird flu that has swept the country for the past five weeks is

different from those found in Indonesia and Vietnam, where the disease has

been transmitted to humans, resulting in death, according to an intermediary

report by the National Veterinary Research Quarantine Service.

Of course, that is in direct contradiction to the following link showing a genetic

similiarity of the virus to one of the Vietnamese clades where there absolutely

have been human cases. But, then again, the Koreans are still denying their

own lab confirmed human case.

Hard to hide that they have not been successful in eradicating the virus, and

the significance of all those ducks dying...

You have to read between the lines to see the truth.

http://www.flutrackers.com/forum/showpost.php?p=156564&postcount=

65

A government official said a highly pathogenic virus that caused bird flu in

North Jeolla Province last month was confirmed to have DNA similar to that

of a Vietnamese strain.

Experts predict the nation will likely suffer bird flu throughout the year if it

fails to exterminate what they call the "southern-type virus."

The above comments suggest that some or all of the H5N1 in South Korea is a

new clade related to H5N1 in Vietnam. This definition is somewhat unclear

because there have been two distinct clades in Vietnam previously. In 2004/2005

clade 1 dominated, but more recently clade 2.3 from China (Fujian strain) has

become dominant. Therefore, the genetic composition in South Korea is unclear,

but several local media stories also refer to a Vietnamese (or southern strain).

Clade 1 was noted for its ability to asymptomatically infect ducks and grow

to high levels in the duck's intestine, creating significant control problems.

With permission from Effect Measure:

Where in the world is the H5N1 virus?

Almost all stories in the news about H5N1 (bird flu) have some obligatory line in them, "It is believed that all or almost all human cases come from contact with infected poultry." This is like a mantra of many public health officials and I suspect some reporters have the requisite disclaimer as a cut and paste text they mechanically insert into their stories. But it isn't true. There are an awful lot of human cases for which no poultry source has ever been located and we have yet another example in the latest Indonesia cases:

The city's husbandry, fishery and maritime agency said Friday it did not find the H5N1 virus in any fowls found in the neighborhood of the latest suspected bird flu victims.

Agency head Edy Setiarto said samples taken from poultry in the Gandaria Utara, South Jakarta, showed negative results.

"We took the samples Thursday and had them examined in our lab in Ragunan, South Jakarta, after scanning an area in the subdistrict with a radius of 100 meters," he said.

"We found out later that day the tests were negative," he said. (Jakarta Post)

This case is mysterious in other ways, too. It was originally reported that the teenage girl's 15 year old brother was also a bird flu victim, but the story now goes that the brother died of typhoid fever 10 days before his sister. Had it been bird flu this would have been looked on as a likely person to person transmission. It seems a bit convenient -- but still possible, I suppose -- that the brother died of another fatal infectious disease within exactly one incubation period of his sister. Since it sounds like the brother died before the diagnosis of bird flu was suspected and the diagnosis is based on an unnamed blood test rather than PCR you have to wonder. Of even more interest is the report that a family member of the two, a 24 year old, is being treated at another hospital with bird flu like symptoms.

Which again raises the question of where the latest confirmed victim acquired the infection. Is there another reservoir besides birds? How about another person? The Indonesian authorities are said to be conducting blood tests on contacts of the victim but we don't know what kind of tests, what their timing is, what follow-up there will be, or, of course, what the results are.

As we have said before it is time for more systematic, widespread and intensive tests to estimate the extent of infection in the natural world with H5N1 virus. We and others have called for seroprevalence studies in exposed populations to see if there is more covert infection than we know about. There is now word from Vietnam that Vietnamese and American scientists will be launching such a study in the fall:

As of October 2008, American experts will conduct wide-scale research in Vietnam on antibodies countering H5N1 that may exist in Vietnamese people's bodies. The research, which will be carried out by experts of the US National Health Institute, will be conducted through a collection of blood samples from man, poultry, water samples, and social surveys on people's awareness of the disease and access to poultry. According to Dr. Polly R. Sager of the US National Health Institute, it is supposed that antibodies may appear in the bodies of people who are infected with less toxic H5N1 virus types. If this supposition is verified, the people who have antibodies may be partly protected against stronger H5N1 virus types. A study involving 850 families in the three provinces of Ha Tay in the north, Thua Thien-Hue in the central region and Tien Giang in the south shows that around 12,000 people may be exposed to bird flu. According to Dr. Sager, bird flu in Vietnam is different from many other countries because in Vietnam, families breed poultry and cattle in the same area. Each animal has their own virus types so it is highly possible to have a combination of flu viruses from different kinds of animals. (Vietnam Net)

So this is good. But we also need some systematic surveys of other wildlife, including rodents, shrews, various primates and domestic animals and livestock.

