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August 01, 2005

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het Binnenhof - nieuws Open link in new window

 —
DEN HAAG - De vogelpest in Rusland vormt geen extra bedreiging voor de Nederlandse pluimveehouderij. Extra maatregelen ter voorkoming van een mogelijke uitbraak zijn op dit moment daarom niet nodig, meldde een woordvoerster van het ministerie van Landbouw maandag. In Rusland dook vorige week bij pluimvee in vier regio's rond de Siberische stad Novosibirsk de versie H5N1 van de vogelpest op. Deze
 
Today 6:46:16 PM - 

rz-online ticker Open link in new window

 — Nowosibirsk - Das für Menschen lebensgefährliche Virus H5N1 - die Vogelgrippe - hat sich von Fernost nach Russland...
 
 
Today 5:58:00 AM -

I-Newswire.com - Free Press Release Distribution Open link in new window

 — Laboratory evidence now shows that the 8-year-old girl from Tangerang, Banten Province, is a probable avian influenza A/H5 case, based on analysis of serological samples. Two WHO Reference Laboratories at the University of Hong Kong and the Centers for Disease Control and Prevention USA, detected high positive rising microneutralisation titres specific for H5N1 in 2 samples taken 3 days apart.
 
 
Today 5:00:01 AM -

Business Wire Open link in new window

 —

PowderMed Manufactures a Vaccine Against H5N1 (Avian Influenza) for Clinical Development

OXFORD, England--(BUSINESS WIRE)--Aug. 1, 2005--PowderMed, the immunotherapeutics company focused on the development and manufacture of DNA-based vaccines for viral diseases and cancer, has announced that it has progressed its H5N1 Avian Influenza Vaccine programme into the final stages of preclinical development. PowderMed has produced an H5N1 vaccine by cloning the H5 gene from the current circulating avian flu strain ("the gene cassette") into the company's proprietary DNA vaccine backbone and the vaccine is now ready for development. Manufacturing and toxicology studies are now in progress, and it is anticipated that this vaccine will enter clinical trials by the middle of 2006.

 

Commenting on the programme, Dr Clive Dix, CEO of PowderMed said:

"We are very excited by the potential for our flu vaccine technology to address the major healthcare challenge that influenza presents, in particular in the event of an avian flu or other pandemic outbreak. Our technology has significant advantages over current flu vaccine technology particularly in terms of the speed of response in the event of a pandemic. As soon as a new influenza strain becomes known, our "plug and play" system would enable us to rapidly insert the relevant DNA gene cassette into our standard DNA backbone. A PowderMed manufacturing facility will be capable of delivering the vaccine requirements of an entire country within 3 months. This is not possible for other technologies."

Just 1.2kg of vaccine DNA would be sufficient to vaccinate the entire population of the US twice - an initial dose and a booster dose. PowderMed has carried out a detailed feasibility study with contract manufacturing partners, which concludes that it could establish a manufacturing capability with a surge capacity of 150 million influenza vaccine doses in a three-month period. Dr Dix points out that this is critical since, "No other vaccine technology offers this speed of response. In the event of a pandemic, most deaths and illness will occur in the first six months of an outbreak. We believe that our technology offers the best potential to save lives and minimise the economic impact of a flu pandemic."

The Avian flu vaccine uses the same standard DNA vaccine backbone as PowderMed's annual flu vaccine, which has already successfully completed a Phase I clinical trial (www.powdermed.com/media.htm) and will enter Phase IIb trials in 2006.

Today 4:00:00 AM -

Technorati Search for: influenza pandemic Open link in new window

 —

... they view as an inevitable influenza pandemic say the world lacks the medical weapons to fight... World Not Set To Deal With Flu Strategy for Pandemic Needed, Experts Say By David Brown Washington... dangerous strain of influenza to appear in decades -- the H5N1 "bird flu" in Asia -- is showing up ...

