Pandemic News/Awareness - Thread 3

H5N1 H2H Under-reporting Supports Complacency

http://www.recombinomics.com/News/06220801/H5N1_H2H_Complacency.html

I don't know what the reasons are for the WHO decision though

Dr. Niman seems to think it is economic. Maybe, it is.

However, he does make a convincing argument for increased

human to human transmission as noted in the prior post and

that is what most interests me.

H2H transmission is at the core of the current pandemic alert system.

The current phase 3 is linked to no or low H2H transmission. Phase 4

represent increased transmission, while phase 5 is significant transmission,

and phase 6 is sustained transmission. There has been increased H2H

transmission since 2005, as measured by virtually any parameter (number

of H2H clusters, size of H2H clusters, length of H2H transmission chains, or

expanded global reach of H2H clusters).

However, raising the pandemic level to 4 would initiate a large number of

costly pandemic preparedness measures, so the WHO has used a number

of approaches to minimize the number of such clusters, which has been

actively embraced by a number of affected countries. The activities have

been ongoing for several years, but have become the subject of recent

media coverage due to Indonesia's decision to reduce reporting on

confirmed or fatal H5N1 cases, at a time when glaring H2H clusters were

being under-reported by Indonesia with support in WHO updates which

failed to describe the fatalities in relatives with bird flu symptoms.

Some Other Thoughts - Different Sources

http://afludiary.blogspot.com/2008/06/just-new-phase-we-going-through.html

Elevating the alert level would likely trigger a number of prescribed actions,

some of which would be expensive and perhaps interfere with trade and

travel. Raising the alert to Phase IV could have had serious economic

and political ramifications.

In the end, the WHO decided to wait and see if additional clusters appeared,

indicating sustained transmission of the virus - and so the alert phase

remained unchanged.

Of course, in doing so, they had to carefully porifice the definitions of

increased human-to-human transmission'- the criteria for phase IV -

in order to remain at phase III. Along the way they admitted that the

existing pandemic scale was `ambiguous' and needed revising.

http://www.scottmcpherson.net/journal/2008/6/20/good-news-bad-news-on-indonesian-bird-flu-front.html

Dr. Henry Niman and others have warned for years that the hasty

administration of Tamiflu without first taking necessary samples causes

false negatives and hinders accurate reporting of human H5N1 cases.

This new report from the Boots On The Ground confirms this in a

decisive and final way. It lessens the viral load and allows H5N1 to

"fall under the radar" of reporting. Likewise, Dr. Giriputro has also

declared -- on and for the record -- that quick test kits are unreliable

for use as the "last word" on whether or not H5N1 is present in someone.

So what can we deduce from all this?

First, there are many, many, many more unreported cases of human

H5N1 than we see in the press. This may be a "DUH" to us, but it is

important to see this in the global media. And it is equally important

that we are vindicated in that venue as well.

Second, we are unable to get some important viral changes mapped,

because these people are getting Tamiflu and testing negative. That

may be good in terms of living, which is always nice, but it does mean

that any genetic changes in the virus from these people are going

undetected.

Third, Indonesia is a human incubator of H5N1, and we must continue

to monitor the situation there 24/7/365, preferably with the full

assistance of the Indonesian government.

Pakistan Reporting Bird Flu in Poultry

http://www.flutrackers.com/forum/showpost.php?p=165228&postcount=14

...the WHO and police officials, district coordination officer and Livestock

and Dairy Development Department staff rushed to Hamid Poultry Farm

and directed the concerned staff for culling the broilers. There were total

6,000 broilers in which 4,000 had already expired and the remaining 2,000

were culled, said an official.

"We sent the samples to Islamabad laboratories and a positive report of

avian influenza virus was received. It created an alarming situation across

the district and the vet doctors were told to rush to the area on emergency

basis," said a doctor.

...the Health Department put the people in a radius of three kilometres of

the Hamid Poultry Farm under observation and their tests would be

conducted...

http://www.recombinomics.com/News/06220802/H5N1_NW_Pakistan_2.html

Although the above comments note that no farm workers had symptoms,

disease onset dates are usually 2-4 days after exposure, so the above

clearance may be premature.

