Pandemic News/Awareness - Thread 3

Indonesia

Here are two current cases in Indonesia with links to poultry, and

symptoms suspicious of bird flu. Unfortunately negative test results do

not always mean the virus is not the cause.

There has been more than one case in other countries that required

autopsy to nail it down a diagnosis, for example, the woman in Nigeria

whose husband insisted, and paid for her autopsy or no one would have

known her true cause of death. She is the only diagnosed case in that country,

but there were other sick family members, one of which died before she did.

Autopsies are not done in Indonesia. It is not their custom to do so.

With the deliberate clamp down of information coming out of Indonesia

on H5N1, we are left to wonder about what is not being said. The one

thing that is certain is that the disease is endemic in that country, and

there will be more cases giving the virus more opportunities to adapt to

humans.

http://afludiary.blogspot.com/2008/11/indonesia-another-suspect-fatality.html

The latest case:

The 15-year old local Semarang girl has been identified as D.S.

A physician attending D.S., Agus Suryanto, said that the cause of death

was a respiratory failure after suffering from fever exceeding 39 Celsius

degree.

"There was a chance that she got infected by bird flu as she had been

living nearby a chicken abattoir,” Agus said as quoted by kompas.com.

http://crofsblogs.typepad.com/h5n1/2008/11/indonesia-pneum.html

A few days earlier, and a different case:

Cissy said tests conducted by the hospital's microbiology lab also showed

the victim's blood and phlegm samples were H5N1 negative.

"We must continue the tests to determine the type of microorganisms that

caused the sudden death because the victim had direct contact with poultry,

" Cissy said in Bandung on Friday.

http://afludiary.blogspot.com/2008/11/indonesia-further-testing-on-negative.html

Dadang Hadiansyah, 32, a resident of Bandung, Indonesia died on Monday

from a severe, rapidly progressing pneumonia. While originally suspected

of having the H5N1 bird flu virus, his tests came back negative.

Hospital officials have announced that further tests will be done to try to

determine the cause of Hadiansyah's death.

False-negatives, and to a lesser extent, false-positives are not uncommon

in medical testing.

Samples must be properly collected, safely transported, and correctly

processed. And even then, sometimes the tests yield incorrect results.

The administration of Tamiflu may help mask the virus, hindering detection.

The virus might even be shifting slightly; enough to have affected the

sensitivity of the tests.

The tests for the H5N1 virus appear to be particularly susceptible to false

negatives.

In the Turkish cluster of 2006, the NEJM reported:

Before H5N1 infection was diagnosed in the eight patients, a total of

8 real-time PCR tests, 12 rapid influenza tests, and 12 ELISA tests were

negative.

Thailand

When H5N1 is found in poultry, health authorities begin to monitor

the people for signs of illness also.

The question is, where did the disease come from? How did those

domestic birds get infected?

http://afludiary.blogspot.com/2008/11/thailand-bird-flu-detected-in-chickens.html

http://afludiary.blogspot.com/2008/11/thailand-monitoring-stepped-up-in.html

Laos

It's that time of year again.

http://www.recombinomics.com/News/11100801/H5N1_Xayabury.html

This outbreak follows two earlier outbreaks in northern Laos, and is

followed by a confirmed outbreak in northern Thailand, less than two

hundred miles southwest of the above outbreak (see satellite map).

These outbreaks in northern Laos and northern Thailand are likely to be

related to each other and outbreaks in northern Vietnam. Recent reports

have described a number of clade 2.3.4 reassortants in northern Vietnam.

These genes are related to 7 of the 8 gene segments in wild bird isolates

in Japan (HA is clade 2.3.2), which are closely related to poultry isolates

in South Korea and Primorie, which were reported earlier this year.

The recent outbreaks signal migration of wild birds into the region, which

will likely lead to reported outbreaks in the regions described above.

Indonesia - 17 in hospital with suspected bird flu

http://crofsblogs.typepad.com/h5n1/2008/11/still-more-from.html

If it is really bird flu, with these numbers we might expect the WHO to be

coming in, the village to be put under the Tamiflu blanket, all poultry to be

culled. Meanwhile, Health Minister Supari, is denying the 15 yr Dewi

Sartika died from H5N1 despite what her doctors have said.

"According to Salman's parents, 27 chickens belonging to their neighbors

died on Nov. 7. In the two days after that, their four chickens also died,"

he said.

Kurnia said the hospital had conducted urgent tests for the first seven

patients, with the results indicating the presence of the H5N1 avian

influenza virus.