 
Today 3:52:09 AM -
 

Pale Horseman Open link in new window

 —
The Ministry of Health in Indonesia reported that a 38-year-old father who died on 12 July was the country’s first laboratory-confirmed H5N1 positive human case of avian influenza. His two daughters also died of severe pneumonia illness compatible with H5N1 infection, but laboratory confirmation is not yet available. Limited samples were available from the 8-year-old daughter who died on 14 July, and the 1-year-old daughter who died on 9 July.

The 8-year-old became ill with fever, diarrhoea, then cough, on 24 June. She was brought to Siloam Gleneagles Hospital, Tangerang, on 28 June, where she died with respiratory distress 20 days after onset. The 1-year-old became ill on 29 June with fever, diarrhoea, then cough, finally respiratory distress, and died 10 days after onset. The father became ill on 2 July with fever, mild cold, then cough and was taken to the same hospital on 7 July where he died 10 days after onset. Samples from the 38-year-old tested positive for avian influenza H5N1 virus by the WHO H5 reference laboratories at the Department of Microbiology, University of Hong Kong, and the Centers for Disease Control and Prevention, Atlanta USA. Samples from the two children are undergoing testing.

The remaining four residents of the house (two members of the family and two household workers) remain healthy and show no symptoms to date. The Ministry of Health is closely following over 300 contacts, including health-care workers, family members, school and office colleagues and neighbours. None of these contacts has shown any symptoms to date.

An investigation is currently underway with team members from Indonesia's Ministry of Health, Ministry of Agriculture, United States Naval Medical Research Unit 2, and WHO to identify potential sources of the infection. Serum samples have been collected from contacts of the cases, starting from the family and neighbours, health-care workers, while any possible poultry contact is being investigated (e.g. market sellers, retail food outlets, pet birds). Environmental and veterinary sampling is being carried out by the Ministry of Agriculture.

Health education to hospital and other health-care workers has been continuing since January 2004, when avian influenza was first reported in Indonesia. The Ministry of Health, working with WHO has carried out seminars and workshops to strengthen surveillance of influenza-like illness, outbreak investigation, and appropriate isolation and barrier nursing. Stockpiling of personal protective equipment to protect health and veterinary workers, and procurement of antivirals for treatment and prophylaxis, as appropriate, is continuing. Information has been provided to assist the community with general health precautions, including frequent hand-washing, avoiding contact with sick animals, and safe and hygienic handling and cooking of poultry.


 
 
Today 3:22:36 AM -
 

Pale Horseman Open link in new window

 —
MOSCOW -- Hundreds of fowl in Siberia have died of the same strain of bird flu that has infected humans throughout Asia, the Russian government said Friday. No human infections have been reported from the Siberian outbreak, Russia's Agriculture Ministry said in the brief statement identifying the virus as avian flu type H5N1.

"That raises the need for undertaking quarantine measures of the widest scope," the statement said. Ministry officials could not be reached for elaboration.

Since 2003, the H5N1 strain has killed at least 57 people in Vietnam, Thailand, Cambodia and Indonesia, which reported its first three human deaths this month.

International health experts repeatedly have warned the bird flu virus could evolve into a highly contagious form passed easily from person to person, sparking a global pandemic. So far, most cases have been traced to contact with sick birds.

The outbreak in Russia's Novosibirsk region in central Siberia apparently started about two weeks ago when large numbers of chicken, geese, ducks and turkeys began dying. Officials say that all dead or infected birds were incinerated, but it was unclear whether that would effectively stop the virus from spreading.

Juan Lubroth, an animal health expert at the Rome-based U.N. Food and Agriculture Organization, said it was still not known how many birds have been exposed. He said the concern was whether birds that appear healthy might have the virus.

Earlier this week, Russia's chief government epidemiologist, Gennady Onishchenko, said the appearance of the virus in Russia could be due to migrating birds that rest on the Siberian region's lakes.

A recent report released by the journal Science said the finding of the H5N1 infection in migrant birds at Qinghai Lake in western China "indicates that this virus has the potential to be a global threat."

