Pandemic News/Awareness - Thread 3

Sometimes it is helpful to look at the Big Picture. I think of what

Dr. Margaret Chan of the WHO had to say about bird flu in this

video for a CIDRAP conference. Does it sound like she thinks that

H5N1 will only be found in 3rd world countries?

https://umconnect.umn.edu/chan

Duplicate post follows. Computer problem...

H1N1 Clade 2C Amantadine Resistance at 100% in United States?

http://www.recombinomics.com/News/07210801/S31N_US_2C.html

Clades are strains of a virus, offspring so to speak, of the original parents.

As viruses evolve, their descendants are mutating away from their origins,

picking up different pieces of genetic material called SNP's (single

nucleotide polymorphism, pronounced snip) from interacting with other

influenza viruses. H274Y is a SNP that confers Tamiflu resistance. S31N,

another SNP, is associated with Amantadine resistance. Tamiflu and

Amantadine are antiviral drugs that we use to treat people infected with influenza.

H1N1 and H3N2 are two of our seasonal influenzas that yearly flu shots are

given for. Last year's vaccine did not protect as well as it had it in prior years.

A doctor might then order an antiviral if you were unfortunate enough to come

down with the flu. Here is the problem. These seasonal influenzas

are becoming increasingly resistant to our antivirals. The bigger issue is

that bird flu, H5N1 will also become resistant, and that is a hugh problem

because there is no vaccine. One way for this to happen is for a human to

become co-infected with both a regular seasonal flu and bird flu. The two

viruses recombine genes. If the seasonal flu was antiviral resistant then the

bird flu could pick up that trait.

Countries preparing for the next expected pandemic are busy stockpiling

antivirals as their only treatment for flu. Reports that the viruses are

becoming more resistant to the only antivirals we have is therefore of

major concern.

All H1N1 amantatine resistance in the US is clade 2C, and appears to be

in virtually all Clade 2C isolates. Oseltamivir resistance is at a lower level

(10-20%), but all H1N1 isolates with H274Y are Clade 2B. However, this

number may increase because oseltamivir levels in South Africa have

reached 100% (on first 23 samples tested), and none have amantadine

resistance, suggesting all are clade 2B.

The above data raises concerns that H1N1 seasonal flu is evolving toward

anti-viral resistance in all isolates, with clade 2B carrying resistance to

oseltamivir, and clade 2C carrying resistance to the amantadines.

These dramatic increases in resistant reservoirs raises serious concerns

about the utility of these anti-virals to control or blunt an H5N1 pandemic,

were both H274Y and S31N have been reported previously.

S. Korea: Cat May Have Died From Bird Flu

http://afludiary.blogspot.com/2008/07/s-korea-cat-may-have-died-from-bird-flu.html

Felines have been dying of bird flu for some time now in Indonesia.

We also know that the South Koreans have been aggressive in their

culling of all birds and domestic mammals in bird flu contaminated

zones in the past much to the dismay of animal rights activistis.

That any cats in a bird flu zone survived a cull in that country only

to die of bird flu is the real surprise.

I never saw a stray, loose cat in South Korea in the year that I spent

there. They were always tied on leashes, but that was 30 years ago...

Dr. Kim Chul-joong, a professor at the College of Veterinary Medicine

at Chungnam National University, said Wednesday, "We isolated the

highly pathogenic strain of avian flu from the dead cat found along the

Mangyeong River in Gimje and have asked the National Veterinary

Research and Quarantine Service to confirm the cause of death of the

cat."

The strain of bird flu found in the country in April and May is known to

infect not only poultry but also mammals such as rats and ferrets. If the

cat is confirmed to have died from bird flu, quarantine authorities may

have to order a cull of dogs, cats and other mammals in the wild.

CIDRAP Update on Nigeria, Hong Kong, Vietnam, South Korea and Laos

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jul2508birds-br.html

Animal health officials in Nigeria today reported finding the H5N1 avian

influenza virus at two live bird markets, as officials in Hong Kong

announced they would go ahead with a buyout of poultry farmers and

merchants to reduce the risk of H5N1 outbreaks in the city.

The H5N1 findings in Nigeria came during routine surveillance, according

to an epidemiology report submitted by Nigeria today to the World

Organization for Animal Health (OIE).

On Jun 27, veterinary officials detected the virus in a chicken at a live

bird market in Kebbi state, in northwestern Nigeria. On Jul 19, animal

health workers found the virus in a duck at a live bird market in Gombe

state in the east-central part of the country. The reports did not say if

bird deaths were reported in the area or if the birds that were sampled

appeared sick.