The virus may be hiding in plain sight. We should be looking for it. Now.

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

Japan and South Korea

Here is what you should understand about the significance of what is

happening there. M2301 has been found in bird flu infected swans in

Hokkaido, Japan. This is a human polymorphism that is found in all

human seasonal flu. It likely offers a selective advantage for infecting

human cells

Stop and think about this. Where is Hokkaido in relation to North

America. I might have this wrong but isn't it only about 800 miles or so

to the westernmost Aleutian Islands?

http://www.flutrackers.com/forum/showpost.php?p=158043&postcount=46

http://www.flutrackers.com/forum/showpost.php?p=158053&postcount=48

H5N1 is a bird flu that is constantly changing and adapting, and this is

just one example of how it is adapting to humans. There are other changes

as well. At least one of the human deaths that occurred in northern Egypt at

Gharbiya, had viral sequences with M2301, and it was predicted that this would

also be found in birds. Now we are seeing it in the infected swans in Japan.

Alarm bells should be going off about this, but instead we are getting spin

from the media in South Korea: http://www.intellasia.net/news/articles/health/111244017.shtml

Dr. Niman of Recombinomics refuting the misleading article above:

http://www.flutrackers.com/forum/showpost.php?p=158154&postcount=4

We are not being told the complete truth about what is going on. Significant

information is being withheld:

http://www.recombinomics.com/News/05190803/H5N1_232_234.html

Recent fatalities in Vietnam are likely to also be from the Fujian strain. In South Korea, a soldier tested positive for highly pathogenic H5, but the failure to detect N1 has led to media reports discounting the H5N1 infection in the soldier...

Although 2007 sequences from ducks in Vietnam have been released, none of the human sequences, including 2008 isolates, have been released. Similarly, the sequence of the clade 2.3.2 vaccine target has also been withheld.

Thus, the analysis of the released sequences from Japan is hampered by the withholding of related sequences from Hong Kong, Vietnam, and South Korea. Similarly, there are few recent H5N1 sequences released from China.

WHO has called for more collaboration on H5N1 research. Such collaborations can begin with the release of the above withheld sequences. Japan has set the bar by promptly releasing sequences from the whooper swans on Hokkaido. It is time for neighboring countries to follow suit.

http://www.recombinomics.com/News/05190804/H5N1_North_America.html

The reassorted genes in the isolates form Japan signal dual infections...

The whooper swan isolates have HA M230I, which would likely increase the likelihood of a bird infection, since M230I is present in all three strains of seasonal flu (H1N1, H3N2, and influenza B)

Polymorphism acquisitions can also be used to trace the movement of the various isolates. The PB2 sequence has three consecutive polymorphisms that have previously been seen in North American isolates (see list here). These sequence support movement of H5N1 along the East Asian flyway which feeds into Alaska in North America. The sequences, as well as the location of these isolates in northern Japan, raise concerns that H5N1 is migrating toward North America. This migration is also supported by the timing of the outbreaks in Japan and South Korea (see satellite map).

Clade 2.3 has not been reported previously in South Korea or Japan. The record size of the outbreak in South Korea provides new opportunities for further evolution of H5N1 as birds migrate out of those countries and into Siberia and Alaska.

Experts welcome Indonesia's vow to share H5N1 data

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/may1908sharing.html

Two researchers who work with H5N1 viruses say they are pleased that Indonesia, which leads the world in human H5N1 cases and deaths, will share the genetic sequences from their virus samples. However, their opinions varied on how useful the genetic sequences will be without the actual H5N1 virus isolates, which are used to make seed strains for vaccines.

"...it allows everyone to see how the Indonesian viruses are evolving genetically," Webby said. "Unfortunately, however, our ability to accurately predict antigenic and biologic properties from sequence data alone is embarrassingly poor. So, no, it [providing genetic sequence data] is not as good as sharing viruses."

Webby added that the most important aspect scientists can determine from a viral isolate that they can't learn from a sequence is antigenicity--how well a virus will cross-react with antibodies generated against other strains. "Antigenic relatedness, not genetic relatedness, is key to vaccine strain selection," he said.

Also, sequence data alone can't predict the transmission and pathogenicity changes that researchers depend on to make risk assessments, Webby said.

"Sequences are very important to understand antigenicity, and even if no viruses are shared, provide the basis to make reagents to experimentally test antigenicity and pathogenicity," he told CIDRAP News. Garcia-Sastre is also principal investigator for the Center for Research on Influenza Pathogenesis, one of six National Institute for Allergy and Infectious Diseases Centers of Excellence for Influenza Research and Surveillance.