The reports echo concerns voiced by the World Health Organization, which urged China to step up its testing of wild geese and gulls. A WHO official estimated that the flu had killed more than 5,000 wild birds in western China.


 
 
Today 3:21:54 AM - 

Amygdala Open link in new window

 — THE COMING FLU PANDEMIC. Your Amygdala stays alert and frightened for you, the home viewer! How many shopping days left until millions die?
Public health officials preparing to battle what they view as an inevitable influenza pandemic say the world lacks the medical weapons to fight the disease effectively, and will not have them anytime soon.

Public health specialists and manufacturers are working frantically to develop vaccines, drugs, strategies for quarantining and treating the ill, and plans for international cooperation, but these efforts will take years. Meanwhile, the most dangerous strain of influenza to appear in decades -- the H5N1 "bird flu" in Asia -- is showing up in new populations of birds, and occasionally people, almost by the month, global health officials say.

If the virus were to start spreading in the next year, the world would have only a relative handful of doses of an experimental vaccine to defend against a disease that, history shows, could potentially kill millions. If the vaccine proved effective and every flu vaccine factory in the world started making it, the first doses would not be ready for four months. By then, the pathogen would probably be on every continent.

Theoretically, antiviral drugs could slow an outbreak and buy time. The problem is only one licensed drug, oseltamivir, appears to work against bird flu. At the moment, there is not enough stockpiled for widespread use. Nor is there a plan to deploy the small amount that exists in ways that would have the best chance of slowing the disease.

The public, conditioned to believe in the power of modern medicine, has heard little of how poorly prepared the world is to confront a flu pandemic, which is an epidemic that strikes several continents simultaneously and infects a substantial portion of the population.

Since the current wave of avian flu began sweeping through poultry in Southeast Asia more than 18 months ago, international and U.S. health authorities have been warning of the danger and trying to mobilize. Research on vaccines has accelerated, efforts to build up drug supplies are underway, and discussions take place regularly on developing a coordinated global response.

The U.S. Department of Health and Human Services will spend $419 million in pandemic planning this year. The National Institutes of Health's influenza research budget has quintupled in the past five years.

"The secretary or the chief of staff -- we have a discussion about flu almost every day," said Bruce Gellin, head of HHS's National Vaccine Program Office. This week, a committee is scheduled to deliver to HHS Secretary Mike Leavitt an updated plan for confronting a pandemic.

Despite these efforts, the world's lack of readiness to meet the threat is huge, experts say.

[...]

The most outspoken is Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. In writing and in speeches, Osterholm reminds his audience that after public calamities, the United States usually convenes blue-ribbon commissions to pass judgment. There will be one after a flu pandemic, he believes.

"Right now, the conclusions of that commission would be harsh and sad," he said.
Just hope you're alive to read it.

For those unfamiliar with influenza.

The influenza pandemic of 1918-1919 killed more people than
the Great War, known today as World War I (WWI), at
somewhere between 20 and 40 million people. It has been
cited as the most devastating epidemic in recorded world
history. More people died of influenza in a single year than
in four-years of the Black Death Bubonic Plague from 1347 to
1351. Known as "Spanish Flu" or "La Grippe" the influenza of
1918-1919 was a global disaster.

[...]

The flu was most deadly for people ages 20 to 40. This
pattern of morbidity was unusual for influenza which is
usually a killer of the elderly and young children. It
infected 28% of all Americans (Tice). An estimated 675,000
Americans died of influenza during the pandemic, ten times
as many as in the world war. Of the U.S. soldiers who died
in Europe, half of them fell to the influenza virus and not
to the enemy (Deseret News). An estimated 43,000 servicemen
mobilized for WWI died of influenza (Crosby).

