Pandemic News/Awareness - Thread 3

mystery fatal disease in bangladesh linked to poultry?

http://www.recombinomics.com/news/07070803/bangladesh_mystery_poultry.html

bird flu? since the cases are all in children, that seems unlikely.

but why tell the people not to eat poultry? not a word about tamiflu

being given out but then this is bangladesh, and they have no prior

experience with this disease. no word on the who expressing any

any concern with this story either.

an unknown disease has claimed lives of two children

in last one week at barakpur union under digholia upazila in khulna district

while 44 children are now under treatment at upazila health complex.

people of the affected area had been advised not to eat any kind of meat,

especially fowl...

the above comments describe a mystery disease in bangladesh. although

the diagnosis of viral encephalitis would include a variety of viral etiologies,

the advice to avoid eating fowl raises h5n1 concerns.

in the recent outbreak earlier this year, there was one confirmed h5n1

case in dhaka, bangladesh.

however, the size of the outbreak in bangladesh and neighboring

west bengal raised concerns that the number of h5n1 cases in both

countries was markedly higher than the one confirmed case.

h5n1 has a neurological tropism in humans and birds...

The Sounds Of Silence

http://afludiary.blogspot.com/2008/07/sounds-of-silence.html

There are many possible reasons for why we are hearing much less news

from around the world about H5N1. Has the virus just gone away?

That does seem extremely unlikely.

Typically, there are far fewer outbreaks this time of year, but the truth of

this situation would appear to be far more complicated than just that. Here

is an excellent analysis of the many possible as well as the probable reasons

for the silence.

Looking at Pakistan, for example, it is easy to see that talking about the

unpopular subject of bird flu in that country can be downright dangerous.

No doubt, this technique of silencing is also being used in North Korea,

Myanmar, China, Egypt, and Indonesia.

Additionally, there are also other methods in use for avoiding the truth

about the spread of bird flu that are not included in this post. They have been

pointed out many times in the older threads on pandemic influenza.

In Pakistan, we recently saw the spectacle of a Basic Livestock Officer

named Mohammad Ibrahim who was made a scapegoat for revealing that

the H5N1 virus had been detected on a farm in Swabi.

Never a shining example of transparency to begin with, Pakistan

provoked the ire of international health officials with this blatant act.

Ibrahim's immediate transfer to another district was a public punishment

designed to send a signal to all other government employees to keep their

mouths shut about avian influenza.

Whatever happened to bird flu?

http://www.nature.com/news/2008/080709/full/news.2008.945.html

From the journal, Nature:

Although some countries are making progress controlling the disease,

the prospects are bleak. Experts are now convinced that the disease has

become endemic in Indonesia, Bangladesh, Vietnam and Egypt, making

eradication impossible. That makes it inevitable that outbreaks will continue

elsewhere as the poultry trade helps to spread the virus.

In 2007, outbreaks in poultry or wildlife were reported in 28 countries.

Twenty two countries have reported outbreaks this year, with South Korea

having its worst outbreak ever in April. Sixty one countries have now been

affected, and the H5N1 virus remains a major threat to agriculture and food

supply, and to human health.

Might bird flu still reach the Americas?

Yes. That it hasn't already is mostly down to good luck, and relative

geographic isolation. If it enters the Americas it could be a disaster for the

food industry in Latin America-Brazil is the largest producer of poultry.

(hat tip croftsblogs)

with permission from recombinomics:

h5n1 pre-pandemic vaccinations

http://www.recombinomics.com/news/07090801/h5n1_pre_vaccine.html

unfortunately, the overall control picture is bleak.

thailand, vietnam and china have notched up successes in curbing

outbreaks in birds, which is key to minimizing the chance that the virus

can pass to humans.

but south korea had its worst outbreak ever in april, and the disease has

become endemic in indonesia, bangladesh, vietnam and egypt.

the commentary on page 162 endorses what might be an intriguing

adjunct: 'pre-pandemic' vaccines, which would be matched not to the

exact pandemic strain, but to earlier variants.

even if these vaccines were only partly effective, advocates argue, they

might confer sufficient protection to prevent death or severe disease.

although this idea is untested, it merits consideration-especially as

strain-specific vaccines would be available only several months into the

pandemic, and even then would be in very short supply.

the above comments in today's nature highlight the downward spiral of

efforts to contain h5n1. since its explosion out of china in late 2003,

h5n1 has expanded its geographical reach to over 60 countries, most of

which were due to the spread of h5n1 into europe, the middle east, and

africa. as noted above, the countries initially hit by h5n1 in late 2003

and early 2004 have fought a losing battle and h5n1 has been declared

endemic in multiple asian countries, and within the past week has been

declared endemic in egypt also.

a recent report on h5n1 from patients in thailand has identified quasi-

species with multiple receptor binding domain changes, including s227n,

which has been reported in human cases in turkey and egypt in 2006 and

2007, as well as m230t. m230i has been linked to fatal cases in egypt,

while the vaccine resistant strain in egypt and israel has m230v. m230i

is also in the clade 2.3.2 sequences in japan, southeast russia and

presumably south korea, where a soldier/culler has tested positive for

h5. human fatalities have been reported in turkey, iraq, azerbaijan,

and egypt and receptor binding domain changes have been reported in

all human outbreaks.

thus, it has become increasingly clear that the spread and diversity of

h5n1 will pose a significant challenge, and the implementation of a pre-

pandemic vaccine to prime the world's population has significant merit.