The following essay is from Effect Measure with permission. The opinions

expressed are from that source. Please remember, opinions are

just opinions, not the person. You can dislike and disagree with

an opinion without disliking and bashing the person expressing it.

Why should the military get a scarce pandemic flu vaccine before almost everyone else?

The headline said, "Vaccination plan puts health care workers first,

" but you had to read the article to find out who goes next: the

military. This according to the Guidance on allocating and targeting

pandemic influenza vaccine released yesterday by the US

Department of Health and Human Services (DHHS). The guidance is

premised on the assumption that in the early phases of a pandemic,

any vaccine will be in short supply and will need to be rationed. The

document gives "strong advice" on how DHHS thinks this rationing

should take place, although much is left unexplained. Since the

allocation to states will come from a national stockpile, the strong

advice will have some weight. Moreover, some of the vaccine will

be taken "off the top" for federal government use and this will not be

subject to any decisions downstream. And some of the federal

allocations appear to us to be highly questionable:

The plan puts a million health care workers, such as emergency

room staff and nurses, at the top. Next are military and "mission

critical" personnel, public health workers and hospital and nursing

home staff.

All of these play a "critical role in providing care for the sickest

persons; highest risk of exposure and occupational infection,"

the plan reads.

"This guidance is the result of a deliberative democratic process,

" HHS Secretary Mike Leavitt said in a statement. "This document

represents the best of shared responsibility and decision-making."

(Maggie Fox, Reuters)

Putting frontline health care workers at the top makes sense (NB:

I am a health care worker but as a researcher-physician would not

be considered "front line," so this isn't special pleading). But why is

the military at the top along with them, ahead of many other "mission

critical" workers like police, fire and communications? Reading the

document provides no obvious answers. The document is replete with

claims that the guidance was developed by an open and transparent

process with ample opportunity for the public and other stakeholders

to comment to the Working Group that drafted the document:

"This guidance is the result of a deliberative democratic process," HHS

Secretary Mike Leavitt said in a statement. "This document represents

the best of shared responsibility and decision-making." (Reuters)

But we also read that in meeting after meeting the same objectives

were identified:

Protect persons critical to the pandemic response and who provide

care for persons with pandemic illness

Protect persons who provide essential community services

Protect persons who are at high risk of infection because of their

occupation, and

Protect children. (Guidance document, Appendix A)

There is no mention of putting the military up at the top. In fact there

is no mention of the military at all. In the "rigorous" decision process

they apparently didn't score very high:

Groups with the highest overall scores, regardless of pandemic

severity, included front-line public health responders, essential health

care workers, emergency medical service providers, and law

enforcement personnel.

Among the general population groups, infants and toddlers ranked

highest. (Guidance document, Appendix A)

So how did they get up to the highest Tier and within the highest Tier

the second highest priority after front line health care workers? The

document doesn't tell us, but the game seems to have been rigged

at the outset by its structure. The entire population was divided into

four categories: homeland and national security, health care and

community support services, critical infrastructures, and the general

population (Guidance Document, p. 5). Each category was then

divided into five Tiers or priority levels, with everyone in a Tier

initially receiving equal priority regardless of category. Thus by

including homeland and national security as a category, the military

was guaranteed a top Tier (since each category had a top Tier).

Moreover each Tier has its own priorities in the event there isn't

enough vaccine to cover the Tier. At the top of Tier 1 are frontline

inpatient and hospital-based health care workers (estimated to be

about 1,000,000) and right after them comes the military (700,000),

before five other Tier 1 categories, i.e., ahead of:

Front-line Emergency Medical Service personnel (those providing

patient assessment, triage, and transport)

Front-line outpatient health care providers (physicians, nurses,

respiratory therapy; includes public health personnel who provide

outpatient care for underserved groups)

Front-line fire and law enforcement personnel

Pregnant women and infants 6-11 months old

Others in Tier 1 (includes Tier 1 health care workers not vaccinated

previously in hospitals, outpatient settings, home health, long-term

care facilities, and public health; emergency service providers;

manufacturers of pandemic vaccine, antiviral drugs, and other key

pandemic response materials; and children 12-35 months old) [p.10]

I don't know how the military got a category of their own and then a

spot almost at the top despite the fact they never scored high in the

"open and transparent" process touted by DHHS, but there you have

it. The reasoning doesn't make much sense. Do we need the military

to be ready to fight a war in the midst of a pandemic? If the whole

world is sick (and much of it sicker than the rich nations), do we think

we are going to be attacked? If the problem is the living conditions

of the military, then change their living conditions. That's called a

non-pharmaceutical intervention and it will be urged on the rest of us.