The hospital is waiting for confirmation of the results from blood tests

conducted by the Micro Laboratory of the Hasanuddin University

Medical School and the Visual Conversion Reaction, he said.

He said the hospital had the other 10 patients admitted Thursday under

observation while waiting for their test results.

The hospital's bird flu team held a meeting Thursday to help deal with

the situation, as this is the first time they have received such a large

number of bird flu patients.

The hospital, which had set aside 11 beds for bird flu patients, had to

expand its facilities following the outbreak.

Delayed H1N1 Tamiflu Resistance Reports in the United States

Some seasonal flu victims do become very ill and end up on vents.

This is why clinicians are going to need to know if their patient's flu

is Tamiflu resistant. This report from Recombinomics indicates that

that information is not yet available. Tamiflu resistance is very

specific to which clade of flu is infecting the victim. The information

exists, and it is important that it be released. This is a serious

problem. Calling all the H1 isolates "Brisbane/59-like" is not

specific enough.

http://www.recombinomics.com/News/11190801/H274Y_US_Delayed.html

This season however, more of the influenza A isolates have been

sub-typed, signaling a concern over the possibility that all or most

H1N1 (especially clade 2B, Brisbane/59) will have H274Y (Tamiflu

resistant).

...it is unclear what is in circulation in the US (or anywhere else in the

world), because the H1 isolates are all being called "Brisbane/59-like"

which produces a "match" with the vaccine, regardless of whether the

isolate is clade 2B or clade 2C.* Phylogenetic classification would be

much clearer.

Moreover, the current status of clade 2B and clade 2C will be clear when

sequences are released because the phylogenetic analysis is very

straightforward and easily distinguishes clade 2B from clade 2C, as well

as sub-clades within these larger sub-clades.

When the NA sequences are generated, the Tamiflu resistance

frequencies will be clear, which will lead to an evaluation of the

current recommendations, which includes use of oseltamivir for

all influenza infections.

Indonesia

Update on the 17 Hospitalized Patients

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/nov2008indonesia-br.html

Because Indonesia is such a hot spot for H5N1 which is now considered

endemic there, when clusters of people are put in isolation with flu like

symptoms it is newsworthy. Information in that country about

the virus is censored. No one really knows for sure what these people

were infected with, but it appears to be easily transmissible, and that

is cause for concern. Is the Health Ministry telling the truth about these

cases? If so, then what is the correct diagnosis? That should have

been part of the information released but was not.

...on Nov 15, the Post reported that Halik Saleh, a spokesman for the

hospital's avian flu team, said the university tests also indicated the

patients had the H5N1 virus but that the hospital decided not to use

either institution's test results and would instead wait for results from

the health ministry.

Lily Sulistyowati, a health ministry spokeswoman, told Reuters today

that the patients' tests were negative for H5N1. She gave no further

details.

Reports of potential H5N1 case clusters raise concern because, if

confirmed, they suggest the possibility of human-to-human transmission,

which would increase the risk of a pandemic.

News about human H5N1 infections in Indonesia has been sketchy since

June, when the health ministry said it would no longer promptly report

H5N1 cases and instead give only periodic updates. Some health officials

have said the lack of timely reporting will hamper efforts to monitor

the world's pandemic risk level.

On Nov 13 the country's health minister, Siti Fadilah Supari, denied

media reports that a 15-year-old girl who died in central Java had

avian influenza. News services had earlier cited one of the girl's

doctors and a local health official as saying tests from two laboratories

indicated she did have an H5N1 infection.

Assam State, Northeastern India

http://afludiary.blogspot.com/2008/11/assam-to-begin-cull-of-30000-birds.html

As if India does not have enough on its plate with terrorist attacks in

Mumbai, now they have to contend with bird flu as well. Bird flu in

India is a frightening thought should it ever become more transmissible

in this country with such teeming numbers of people.

The Indian health ministry Thursday confirmed outbreak of bird flu after

laboratory tests confirmed strains of the deadly H5N1 avian influenza.

Sale and purchase of poultry has been banned in the state.

Choudhury said about 30,000 chickens and ducks would be slaughtered

in about 40 villages of Thakurichuba village, about 40 km west of

Guwahati. The veterinary personnel involved in the culling process were

being administered the antiviral drug Tamiflu as a precautionary measure.

Hong Kong

When a disease like this occurs in Hong Kong, you have to

wonder what is going unreported in mainland China as they

are so close geographically. Hong Kong is like the canary in

the coal mines. Luckily for us, there are world class virologists

working in Hong Kong, and we owe them a hugh debt for their

work with SARS and H5N1, bird flu.