The location is near the human outbreak that began in October, 2007, but

was not reported until December. Three brothers were H5N1 confirmed

and the familial cluster defined human to human to human transmission.

Bird Deaths on Russian Islands Near Japan

http://www.recombinomics.com/News/06240802/Birds_Kunashir.html

The Russians are saying the tests are negative for bird flu so far but

the location where the birds have died is worrisome as it is close

to other areas that have positive cases not to mention the close

proximity to Alaska.

Check the map for location:

http://tinyurl.com/6rzqc3

Like the excessive poultry deaths on Komchatka, thus far the testing has

not produced confirmation of H5N1, but the location of the dead or sick

birds raises concerns that the Fujian strain of H5N1 is migrating north

along the East Asian flyway, which links to Alaska.

Supari: Namru-2 is of no benefit to Indonesia

http://crofsblogs.typepad.com/h5n1/2008/06/supari-namru-2.html

The fate of the US Naval lab, NAMRU2 is probably going to be decided

by the controversial Health Minister, Supari. She has not only been

refusing to send viral samples of H5N1 from human cases in Indonesia

to the WHO, and but has initiated news censorship of the true extent of

human and poultry cases in Indonesia.

I am wondering how much money has the world already given to

the corrupt govt in Indonesia for tsunami relief? Who is paying for the

enormous amount of Tamiflu that is being used there? Isn't this

country supposed to be a US ally?

Health Minister Siti Fadilah Supari refused to respond to written questions

posed by the House of Representatives` Commission I to her on the

presence of the US Navy`s medical laboratory Namru-2 in Indonesia.

"To me, nothing needs to be explained because the presence of

Namru-2 is obviously of no benefit to Indonesia," the minister said in a

working meeting with the House`s Commission I here on Wednesday.

"The Namru-2 laboratory is not any better than our own laboratories

such as the Eijkman Laboratory in Bandung. Why didn`t Commission I

visit our own laboratories which are of clear benefit to the country?"

she said.

Minister Supari said the health ministry`s Health Research and

Development Center had gained nothing from Indonesia`s cooperation

with Namru-2.

"We only got small research jobs, while when we asked cooperation

in tuberculosis (TBC) research, they refused because they did not have

any interest in it," she said.

The US Embassy's Fact Sheet on NAMRU2

http://www.usembassyjakarta.org/press_rel/April08/FactSheetNAMRU2.html

It would appear that no matter how much is done for Indonesia, it will

never be enough for Supari. She seems to be infected with a terminal

sense of entitlement.

What has NAMRU-2 done for Indonesia?

* They continuously provide essential training in fundamental laboratory

techniques to hundreds of Indonesian health workers and researchers.

* They have trained over 50 Indonesian scientists in the laboratory

cultivation of malaria parasites and in sophisticated disease detection

methods.

* They train 30 Indonesian university students each year in virology

and bacteriology techniques.

* They demonstrated that primaquine prevents malaria, thereby making

this common and affordable drug useful to Indonesians who travel to

high-risk areas.

* They led a $4 million effort against a malaria epidemic in Central

Java; annual malaria cases decreased from 70,000 to fewer than 4,000.

* They provided training, advanced testing, supplies and epidemiology

support to the Ministry of Health to characterize recent dengue outbreaks

in Palembang, Bandung, Jakarta, Yogyakarta and Medan.

* Provides job for over 150 Indonesians.

* They donated a fully furnished research laboratory in Jayapura, Papua, to LITBANGKES.

Present Situation and Clinical Features of A/H5N1 Human Infection

http://www.flutrackers.com/forum/showpost.php?p=166010&postcount=26

Here are the disturbing facts about bird flu in Indonesia from an

abstract of a presented paper at the 13th ICID - Kuala Lumpur,

Malaysia- June 19-22, 2008 ( also posted in the Scientific Library

Forum). They are saying that Tamiflu has not worked for these

cases.

A proportion of the cases (about 50%) had history of direct contact with

sick, healthy or died poultry, 30% had history of indirect contact with

poultry in the environment either sick or healthy. In about 20% of

the cases the history of contact to source of infection could not be

concluded.