With permission from Effect Measure:

Nature looks at the status of avian influenza three years after their Special Issue

I always cringe when I see headlines that say, "Whatever happened to

bird flu?" Usually what comes next is a recital of other "scares" that

never materialized, the poster child being Y2K (although it has been

strongly argued that the reason Y2K didn't happen was precisely

because the business world prevented it with a sustained and intense

effort). The article in question, however, just appearing in Nature

magazine, still the world's pre-eminent science journal, is authored by

one of Nature's senior correspondents, Declan Butler, the same journalist

writing in the same journal who helped put avian influenza on the public

map as a top public health worry back in 2005... So it's interesting to see

his take on the problem better than three years after Nature's special issue:

Q. Is bird flu affecting fewer people now?

Yes and no. The 88 cases and 59 deaths reported last year are lower than

the 2006 peak of 115 cases and 79 deaths, when the virus first arrived in

Turkey and Egypt and sparked a large number of cases there. Thirty four

cases have been reported so far this year.

Vietnam, Thailand and China -- the only countries to report cases from

2003-04 during the current epidemic -- have made progress in controlling

the spread of the virus in poultry. Once major hotspots, all three countries

have consequently seen a significant drop in human cases.

But cases have since cropped up in 12 other countries, with Indonesia

leading at 135 cases -- more than one-third of the worldwide total of

385. A major worry is that Bangladesh, which reported its first human

case in May, might go the way of Indonesia because the virus is firmly

established in the country's poultry. The apparent current downturn in

cases could be short-lived. (Declan Butler, Nature)

Written in question and answer format, Butler surveys the current

situation. I'm pretty much in agreement with his assessments, although

perhaps not as sanguine as he is the situation is improved as much in

southeast asia. The poultry situation, as he observes in his piece,

remains dire, with little progress and lots of extension into new areas

like the Indian sub-continent, where the disease threatens to become

endemic in poultry. He believes the failure to reach the Americas is

just a matter of luck and that time will run out, possibly with devastating

effects on the North and South American poultry industries.

I'm also not so optimistic that the many national plans that represent

the main product of government public health responses represent as

much progress as he implies. Eisenhower's famous dictum that it's not

the plan but the planning is certainly true, but too many government

planners think that The Plan, often represented by hundreds or

thousands of pages of details, is A Sufficient Answer. The Plan will be

out the window in the first week of a pandemic. Like military battle

plans they don't survive the first engagement with the enemy. Too

many of them have been produced mechanically, without the genuine

planning function involving entire agencies that gives them their main

value. Indeed, many of those agencies are in much worse shape than

they were three years ago, as governments continue to disinvest or

defer investment in critical public health and social service

infrastructure. In my view, we haven't made progress in preparedness

but have back slid even more.

Vaccine technology continues to be an active and fruitful area of work,

and given time we will see significant progress there. Given time.

Then, of course, there will be the problem of productive capacity,

distribution, access, etc. Vaccines have significant technical problems,

but the real obstacles are political and economic. Flu scientist

themselves are sometimes part of the ethical and political problem.

In a Commentary on the failure of this year's seasonal flu vaccine in

the same issue of Nature, Steven Salzberg takes WHO and CDC to

task on sharing flu sequences:

The WHO and the CDC have stated publicly that they support placing

sequence data in the public domain. Unfortunately, the WHO's own

centres do not release all their influenza sequences, and when they

do, they often use the Los Alamos National Laboratory influenza

database. This database is, as reported on its own website, "a

private database for collaborators" -- access is restricted to a

private group of subscribers. A closed database limits the free

exchange that is so important to scientific research, and it sets the

wrong example. (Steven Salzburg, Nature)

Salzburg could have added some of the world's most eminent flu

scientists to this list. We've discussed this many times here, but we'll

say it again: these scientists are acting unethically when they do not

immediately share their sequences via publicly accessible databases.

Pandemic influenza isn't just any field of scientific research. It is one

of urgent interest to everyone on the planet. Nature could help by

refusing to even submit a morificecript for review unless any sequence

mentioned in the paper has already been deposited in a publicly

accessible database like GenBank.