The effect of the influenza epidemic was so severe that the
average life span in the US was depressed by 10 years. The
influenza virus had a profound virulence, with a mortality
rate at 2.5% compared to the previous influenza epidemics,
which were less than 0.1%. The death rate for 15 to
34-year-olds of influenza and pneumonia were 20 times higher
in 1918 than in previous years (Taubenberger). People were
struck with illness on the street and died rapid deaths. One
anectode shared of 1918 was of four women playing bridge
together late into the night. Overnight, three of the women
died from influenza (Hoagg). Others told stories of people
on their way to work suddenly developing the flu and dying
within hours (Henig). One physician writes that patients
with seemingly ordinary influenza would rapidly "develop the
most viscous type of pneumonia that has ever been seen" and
later when cyanosis appeared in the patients, "it is simply
a struggle for air until they suffocate," (Grist, 1979).
Another physician recalls that the influenza patients "died
struggling to clear their airways of a blood-tinged froth
that sometimes gushed from their nose and mouth," (Starr,
1976). The physicians of the time were helpless against this
powerful agent of influenza. In 1918 children would skip
rope to the rhyme (Crawford):

I had a little bird,

Its name was Enza.
I opened the window,
And in-flu-enza.
Read The Rest Scale: 4 out of 5. Just the way it was, and may
be.
 

 

Today 2:49:27 AM -



Instapundit.com

Open link in new window


 —

DAVID BROWN IS
SOUNDING THE BIRD FLU ALARM in the
Washington Post.



Public health officials preparing to battle what they
view as an inevitable influenza pandemic say the world lacks
the medical weapons to fight the disease effectively, and
will not have them anytime soon.


Public health specialists and manufacturers are working
frantically to develop vaccines, drugs, strategies for
quarantining and treating the ill, and plans for
international cooperation, but these efforts will take
years. Meanwhile, the most dangerous strain of influenza to
appear in decades -- the H5N1 "bird flu" in Asia --
is showing up in new populations of birds, and occasionally
people, almost by the month, global health officials say.


If the virus were to start spreading in the next year,
the world would have only a relative handful of doses of an
experimental vaccine to defend against a disease that,
history shows, could potentially kill millions.



 


Read the whole thing. And then worry a bit.


UPDATE: Reader Jim McMurry emails:



The worries about bird flu are past the realm of "could
be a threat" and have entered the phase of the ticking time
bomb and we cannot see the time marker, nor know when it
will go off in the USA. I am betting on October 2006, but it
could come sooner.



Well, we don't know. A major flu pandemic is pretty much
inevitable sooner or later. On the other hand, many of the
casualties from the 1918 flu were people who were weakened by
TB, meaning that perhaps lethality won't be as bad this time.
But I certainly think that we need to be working hard on
antiviral drugs, and protocols for the rapid production of new
vaccines, not only to be ready for bird flu but to be ready for
all kinds of potential natural and unnatural outbreaks.


Yesterday 3:03:41 PM -



 

linkfilter.net - fresh links

Open link in new window


 — Public health
officials preparing to battle what they view as an inevitable
influenza pandemic say the world lacks the medical weapons to
fight the disease effectively, and will not have them anytime
soon.     Public health specialists and manufacturers are
working frantically to develop vaccines, drugs, strategies for
quarantining and treating the ill, and plans for international
cooperation, but these efforts will take years. Meanwhile, the
most dangerous strain of influenza to appear in decades -- the
H5N1 "bird flu" in Asia -- is showing up in new
populations of birds, and occasionally people, almost by the
month, global health officials say.     If the virus were to
start spreading in the next year, the world would have only a
relative handful of doses of an experimental vaccine to defend
against a disease that, history shows, could potentially kill
millions. If the vaccine proved effective and every flu vaccine
factory in the world started making it, the first doses would
not be ready for four months. By then, the pathogen would
probably be on every continent.     [e-mail/password:
dev.null@washingtonpost.com/devnull]
 

 

Yesterday 2:53:49 PM -


Balloon Juice

Open link in new window


 — While I am grateful to the
NY Times and
WaPo for a day off from the Plame affair, I really
didn’t want to read this:

Public health officials preparing to battle what they view
as an inevitable influenza pandemic say the world lacks the
medical weapons to fight the disease effectively, and will
not have them anytime soon.


