Pandemic News/Awareness - Thread 3

Indonesia: The penny drops

http://crofsblogs.typepad.com/h5n1/2008/06/indonesia-the-p.html

This kind of censorship is dangerous. There should be international

repercussions. Isn't Indonesia a US ally?

After almost two years of successfully suppressing news of poultry

deaths, the Indonesians rightly concluded that they could get away with

suppressing news of human deaths.

The Indonesians, alas, are not the only quiet ones. OIE has kept its

bureaucratic mouth shut as well, leaving it up to the rest of us to notice

when something was going very wrong. The world media, understandably

more interested in humans than in poultry, didn't pick up on the OIE's

deafening silence.

What is the OIE?

www.newfarm.org/columns/elbert/2003/sept/091903.shtml

OIE stands for Office International Des Epizooties. It's easier to think of it

as the World Organization for Animal Health. It has been in existence since

1924, when 28 countries signed an international agreement. Today 164

countries are members of OIE.

Each member country undertakes to report the animal diseases that it detects

on its territory...

North Korea

http://www.flutrackers.com/forum/showpost.php?p=162945&postcount=1

Because of the political secrecy in North Korea, there is no way to confirm

this report but it is likely to be true given the tremendous outbreak of

H5N1 in South Korea.

The case was first reported June 3, when several birds were found dead in

a small mountain area near the military base, said the aid agency. There

were no details on whether it was the H5N1 virus, which can be deadly to

humans.

South Korea's Unification Ministry said it could not immediately confirm the

report.

Separately, dozens of magpies were found dead inside a political prison

camp in Hwasong in North Hamgyong province, the aid group said.

A prison camp official's 5-year-old child subsequently suffered a high fever

and died, the group said. There was no way to confirm if the child caught a

virus from the birds or to know what killed the child.

The Buddhist-affiliated group that sends food and other aid to the North also

said two prisoners showed similar symptoms and three others were

subsequently diagnosed with an unidentified virus.

http://www.recombinomics.com/News/06110801/H5N1_NK.html

hong kong

http://afludiary.blogspot.com/2008/06/hong-kong-bird-flu-discovered-in-4.html

what a difference a couple of days makes.

on monday hong kong authorities were sounding the all-clear, saying that no

other live markets tested positive for the virus.

that was then. this is now.

hong kong officials say they plan to slaughter all live poultry in the

territory's street markets after detecting the dangerous h5n1 bird

flu virus.

agriculture, fisheries and conservation director cheung siu-hing said

tests returned wednesday showed birds infected in four markets.

of particular concern is that these infected birds were discovered by

routine testing, that no unusual bird die offs had been reported, raising

the specter that these birds are asymptomatic carriers of the virus.

UK : Testing Dead Swans In Wales

http://afludiary.blogspot.com/2008/06/uk-testing-dead-swans-in-wales.html

Finding dead swans is an ominous sign, a warning signal that a highly pathogenic

virus could be present. Unbelievable, for them to ignore this because there were

less than 10 dead.

The following link demonstrates exactly the type of response that we would

expect from an agency that does not want to find a positive result.

Positive results look really bad, and have economic consequences. So what

do they do? They try not to test, but then they relent after the specimens may

have already degraded.

Where have we seen this type of response before? How about in Canada?

Geese died on a farm on Prince Edward Island. The specimens were not

tested for several days, and were, of course, degraded. Strangely the testing

lab would not even reveal the size of the PCR insert. Why? Because if they

did, we would know whether or not it was a highly pathogenic virus. Oh,

but public health did however, offer the people on the farm Tamiflu.

DEFRA's response is irresponsible, and is dangerous to world health.

http://www.recombinomics.com/News/06130801/H5N1_Swan_England_Concern.html

Mr Jones said he was initially advised by Defra that the government would

not test for bird flu in cases involving less than 10 dead wild birds.

He was advised to safely bag up the birds in black bin liners and throw

them into a waste bin.

But last night the Welsh Assembly confirmed experts would test the

carcasses today, as part of the avian flu surveillance programme.

They stressed at this stage there was no evidence bird flu could be the

cause of death.

Indonesia Agrees To Resume Bird Flu Notifications

http://afludiary.blogspot.com/2008/06/who-indonesia-agrees-to-resume-bird-flu.html

If you believe that they will report their bird flu cases either in humans or

birds in a "timely manner" then I've got some swamp land in Florida that

I'd like to sell you...