And not everyone with expertise thinks they have the rest of it right,

either:

Mike Osterholm, an infectious disease expert at the University of

Minnesota's Centers for Infectious Disease Research and Policy, said

the plan did not do enough to protect critical workers.

While it designates people involved in making vaccines and drugs for

flu, it does not account for other drugs such as insulin and antibiotics,

he said.

"It does nothing to help support the manufacturing and transportation

system for moving these drugs from offshore to the United States,"

Osterholm, who advised the government on the guidelines, said in a

telephone interview. (Reuters)

DHHS has it right that it is critically important to discuss this with the

public in an open and transparent manner. It sounds, though, that

someone shot an arrow and the Working Group complied by painting

the target around it.

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.

Information Control in South Korea

http://afludiary.blogspot.com/2008/07/i-guess-they-didn-get-memo.html

There has been plenty of bird flu in South Korea. This year the Koreans

battled their biggest out break ever. They should be commended for

being mostly successful.

They do seem however, to be engaging in information suppression.

They never admitted that one of their soldiers, who was positive for an

H5 virus had bird flu and survived. There is only one H5 virus that humans

have ever been infected with, and that is a fact. Now we are seeing a

distortion of facts in the media regarding how easy it is for felines to

be infected with bird flu. There is such a plethora of information from

other countries about infected mammals that this is a no brainer. Cats

have gotten infected before, lots of them in Indonesia. So many that

the Indonesians actually have a word describing the sound that a dead

cat makes when falling out of tree

Influenza, a promiscuous virus

http://birdflujourney.typepad.com/a_journey_through_the_wor/2008/07/influenza-a-pro.html

It is not unusual for wild birds infected with H5N1 to be found in

Hong Kong. They are routinely testing wild birds for bird flu because

it is so common in that area.

So the Chinese are going to host the Olympic equestrian events in

Hong Kong because it is safer than on the mainlaind...

We continually learn more about the wide range of species susceptible to

H5N1 infection, sometimes by surprise as was the case with cats, and

sometimes like the calf experiment, deliberately. Unless someone, some-

where has scientifically validated the assumption then it is only an

assumption at this point. An assumption that seems to be rather flimsy -

at best - since there are strains of influenza that horses are known to be

susceptible to, H7N7, H3N8, and H3N2.

112th Death in Indonesia

http://www.flutrackers.com/forum/showpost.php?p=171915&postcount=81

That is 112 deaths from bird flu, that we know about, just in this one country.

There have also been many suspected cases such as family members who

died without testing shortly before their relatives were sickened and

diagnosed.

The world wonders why the director general of communicable disease control

at the Health Ministry has decided to release this information not that we are

complaining or anything.

India

http://crofsblogs.typepad.com/h5n1/2008/07/west-bengal-bur.html

More than 300 dead chickens in a highly decomposed state were found

lying beside NH31 this morning, triggering a bird flu scare in the area.

The administration is still in the dark about how such a large number of

dead broiler chickens were thrown beside the highway, about 10km from

here. Three dogs died after eating the birds, sources in the administration

said.

Vietnam

http://afludiary.blogspot.com/2008/08/vietnam-new-outbreaks-of-bird-flu-in.html

Bird flu was discovered in a flock of 1,000 chickens in the southern

province of Dong Thap on July 31, reported the Veterinary Agency.

With this new discovery, bird flu is currently in two provinces, Dong Thap

and the central province of Nghe An.

Nigeria

http://crofsblogs.typepad.com/h5n1/2008/08/more-on-the-nig.html

...checks in Kano revealed that about one thousand birds had been lost in

the farm at Fagen Kawo as a result of the outbreak, while the state

government and the Federal government had moved in swiftly for

intervention.

Australia: Will Doctors Work In A Pandemic?

http://afludiary.blogspot.com/2008/08/australia-will-doctors-work-in-pandemic.html

The moral dilemma for health care workers during a pandemic

remains largely unaddressed by most governments and health

care facilities.

The assumption appears to be that, `of course doctors and

nurses will work. It's their duty'.

This despite the fact that again and again we've seen polls and studies

that indicate that a certain percentage of HCW's (health care workers)

would be reluctant to work during a pandemic.

Quoting from this study, 30% of the doctors participating expressed

reluctance to work during a pandemic.