Butler notes that media interest in bird flu remains high, although it

has moved off the front pages to positions deeper in the news. We

noted the same thing in our post of yesterday, where avian influenza

was the top reported disease in the HealthMap system that datamines

newsreports from all over the world for disease outbreak information.

Like the virus itself, the big headlines have diminished but the disease

is endemic in the news.

The subtitle of Butler's question-titled Nature News piece probably

sums it up as well as anything:

Whatever happened to bird flu?

The media frenzy over bird flu has receded, but the threat of a global

epidemic still looms large.

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.

Poverty of Aspect

SophiaZoe tackles explaining why the current view of comparing

the Case Fatality Ratio of the bird flu of 1918 to the possible CFR

of the next pandemic could be a fatally flawed miscalculation.

The CFR of 1918 bird flu was 2%. The current CFR of H5N1 is

over 60%, clearly a hugh difference should the ratio not drop.

http://birdflujourney.typepad.com/a_journey_through_the_wor/2008/07/poverty-of-aspe.html

We have exactly one pandemic we can look to that falls under what

has been designated the entrance point to be categorized as severe.

As defined by the US CDC a severe pandemic hits the threshold when

at least 30% of a population falls ill and at least 2% of those die.

Just as a Category 5 hurricane begins when winds reach 156 mph

(250 km/h) that does not preclude a Cat5 storm from being stronger,

or have wind gusts significantly higher, there is no scientific support

for the belief that a severe pandemic cannot have a fatality ratio of

greater than 2%. In point of fact, there were many places around the

world that experienced significantly higher fatality ratios during the 1918

pandemic, it being the one and only example we have to look to with any

degree of confidence (such as it is, confidence that is).

September 2006 WHO report:

Influenza Research at the Human and Animal Interface

[snip]

One especially important question that was discussed is whether the H5N1

virus is likely to retain its present high lethality should it acquire an ability

to spread easily from person to person, and thus start a pandemic. Should

the virus improve its transmissibility by acquiring, through a reassortment

event, internal human genes, then the lethality of the virus would most

likely be reduced. However, should the virus improve its transmissibility

through adaptation as a wholly avian virus, then the present high lethality

could be maintained during a pandemic. [emphasis added]

We may not understand the why behind the lethality but that does not

change the fact that it is highly lethal. And while there is no way of

knowing with certainty what the properties of a pandemic strain of H5N1

would be, it is foolish, in the extreme, to ignore the possibility that a

wholly avian H5N1 , though adapted to humans, could retain much, or

a significant portion, of its current lethality.

H5N1 And The Long War Against Flu

http://www.dailykos.com/story/2008/7/13/75023/3837/324/550892

There were 105 comments on this story at the Daily Kos as I read this.

DemfromCt is the writer, a pediatric pulmonary physician. He is also editor

at Fluwiki. Fluwiki is a flu forum that is monitored by Congress so they

must find it useful. This is a political piece, and a very good one. If you

did not realize that pandemic preparation is political perhaps you will after

reading this. The comments that follow contain lots of information.

Like hurricanes, pandemics can't be predicted. We don't know when the next

category 5 storm will hit and where, but the inevitability of severe weather is

matched by the inevitability of flu pandemics. As we all now know, there were

three in the last century (1918, 1957 and 1968) and the 1918 pandemic was

truly devastating. Note the spike in mortality representing the 1918 pandemic.

For that reason (mortality, and especially child mortality), the mitigating

efforts of public health and national security agencies have taken place.

(hat tip Avian Flu Diary)

A Network Model of H5N1 Avian Influenza Transmission Dynamics in Domestic Cats

http://www.flutrackers.com/forum/showthread.php?t=74278

ABSTRACT

Naturally occurring cases of influenza in cats owing to the H5N1

strain have been reported in several countries. A cat reservoir

of H5N1 in the United States could provide an environment for zoonotic

disease spread to humans. This scenario was the impetus to develop

a model to study potential transmission of H5N1 virus in domestic cats

utilizing information on cat ownership and cat-cat interaction patterns,

in addition to biological properties of the virus. The roaming behaviour

of cats significantly influenced epidemic dynamics, as demonstrated by

the simulation results from this model. A better understanding of the

behaviour of domestic cats and the H5N1 influenza virus can be used

to predict epidemic dynamics following the introduction of H5N1 virus

into the United States and to develop effective strategies to prevent

virus transmission to both cats and humans.

Does anyone remember this story from January 2007?

http://www.newscientist.com/channel/health/mg19325883.800-deadly-h5n1-may-be-brewing-in-cats.html

Chairul Anwar Nidom of Airlangga University in Surabaya, Indonesia,

told journalists last week that he had taken blood samples from 500

stray cats near poultry markets in four areas of Java, including the capital,

Jakarta, and one area in Sumatra, all of which have recently had

outbreaks of H5N1 in poultry and people.