... a senior official at the World Health Organization has announced that

Indonesia's Health Minister Supari has agreed to resume notifying the WHO

in a timely fashion about bird flu cases and fatalities.

Although the statement by Dr. David Heymann at the WHO that "the minister

will continue - as she has been - notifying WHO . . . " doesn't really inspire

a lot of confidence.

...Indonesia hasn't filed an OIE report on infected poultry since September of 2006.

HOW BAD WILL THE PANDEMIC FLU BE?

A strong message from the Association of Professionals in Infection

Control and Epidemiology (APIC).

http://tinyurl.com/6qa67t

This analysis by Dr. Michael Osterholm of CIDRAP appeared in Nature in

May of 2005:

http://tinyurl.com/6lkkwh

Rumors from North Korea

http://crofsblogs.typepad.com/h5n1/2008/06/more-on-the-rum.html

No way to know if this is true or not due to the secrecy there but given

the magnitude of infection in South Korea, it is certainly possible.

The provincial government of the Jungpyung county announced the disease

was similar to the' bird-flu', instead of announcing that it was in fact the

'bird-flu'. Following morning, several numbers of birds were found dead

in the Jungpyung County.

The local government has designated the frequently used roads as the

epidemic area and made a notice to the residents to look out for estranged

symptoms from their livestock (poultry).

There is no particular plans to combat the epidemic except the slogans that

says 'Prevent the Bird -Flu Epidemic' in most of the public places such as

factories, public enterprises.

CIDRAP on Indonesia

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun1308indo.html

Today's AP story says that a 34-year-old woman named Susi Lisnawati died

of avian flu Jun 3. Speaking anonymously, a senior health ministry official

and four other health workers confirmed the case to the AP. But the

government had not yet notified Lisnawati's husband, Ali Usman, that she

had the virus, according to the story, which came from Bitung, a city near

the northeastern tip of Sulawesi island.

The case has not been reported in the local news media, and it took the AP

a week to track down and confirm it, the report said.

The case apparently raises Indonesia's H5N1 death toll to 110, out of a total

of 135 cases. The WHO's tally for Indonesia stands at 133 cases with

108 deaths; the agency has not yet included Lisnawati and a 15-year-old girl

whose case was announced by Supari just last week, though she had died

May 14.

Under the IHR--agreed to by all WHO member countries--governments are required to

quickly report cases of diseases labeled as global health threats. Novel influenza strains

are among the diseases that countries are specifically obligated to report.

Indonesia has been at odds with the WHO since early 2007, when Supari announced the

government would no longer send H5N1 virus samples to the agency. The country wants

guarantees that it will receive a supply of any vaccine derived from the isolates it supplies.

The WHO has relied for decades on free sharing of flu viruses in its effort to identify new

strains, develop vaccines, and monitor drug resistance.

http://crofsblogs.typepad.com/h5n1/2008/06/the-death-of-li.html

More on the Indonesian Case

She was not placed in isolation in the hospital. She was buried in traditional manner with

body bathing & no sealed casket. Youngest child given tamiflu. No apparent contact

with poultry.

Also, apparently, Indonesia is going to start reporting on Monday - a monthly recap of the status

of bird flu deaths.

Indonesia - The Disinformation Campaign

Getting the top award for deliberate disinformation on bird flu

infections in humans as well as birds is, Indonesia!

http://www.recombinomics.com/News/06170801/H5N1_Indo_Disinformation.html

...there have been four recent cases which have not been reported because

of mis-diagnosis, which include respiratory disease, dengue fever, typhus,

and H5N1 negative. These mis diagnosis have been associated with

comments from high ranking health officials (Health Minister, Director

General of Communicable Diseases, and Health Ministry spokeswoman).

This disinformation campaign goes well beyond the cases missed because

of lack of testing or lack of sensitivity in the H5N1 tests and raises significant

pandemic concerns.

Second Runner Up - China

Well, the Olympics are coming, what else can they do, and compared

to Indonesia, they look like an open book...

The Hong Kong Outbreak

http://www.flutrackers.com/forum/showpost.php?p=163698&postcount=108

They slaughtered all poulty in the wet markets of Hong Kong. No one

knows how the birds got infected. They vaccinate them for H5N1 on the

farms. No positives in any of the farms, they said.

Now they are worried about all of the chickens that have already been

sold, some 90,000, and are warning the public to be cautious.

http://www.flutrackers.com/forum/showpost.php?p=163753&postcount=112

Hong Kong SAR authorities received a briefing after the timely deployment

of the Guangdong Provincial Department of Agriculture veterinary

departments to do a good job in monitoring. This year, Guangdong

Province, a total of monitoring poultry serum samples 58,600 copies, the

rate of qualified immunity provisions of international standards;

monitoring pathogens in the 18,960 samples, found no positive

samples.