Fever, cough and breathlessness are the most frequent encountered

clinical feature. For the purpose of screening some criterias for suspect

are used: ILI, ARI or pneumonia with history of contact with AI source

of infection, rapid progressive pneumonia leading to ARDS or fatality,

unresponsive pneumonia treated adequately with antibiotics, clustering,

or when viral infection is likely (leucopenia, lymphopenia). Antibiotics

are used as initial treatment of CAP empiricly and when there is

evidence of secondary bacterial infection. Antiviral treatment with

oseltamivir has limited clinical benefit especially when given earlier.

Limited news reports from Indonesia

suggest that Tamiflu is currently still effective, so I interpret this phrase

to mean that it does work if given shortly after infection or possibly used prophylactically.

Hello, Al. You are probably right! Of course, I did read this originally at

1:30 am after working a very stressful shift on a pysch unit. I suspect

my analytical ability was not up to snuff.

The questionable wording:

" Antiviral treatment with oseltamivir has limited clinical benefit

especially when given earlier. "

Or:

"Antiviral treatment with oseltamivir has limited clinical benefit

especially when given earlier. "

I did find this very confusing since using Tamiflu during the first

48 hours seemed to be the standard of care. It is true that the Tamiflu

blanket must be still effective or they would not go to the trouble of using

it to protect groups of people at risk.

However, if you tell me that a drug has "limited" clinical benefit

though, I am going to think that it is not very effective even though this is

all there is to work with. Of course, if someone is misdiagnosed, then

they might not get Tamiflu early enough...

Maybe, the wording could have been better in this abstract.

Lost in translation perhaps? Or this reader needs more sleep...

Nice to hear from you, though.

H5N1 Pre and Post-Pandemic Vaccine Concerns

http://www.recombinomics.com/News/06230801/H5N1_Vaccine_Concerns.html

Here is the situation. Several countries have stockpiled some type of

prepandemic vaccine, the US among them. The problem, or problems

I should say, are these. There isn't nearly enough vaccine, and these

are based on older strains of H5N1 that may not be effective on the actual

pandemic strain, whatever it might be, since viruses constantly evolve.

And, btw, the shelf life is about to expire on the first US prepandemic

vaccine in about 18 months.

Question, so what is the most effective use for these soon to be outdated,

limited supply of immunizations? Dr. Niman of Recombinomics answers,

but govt may not like the suggestions. They would rather keep these

vaccines on hand to have something to give out to a few million people

even if it doesn't work.

Here is a smarter solution, that might just be in the world's best interest.

Give them away now. Give them to the countries where humans are

being infected right now to help delay adaptation of the virus to humans.

We can only benefit from what otherwise will just be an expensive waste

as the virus evolves away from the early strains these vaccines were

based on.

Both the 1918 and 1968 pandemics showed a wave as lasting 17 weeks

with a peak at week 8.

Current estimates for start of vaccine production in the EU from time of

identifying the pandemic virus is 22 weeks. This would likely still be of

some use but may be better characterized as a 'post pandemic' vaccine

or at least post 1st wave.

..the dramatic spread of clade 2 was been recent, and it accounts for

virtually all reported human cases in the past few years. However,

most approved pre-pandemic vaccines target clade 1, which was the

H5N1 in humans when vaccine development programs began in early

2005.

Stockpiling these vaccines, or those targeting early clade 2 isolates, will

not be optimal for the current clade 2 in circulation, as the various sub-

clades evolve away from the 2005 isolates. Thus, these vaccines may

be useful for priming patients now, but would have limited utility for a

raging pandemic, and may in fact drive H5N1 evolution because of poor

matches as seen in poultry vaccines.

However, use of these vaccine now, when H5N1 has not been

established in human populations could delay adaptation to humans

by reducing the number of human H5N1 infections.

Migration of H5N1 Clade 9 Into Indonesia

http://www.recombinomics.com/News/07040801/H5N1_Indo_Clade_9.html

To better understand the Recombinomics commentary, here is the

definition of a clade from this govt site:

http://www.pandemicflu.gov/glossary/index.html

clade: A group of organisms, such as a species, whose members share

homologous features derived from a common ancestor. The avian virus

H5N1 clade 1 includes human and bird isolates from Vietnam, Thailand,

Cambodia, Laos, and Malaysia. Clade 2 viruses have been identified in

bird isolates from China, Indonesia, Japan, and South Korea.

homologous: Similar in position, structure, function, or characteristics.