Public health specialists and manufacturers are working
frantically to develop vaccines, drugs, strategies for
quarantining and treating the ill, and plans for
international cooperation, but these efforts will take
years. Meanwhile, the most dangerous strain of influenza to
appear in decades—the H5N1 “bird
flu” in Asia—is showing up in new populations of birds, and
occasionally people, almost by the month, global health
officials say.


If the virus were to start spreading in the next year,
the world would have only a relative handful of doses of an
experimental vaccine to defend against a disease that,
history shows, could potentially kill millions. If the
vaccine proved effective and every flu vaccine factory in
the world started making it, the first doses would not be
ready for four months. By then, the pathogen would probably
be on every continent.


Theoretically, antiviral drugs could slow an outbreak and
buy time. The problem is only one licensed drug,
oseltamivir, appears to work against bird flu. At the
moment, there is not enough stockpiled for widespread use.
Nor is there a plan to deploy the small amount that exists
in ways that would have the best chance of slowing the
disease.



This isn’t going away, it can’t be negotiated, so we better
start preparing. Just as a curious side note, the the late night
crazies at Art Bell’s
Coast to Coast
have been
fretting about
this for years
.

Yesterday 1:40:53 PM -


Fragments From Floyd

Open link in new window


 —

There is an ember of hope that avian flu might be stopped
soon, while it remains only a spark and not a raging
conflagration.


Will the nations with the most to lose economically gamble on
the altruistic (read: economic self-preservation) move to put
out the small fires in Indonesia, Viet Nam and Thailand by
sending their supplies of antivirals and vaccines there to
possibly contain the spread? A recent
Washington Post article points out that...


"... unless antiviral drugs squelch a pandemic at the
outset, their ultimate usefulness will be small. ... In
theory, even a modest amount of vaccine might be useful.
Fighting disease outbreaks is like fighting fires. You do
not have to hose down the whole world to put the fire out,
but you do have to hose down the perimeter to keep it from
spreading. It might be possible to contain an H5N1
outbreak at its source if the surrounding population were
immediately vaccinated.

Would the United States, Europe and Japan be willing to
donate their precious vaccine supply to mount this long-shot
defense? This is perhaps the biggest unanswered question in
pandemic flu planning -- and one likely to be answered only
at the moment of truth.


Officially, it is a possibility.


If it was done in consultation with the World Health
Organization -- and with other governments that would make
contributions, as well -- we would be more likely to
consider it," said Gellin at HHS. But observers both in and
out of the government said, not for quotation, that they
doubt the U.S. government would ever send a significant
amount of its vaccine stockpile overseas.
 



Even if this scenario played out and we gave up our
stockpiles to put out small fires overseas, there remains the
wildcard of spread over vast distance by bird migration (or
infected airline passengers) starting too many small fires to
handle; and the barrier of secrecy and disinformation across the
vast Chinese borders where a significant brush fire may already
be spreading.


We (global mankind, science and public health) have not
adequately anticipated and prepared for such a scenario, even
though
we could have seen it coming for a decade or more. If we
could turn back time 15 years and know with certainty the
pathogens we would face in the future, would there have been any
better cooperation between continents? Would we have wasted so
much talent, wealth and technology (ostensibly) to protect our
people and way of life from acts of terrorism if we'd accepted
that it was emerging infectious disease that posed by far the
greater threat to our economy and to our very survival?


It seems we may be very near the moment of truth. Is it too
late to turn our swords into vaccines?

Yesterday 9:44:21 AM
-


Global
Issues


Open link in new window


 — Washington --
World Health Organization (WHO) laboratories at the University
of Hong Kong and the U.S. Centers for Disease Control and
Prevention (CDC) say the July 14 death of an 8-year-old girl in
a suburb of Jakarta, Indonesia, was probably caused by the H5N1 bird flu virus. In a July 29 avian influenza update,
WHO says laboratory evidence shows that the girl -- the daughter
of a 38-year-old man who died July 12 and who was the country’s
first confirmed H5N1-positive human case of bird flu --
“is a probable avian influenza” case, based upon blood tests.
 