Initial reports were saying that this was a low pathogenic virus

but given the numbers of dead birds, it is more likely to be HPAI

(highly pathogenic avian influenza), H5N1.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/dec0908birds-jw.html

...the H5 avian flu virus struck 60 chickens, which died yesterday. He

did not say if the virus at the farm was the highly pathogenic H5N1

subtype.

Malik Peiris, a virologist at the University of Hong Kong, said it is "highly

likely" that the virus is the lethal H5N1 strain, because other strains

aren't as deadly as the one involved in the outbreak appears to be,

according to a report from Reuters today. "But this has to be confirmed,"

he said.

Chow said in the press release that he elevated Hong Kong's avian flu

alert to serious after receiving the H5 test results. He said the

agriculture department will cull 80,000 chickens within a 3-km radius of

the index farm and will destroy another 10,000 chickens from the area

that have been transported to a wholesale market.

Vaccine Failure

The poultry have been vaccinated but the vaccine did not protect them.

http://www.flutrackers.com/forum/showpost.php?p=195250&postcount=29

http://www.recombinomics.com/News/12090802/H5N1_HK_Vaccine.html

... the death of 60 chickens has led to the culling of over 80,000 and

has raised vaccine concerns. There have been outbreaks in adjacent

Guangdong Province, and concerns about failed vaccinations were

also raised.

...the latest outbreak in Hong Kong, which is almost certainly H5N1,

raises additional vaccine issues and human infections in the area.

Similarly, these outbreaks in the Hong Kong regions also raise

concerns about the lack of reports of H5N1 infections in China.

Indonesia

Indonesia admits to two more human cases of bird flu though it is

widely believed that there are many more cases that they do not

admit to.

http://afludiary.blogspot.com/2008/12/who-indonesia-confirms-two-human-h5n1.html

The Ministry of Health of Indonesia has announced two new confirmed

cases of human infection with the H5N1 avian influenza virus. A 9-year-

old female from Riau Province developed symptoms on 7 November

and was hospitalized on 12 November. She recovered and was

discharged from hospital on 27 November. Laboratory tests confirmed

the presence of the H5N1 avian influenza virus. Investigations into

the source of her infection indicate poultry deaths at her home on

2 November.

The second case, a 2-year-old female from East Jakarta, developed

symptoms on 18 November, was hospitalized on 26 November and

died on 29 November. Laboratory tests have confirmed infection with

the H5N1 avian influenza virus. Initial investigations into the source of

her infection suggest exposure at a live bird market.

Cambodia, India, and Hong Kong Update

http://pandemicchronicle.com/2008/12/h5n1---'tis-the-season/

Assam, India

The people may just coincidentally have seasonal flu, but birds

in the area definitely had H5N1 so all of the poultry have to be culled.

It is of course, a continuing concern that none of these people

develop a coinfection of both seasonal flu and H5N1, giving bird flu

the opportunity to pick up the genes to become more easily

transmissible from seasonal flu. Lots of Tamiflu will be given out.

They have no choice but to jump on this.

India is sending bird flu experts to the northeastern state of Assam

and setting up isolation units to treat up to 90 people showing signs

of the virus, health authorities said on Friday.

Health workers have yet to confirm any human cases of H5N1, but

they said some patients were suffering from fever and respiratory

infections, which are symptoms of the virus in humans.

Veterinary officials in Assam state, which is rich in tea and oil, have

slaughtered more than 250,000 chickens and ducks in the past two

weeks, after the virus was detected in poultry last month in a village

close to Guwahati, the region's main city.

New Delhi has rushed federal medical experts, including

epidemiologists and microbiologists, to the affected areas.

Cambodia

A good 2/3 of the victims die. This young man is very lucky

to be recovering.

A 19-year-old Cambodian who ate dead poultry has been confirmed

with H5N1 bird flu, the country's first human case in more than 18

months, the World Health Organization (WHO) and government said

on Friday.

The man, the eighth person in Cambodia to have contracted bird flu

since its first case in 2005, was in a stable condition in the capital's

Calmette hospital, Sok Touch, head of the Health Ministry's

Communicable Diseases department, said in a statement.

Hong Kong

This always seems to happen before a holiday festival. Lots of money to

be made, and who cares if anyone gets sick?

The avian flu virus found in a Yuen Long chicken farm is the deadly

H5N1 strain, the government has confirmed.

Secretary for Food and Health York Chow Yat-ngok also said it may

not be a coincidence that the two recent H5N1 outbreaks in the territory

occurred just before traditional celebrations.