Meanwhile Today, Back in Guangdong

http://www.flutrackers.com/forum/showpost.php?p=164256&postcount=2

Just a coincidence, nothing to worry about...

China on Tuesday reported a bird flu outbreak in ducks in the southern

province of Guangdong, close to Hong Kong where poultry at all

commercial markets was culled last week.

The Guangdong outbreak, in a village administered by Jiangmen city, was

first detected on June 13, the official Xinhua news agency said.

The National Avian Influenza Reference Laboratory confirmed on Tuesday

that the virus the birds contracted was a subtype of the H5N1 strain, Xinhua

quoted the Ministry of Agriculture as saying.

A total of 3,873 ducks died of the disease and a further 17,127 were

culled as part of a contingency plan that the report said had effectively

contained the outbreak.

Poultry Deaths on Kamchatka Peninsula Near Alaska

http://www.recombinomics.com/News/06190801/Poultry_Kamchatka.html

There have been excessive poultry deaths in Kozyrevsk on the Kamchatka

peninsula in eastern Russia. They are saying negative for now, but

H5N1 has been detected about 400 miles to the south of this area.

Our testing in Alaska and Canada is questionable for accuracy at this time.

They keep testing fecal samples instead of pharyngeal as well as other

questionable practices that could lead one to believe that the testing

methods are not as serious as they need to be. Are their PCR primers

up to date? Probably not...

These Russian poultry deaths could be significant for North America.

This is only 400 miles from Alaska.

The above translation describes excessive poultry deaths in Kozyrevsk

on the Kamchatka peninsula in eastern Russia, approximately 400

miles from Alaska (see satellite map). Although initial tests are

negative for bird flu, samples have been sent to Moscow for further

analysis.

There have been recent H5N1 outbreaks just to the south of this

location in Japan, Russia, and South Korea.

How Scientists in Alaska Think

http://alaskareport.com/news68/ned71132_alaska_bird_flu.htm

The U.S. government spent millions in the last few years to enable

biologists to capture migratory birds and swab their rear ends to

search for signs of a deadly virus first found in Hong Kong in 1997. Since

2003, the Asian H5N1 virus has spread west across Asia to Europe and Africa,

and has killed more than 240 people.

Alaska, so far, is clean.

Indonesia Sharing H5N1 with the WHO

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun1908indo-jw.html

Here there are two different stories regarding the transparency of information

on human cases of bird flu in Indonesia. First, this is what the WHO is saying

as per CIDRAP.

The two latest cases raise the WHO's H5N1 count for Indonesia, the

hardest-hit country, to 135 cases with 110 deaths. The global

count has reached 385 cases, including 243 deaths.

Heymann told Reuters that Indonesian authorities were trying to confirm

another suspected H5N1 case that was fatal.

According to Reuters, another WHO official said the agency has a good

relationship with Indonesia, despite the country's reluctance to share

H5N1 virus isolates. Indonesia is seeking guarantees that it will receive a

supply of any vaccines developed from the isolates it provides.

"There is a strong working relationship between the WHO country office

and the government," John Rainford, a WHO spokesman in Geneva, told

Reuters. "Even if there is a conflict on issues like virus-sharing, it hasn't

eroded the ability to carry out joint investigations."

A WHO official who requested anonymity told CIDRAP News this week that

the agency had been aware of recent H5N1 cases in Indonesia despite the

delay in receiving official notification.

Speaking before the latest case confirmations, the official said, "The fact

that you don't yet have official notification of any cases doesn't mean there

isn't unofficial awareness." He said the two recent cases didn't change WHO

experts' assessment of the risk posed by the virus.

(hat tip Avian Flu Diary)

Emmy Fitri On Indonesia's Case Counts

http://afludiary.blogspot.com/2008/06/emmy-fitri-on-indonesia-case-counts.html

Next, this is what a knowledgeable journalist in Indonesia is reporting.

No one knows for sure how many people have died of this disease or where

the virus has hit? Moreover, do not expect to learn what abilities the virus

has developed because it is free-ranging, unobserved, on the loose, or let

loose.

Officials at the Health Ministry are also in the dark. "We're not supplied with

updates on bird flu cases in humans anymore. Try tomorrow, I can ask

around," a ministry official replied last week to a query on the latest death toll.