 

Yesterday 6:09:59 AM -


The
American Street


Open link in new window


 —


World Not Set To Deal With Flu
Strategy for Pandemic Needed, Experts Say


By David Brown
Washington Post Staff Writer
Sunday, July 31, 2005; A01



Public health officials preparing to battle what they
view as an inevitable influenza pandemic say the world lacks
the medical weapons to fight the disease effectively, and
will not have them anytime soon.


Public health specialists and manufacturers are working
frantically to develop vaccines, drugs, strategies for
quarantining and treating the ill, and plans for
international cooperation, but these efforts will take
years. Meanwhile, the most dangerous strain of influenza to
appear in decades — the H5N1 “bird flu” in Asia — is
showing up in new populations of birds, and occasionally
people, almost by the month, global health officials say.


If the virus were to start spreading in the next year,
the world would have only a relative handful of doses of an
experimental vaccine to defend against a disease that,
history shows, could potentially kill millions. If the
vaccine proved effective and every flu vaccine factory in
the world started making it, the first doses would not be
ready for four months. By then, the pathogen would probably
be on every continent.


Theoretically, antiviral drugs could slow an outbreak and
buy time. The problem is only one licensed drug,
oseltamivir, appears to work against bird flu. At the
moment, there is not enough stockpiled for widespread use.
Nor is there a plan to deploy the small amount that exists
in ways that would have the best chance of slowing the
disease.


The public, conditioned to believe in the power of modern
medicine, has heard little of how poorly prepared the world
is to confront a flu pandemic, which is an epidemic that
strikes several continents simultaneously and infects a
substantial portion of the population.


Since the current wave of avian flu began sweeping
through poultry in Southeast Asia more than 18 months ago,
international and U.S. health authorities have been warning
of the danger and trying to mobilize. Research on vaccines
has accelerated, efforts to build up drug supplies are
underway, and discussions take place regularly on developing
a coordinated global response.


The U.S. Department of Health and Human Services will
spend $419 million in pandemic planning this year. The
National Institutes of Health’s influenza research budget
has quintupled in the past five years.


“The secretary or the chief of staff — we have a
discussion about flu almost every day,” said Bruce Gellin,
head of HHS’s National Vaccine Program Office. This week, a
committee is scheduled to deliver to HHS Secretary Mike
Leavitt an updated plan for confronting a pandemic.


Despite these efforts, the world’s lack of readiness to
meet the threat is huge, experts say.


“The only reason nobody’s concerned the emperor has no
clothes is that he hasn’t shown up yet,” Harvey V. Fineberg,
president of the National Academy of Sciences’ Institute of
Medicine, said recently of the world’s efforts to prepare
for pandemic flu. “When he appears, people will see he’s
naked.”


Other scientists are sounding the alarm as well.


The most outspoken is Michael T. Osterholm, director of
the Center for Infectious Disease Research and Policy at the
University of Minnesota. In writing and in speeches,
Osterholm reminds his audience that after public calamities,
the United States usually convenes blue-ribbon commissions
to pass judgment. There will be one after a flu pandemic, he
believes.


“Right now, the conclusions of that commission would be
harsh and sad,” he said.


In hopes of slowing a pandemic’s spread, public health
specialists have been debating proposals for unprecedented
countermeasures. These could include vaccinating only
children, who are statistically most likely to spread the
contagion; mandatory closing of schools or office buildings;
and imposing “snow day” quarantines on infected families —
prohibiting them from leaving their homes.


Other measures would go well beyond the conventional
boundaries of public health: restricting international
travel, shutting down transit systems or nationalizing
supplies of critical medical equipment, such as surgical
masks.


But Osterholm argues that such measures would fall far
short. He predicts that a pandemic would cause widespread
shutdowns of factories, transportation and other essential
industries. To prepare, he says, authorities should identify
and stockpile a list of perhaps 100 crucial products and
resources that are essential to keep society functioning
until the pandemic recedes and the survivors go back to
work.