H5N1 is endemic in Indonesia, so it seems easy to forget that it winged it

there from somewhere else, and now this Clade 9 has appeared. I am

not the only one wondering if this will be a threat to Australia at some point.

This new clade represents an independent introduction, and the public

sequences...are limited to waterfowl and are most closely

related to clade 9 sequences in China.

The location of the clade 9 sequences suggest that the Indonesian

sequences were due to migratory birds flying along the Australia /

East Asia Flyway and raise concerns that the current public

sequences from Indonesia seriously under-represents the H5N1

diversity in Indonesia.

Reports of Vaccine Resistance to H5N1

Two different countries on two different continents now

reporting problems with bird flu vaccine effectiveness.

Of course, they are referring to a vaccine used only for

birds. There is no vaccine in use for humans at this time.

Vaccine Resistant H5N1 in Hong Kong

http://www.recombinomics.com/News/07070804/H5N1_HK_Vaccine.html

The bird flu vaccine used for local chickens is gradually losing its

effectiveness, and total failure is not too far away, a leading

microbiologist warned yesterday.

This is happening because the H5 virus, which causes bird flu, is

shifting further away from the so-called Fujian strain against which

the vaccine was originally effective, the University of Hong Kong's

head of microbiology, Yuen Kwok-yung, said.

H5N1 Endemic in Egypt

http://www.recombinomics.com/News/07070802/H5N1_Egypt_Endemic.html

The event is unlikely to be contained and is now considered to be

endemic. No more follow-up reports will be made, but instead,

information about this disease will be included in the future six-

monthly reports.

The above comments from the OIE final report from Egypt declare

H5N1 endemic. Consequently, updates will be submitted at six month

intervals. The declaration is not a surprise. At the end of 2007 and

beginning of 2008, Egypt reported widespread outbreaks in spite of

an extensive vaccine campaign. Many of the H5N1 outbreaks were

in vaccinated flocks...

Concern Justified

http://afludiary.blogspot.com/2008/07/expert-poultry-vaccine-losing.html

Sometimes the use of vaccines might not be the best idea. It

would appear that it can result in unintended, disastrous consequences.

While the use of poultry vaccines is controversial, and certainly not

universally accepted, in many countries where the H5N1 bird flu virus

is endemic their use is widespread.

The concern has always been that vaccinated flocks could contribute to

the silent spread of the disease due to incomplete protection from the

virus, resulting in asymptomatic, but infectious birds.

human adaptation of the h5n1 virus

http://afludiary.blogspot.com/2008/07/study-human-adaptation-of-h5n1-virus.html

silently spreading and adapting to humans in the countries where the

h5n1 virus is now endemic, infections are misdiagnosed, under reported

or never reported as the news about bird flu is now heavily censored. how

is it going to be possible to stop the global expansion of avian influenza?

obviously, it isn't going to be stopped.

"the mutations needed for the emergence of a potential

pandemic virus are likely to originate and be selected within infected

human tissues," said professor dr prasert auewarakul from mahidol

university, thailand. "we analyzed specific molecules called

haemagglutinin on viruses derived from fatal human cases. our results

suggest new candidate mutations that may allow bird flu to adapt to humans."

viruses with a high mutation rate such as influenza virus usually exist as

a swarm of variants, each slightly different from the others. these are

called h5n1 bird flu quasispecies. professor dr auewarakul and his

colleagues found that some mutations in the quasispecies were more

frequent than others, which indicates they may be adaptive changes that

make the virus more efficient at infecting humans. most of these

mutations were found in the area required for the virus to bind to the

host cell.

"this study shows that the h5n1 virus is adapting each time it infects a

human," said professor dr auewarakul. "such adaptations may lead to

the emergence of a virus that can cause a pandemic. our research

highlights the need to control infection and transmission to humans to

prevent further adaptations."

each human infection is viewed as another opportunity for the

h5n1 virus to adapt to human receptor cells.

this study, using virus samples from various organs removed during

autopsies, showed the virus doing exactly that. adapting each time it

infects a human host.