The idea for the GISAID database was generated by a group of 70 scientists and health officials who signed a letter in the August 31, 2006, issue of Nature proposing the formation of a new consortium to promote greater sharing of H5N1 genetic sequences.

...the public can freely access the database, which includes both human and animal H5N1 sequences, after they register and agree to share and credit the use of others' data, analyze findings jointly, publish results collaboratively, and refrain from pressing intellectual property rights issues that relate to diagnostic, drug, and vaccine developments.

Bangladesh Confirms First Human Bird Flu Case

http://afludiary.blogspot.com/2008/05/bangladesh-confirms-first-

human-bird.html

What many have always suspected is proven to be true, given the density

of the population and the amount of infected birds. This case occurred in

January. It is now almost the end of May. Another example of a major

information withhold. You have to wonder how quickly the world would be

informed if the pandemic actually starts in a country such as Bangladesh.

Not until the bodies start piling up, and they couldn't hide it anymore, is my

guess.

It does not take months to get a diagnosis. So, when, you might ask, did

the CDC here in the US get the samples? Not a word from them about this...

How did the toddler get infected? No nearby farm, but conveniently, his family

bought some chickens presumably to eat. This whole story gives us more

questions than answers. The family lives in a slum in Dhaka, the capital city.

.

The child is recovering after treatment. The statement said the case was diagnosed by the Centers for Disease Control and Prevention in Atlanta.

Bangladesh in recent months have culled hundreds of thousands of birds after the virus was detected last year.

"We got the confirmation yesterday from the CDC (US Centers for Disease Control and Prevention) yesterday," said Mahmudur Rahman.

"Although there is no farm in the neighbourhood we suspect that he got the illness after his family bought chickens from a farm," he said.

http://www.recombinomics.com/News/05220804/H5N1_Dhaka_Child.html

Although human infections in Bangladesh are not a surprise, the timing of the confirmation is curious. In January, H5N1 infections in Bangladesh and west Bengal were widespread (see satellite maps here and here). Bangladesh had also confirmed H5N1 in wild birds, including crows, and dead crows were reported in Dhaka.

Similarly, sequences from recent outbreaks in India (West Bengal and Tripura) have also been withheld, but wild bird deaths have been reported in both regions, and deaths in Tripura were associated with deaths of dogs, cats, and jackals which ate the birds. Thus, it is likely that H5N1 in eastern India is closely related to the H5N1 in Bangladesh, and there have also been unreported human cases in India.

More information on additional "suspect" human samples from Bangladesh and India would be useful, as would release of H5N1 sequences from both countries.

H5N1 Expanding Geographic Range

http://www.recombinomics.com/News/05220803/H5N1_Aomori.html

They were in the same Towada Lake where the first positives were found a month ago (see satellite map). These swans were on the east side of the lake and therefore in the Amori Prefecture. A new outbreak in Korea was also reported this week, suggesting a new wave of birds may be migrating through the area.

The HA is closely related to a wild bird sequence from Hong Kong in 2007 which has been selected as the clade 2.3.2 vaccine target, but the sequence has been withheld. It is not clear of the withholding is linked to publication, or if the publication centers on the fact that the isolate is a reassortant. However, both isolates from Japan are reassortants, and the identity level of 99.7% or higher suggests the isolates in Korea are also Fujian reassortants linked to wild birds in Hong Kong..

Fujian sequences have not been reported previously in long range migratory birds like whooper swans. The detection in Japan over a one month period suggest that the level of Fujian infections is high, which is supported by the record levels reported in Korea, and the first reported H5N1 case in Primore in southeastern Russia.

The repeated detection of H5N1 in whooper swans in multiple locations over a one month time period raises additional concerns regarding an expanded geographical reach of H5N1.

Prior to the lab confirmation of H5 in the soldier in South Korea, the human Fujian isolates had been limited to the large clade 2.3.4 sub-clade. Since the 2007 / 2008 wild bird sequences in Hong Kong have not been released, it is not clear when the 2.3.2 / 2.3.4 reassortant formed, but its presence in long range migratory birds in locations in Japan and Russia in regions which have not previously reported H5N1 raise concerns of a significant global expansion of Fujian H5N1, which includes migration to North America.

Ambassador Moriarty to Host Town Hall Meeting in Chittagong for American Citizens

http://dhaka.usembassy.gov/warden_message_may21_08.html

Gee, I wonder what they might be discussing at this meeting for American

citizens at the embassy in Bangladesh.

It might have already been scheduled but the timing sure is interesting...