Of these cats, 20 per cent carried antibodies to H5N1. This does not

mean that they were still carrying the virus, only that they had been

infected - probably through eating birds that had H5N1. Many other

cats that were infected are likely to have died from the resulting illness,

so many more than 20 per cent of the original cat populations may

have acquired H5N1.

This is a much higher rate of infection than has been found in surveys

of apparently healthy birds in Asia. "I am quite taken aback by the

results," says Nidom, who also found the virus in Indonesian pigs in

2005. He plans further tests of the samples at the University of Tokyo

in February.

Indonesian man dies of bird flu

http://ap.google.com/article/ALeqM5iHvsX7x_0-zl9F7ydDjEt38m5qUAD91VIQVG0

The only way we have of knowing of these deaths is now due to the

courageous reporting of the press in Indonesia. The translators

on the flu forums have been following this story for a few days,

and it appears to be true.

An Indonesian cargo worker died of bird flu, relatives confirmed Thursday,

raising the unofficial toll in the world's hardest hit nation to 111 in three years.

The government recently started delaying announcements about bird flu

fatalities, sometimes by several weeks. But health workers speaking on

condition of anonymity confirmed the tests came back positive.

Asnawi Sandri, a 38-year-old father of two, died in the hospital on

July 10, days after he came down with symptoms of the disease, including

high fever, coughing and breathing difficulties, said Abdul Kadir, his

brother-in-law.

"The doctor told us he died of bird flu," he said. "The tests came back

positive from Jakarta."

But as part of a widely criticized campaign to shift focus to successes in

battling the disease, it recently altered its policy, saying updates would

only be made once a month. The first such posting appeared June 19, but

the Health Ministry said Thursday the next one would not come until the

month's end. It gave no reason for the delay.

Sandri lived in Belendung, a village 24 miles west of the capital, Jakarta,

where chickens and ducks freely roam the dusty streets. But it is not clear

where he contracted the H5N1 virus, with residents saying none of the

poultry had fallen ill or died.

Though officials took blood samples from relatives and neighbors, they

have not culled any of the birds, Kadir said.

A member of the national bird flu commission, however, confirmed that

the cargo worker died of bird flu, a local health worker said told The

Associated Press. He asked not to be named because he did not have

authorization to speak to the media.

Indiana Pandemic Ethics Summit

http://afludiary.blogspot.com/2008/07/pandemic-ethics-summit.html

IUPUI (Indiana University-Purdue University Indianapolis) held a two-day

ethics summit this week to discuss these, and other ethical questions

that will surely come up in a pandemic.

IUPUI hosts summit on ethical issues of pandemic diseases

A disease pandemic doesn't have to exist to have a discussion about

ethical dilemmas that could come with it, including:

How should limited, potentially life-saving resources like vaccines or

ventilators be allocated? Do those who are sickest or those who are

hardiest have first dibs when such resources are limited?

What recourses do employees have if they want to stay home on the

advice of the local health department but against employers' wishes?

How should hospitals handle employees who refuse to come to work?

These and myriad other questions were on the agenda this week at the

first-ever summit on ethical questions a pandemic might pose.

Held on the campus of Indiana University-Purdue University Indianapolis,

it brought together public health officials from 35 states and territories.

http://afludiary.blogspot.com/2008/07/idaho-blogex-time-to-prepare-is-now.html

Indiana Pandemic Exercise - Day 2

July 16: The Time To Prepare Is Now

This is an Exercise. It Is Not Real.

If pandemic flu was rampant in southeast Asia for real, everyone in the

U.S. would be going to the banks for cash and going to the grocery stores

for groceries. Soon, cash and groceries would not be available.

Therefore, waiting until you hear news about pandemic flu being declared

somewhere in the world is not an effective plan. You must plan ahead of

Of course, we would prefer that everyone is prepared ahead of time and

that there is no "rush of the masses."

http://afludiary.blogspot.com/2008/07/blogex-coroners-morticians-and.html

July 17: Coroners, Morticians, and Cemeteries are overwhelmed.

THIS IS AN EXERCISE. IT IS NOT REAL.

This entry shows what high death rates from pandemic flu could cause.

We're posting it today because it is part of the scenario that we'll be using

when we talk to the coroners, funeral directors, and cemetery managers

tonight.

The funerary industry would not be overwhelmed until approximately the

second week of the pandemic flu coming to Southeast Idaho, so this post

is a bit out of chronological order but still an imporant planning point.

The high death rates caused by pandemic influenza in Southeast Idaho

have overwhelmed county coroners, morticians, and cemetery managers.

Many middle-age people haven't yet purchased cemetery lots but are

dying from the flu. The nationwide nature of the pandemic has created

a shortage of mortuary supplies everywhere.