Even worse, the usual standardized procedure for treating a suspected

case of bird flu reportedly has not been performed since the minister decided

no longer to publicize human cases of bird flu . The procedure includes placing

the suspected patient in an isolation room during treatment, requiring doctors

and nurses to wear protective masks and gloves and the distribution of

antiviral drugs to close family members of the patient. In the past,

suspected bird flu patients were not charged a rupiah for treatment, medicine

and even for coffins if they did not survive.

H5N1 Misdiagnosis In Indonesia Hides Human to Human [H2H Transmission

http://www.recombinomics.com/News/06200801/H5N1_Indo_Hide_H2H.html

H2H has been vigorously denied at the highest levels in Indonesia, and

the WHO updates act as enablers for this dis-information. Although the

growth of these clusters appear to be somewhat limited, analysis is

difficult because of the more widespread use of Tamiflu, which lowers the

H5N1 levels and leads to false negatives, especially in mild cases which

may be contacts of the confirmed cases.

WHO has defended its position by saying that the H5N1 transmission in

Indonesia has remained unchanged, but that analysis is based on the

small number of reported cases. The statements from the highest levels

in Indonesia on the effect of H5N1 on Indonesia's image and the blackout

on suspect and fatal cases do not support a transparent policy or aggressive

testing of suspect cases. These policies support the silent spread of H5N1

in Indonesia, which is not being effectively monitored by current policies and

practices in Indonesia and at the WHO.

http://www.recombinomics.com/News/06200803/H5N1_Indo_WHO_Omission.html

WHO Commission By Omission On H5N1 H2H In Indonesia

...when WHO did publish the update, the exposure to sick and dead poultry

was mentioned, but the exposure to the brother of the confirmed case was

not. He had died 10 days prior to the death of the confirmed case, strongly

suggesting that he infected the confirmed case. Although the brother

was misdiagnosed with typhus, neither the typhus diagnosis nor his death

was included in the update. Similarly, the hospitalization of another

brother after the death of the confirmed case was also not mentioned.

The second brother tested negative for H5N1, but false negatives are

common in Indonesia, especially for samples collected after the start of

Tamiflu treatment. Such treatment is common for contacts of confirmed

cases.

Thus, this cluster had at least three family members, and the death of the

first brother strongly suggests that he was H5N1 infected and infected his

sister, who may have then infected her other brother, based on disease

onset dates. WHO consultants are well aware of the frequent misdiagnosis

of H5N1 cases in Indonesia. Such misdiagnosis in patients who were

subsequently H5N1 confirmed were tabulated in a New England Journal

publication from the beginning of this year.

On condition of anonymity, the WHO official above noted that this cluster

was not behaving in a usual manner. This comment is supported by

additional clusters in March, which also included an H5N1 confirmed case

linked to a fatally infected family member who was diagnosed as having

lung inflammation or dengue fever. However, although such clusters are

common in Indonesia, these clusters do not appear in WHO situation

updates, or in WHO comments on new cases.

http://afludiary.blogspot.com/2008/06/indonesia-some-bird-flu-cases.html

Indonesian Scientist Admits Misdiagnosis Occurring

Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease

Hospital in Indonesia, told an infectious disease conference in Kuala

Lumpur that misdiagnosis and the late administration of drugs were

partially responsible for the high mortality rates.

"It (H5N1) is misdiagnosed initially as dengue, bacterial pneumonia,

typhoid and upper respiratory tract infection because of similar clinical

features (symptoms)," Giriputro said.

H5N1 H2H Transmission Dictates New Pandemic Alert System

http://www.recombinomics.com/News/06210801/H5N1_New_Alert.html

Commentary from Dr. Henry Niman at Recombinomics on the WHO

revision of the pandemic alert system, and why it has been

changed.

Dr. Niman has done an excellent job of following the trail of cases of

suspected human to human transmission of bird flu. He makes an

interesting case for the reality of how frequently in actuality, that H2H

has been occurring. Apparently this has been going on for some time

but is seldom acknowledged.

H2H means human to human transmission of H5N1. B2H is bird to

human.

The World Health Organisation (WHO) has released details of a new flu

pandemic alert system to replace its existing one, which has been

criticised for lacking clarity.

Currently, the world is in phase 3 of the alert system, which is defined as

"no or very limited human-to-human transmission". The six-step, three-

layer alert system is a ladder going from "low risk of human cases" in

phase 1 to "efficient and sustained human-to-human transmission" in

phase 6, the pandemic phase.