At last, front page Sunday treatment of this story. Of
course, if you’ve been reading Just a Bump in the Beltway for a while this is not news to
you.


Charles Roten put up a list of resources
if you
want further information
back in June. And, of course, there
is The Flu Wiki, which has
now become the gathering place in English for all things flu. If
you read nothing else, study
CanadaSue’s imagined scenario for her hometown, Kingston,
Ontario.


The Post article, while lengthy, doesn’t spend any time on 1.
why this is important; 2. the potential sequalae of such a
pandemic; 3. the miserable failure of the government to do any
planning. Mike Osterholm is hardly the only scientist who has
been screaming bloody murder about H5N1 for some time.
That said, I heard NIAID’s Tony Fauci on
Diane
Rehm’s
NPR show last week, and half of what he said was
talking out of his ass (or covering it.) If I know that, and I’m
no scientist, what else are we missing? It will show up on The
Flu Wiki, for sure.


 

 

Yesterday 12:43:23 AM -


Last Week





Effect Measure


Open link in new window



 —

Four geographic areas seem to be "cause for concern" on the
bird flu front, (as Henry Niman would say). They are
Vietnam, Indonesia, Russia and China.



Vietnam (Thanhnien
News
)
: This is the easiest, although not necessarily
the least concerning (I'm having trouble ranking different
kinds of concerns, so I won't try). It's easiest because it
represents "more of the same," where the "same" is not good.
Two more H5N1 deaths have been reported, a 24 year
old man from Tra Vinh (Mekong region, in the south) and a 26
year old woman from Ho Chi Minh City (also in the south).
Both are confirmed bird flu cases, the first in the south
for some time. The southern cases continue to be more
serious than those from the north. Both cases were said to
have eaten chicken before they became ill. So this disease,
possibly in several different forms (north and south)
continues to incubate and simmer in Vietnam, with endemic
infection of poultry and sporadic but fairly steady human
cases. Such smoldering is typical of pre-pandemic phases
which then break out explosively. But of course, sometimes
this doesn't happen. I'm not a betting person, so I prefer
to purchase insurance for uncertain events in the form of
adequate preparation. Are you listening CDC?



Indonesia: The reference laboratory in Hong Kong has
confirmed what everyone knew anyway, that the index case in
the family cluster of three fatal cases in a Jakarta suburb,
the eight year old daughter, indeed died of H5N1.
Tests results on her 1-year old sister are awaited but we
know the answer already. Meanwhile, epidemiologic
investigations seem to be coming up empty. How did this
civil servant and his two children in a middle class suburb
contract this fatal disease? We are learning some more
details about

the basis for the claim
by the Indonesian Health
Minister that they were infected by contaminated bird feces
(the Chickenshit Theory). The Minister of Agriculture
reported that feces from a caged bird on the side of the
road opposite the family's house were "positive for H5N1"
but the bird in the cage showed no sign of the virus and
other environmental sampling, including caged birds in
neighbor's houses. So much for the Chickenshit Theory.



The

three family members fell ill
on July 24, July 29 and
July 2, so this doesn't sound like a common source outbreak
but more like person to person (perhaps index case to other
two family members). Indonesian authorities are following up
some 300 contacts of the family, but have so far reported no
additional illnesses. Forty-four referral hospitals have
been alerted and prepared for possible new cases. So at the
moment there is no identified source for the three fatal
cases and the evidence of human to human transmission is
strong.



Russia: The bird flu outbreaks in Russia have been
widely reported to be with H5N2 and therefore no risk to
humans. Aside from the fact that it doesn't necessarily
follow that H5N2 infections of birds are no risk to humans,
the point is now moot, as

fresh outbreaks are being identified as H5N1
.
Today the Russian Agriculture Ministry announced that the
hundreds of chicken, geese, ducks and turkeys that died in
Siberia last week died of H5N1 infection. This virus
is on the wing, literally and figuratively, and it can't be
stopped. It seems it will inevitably spread to bird
populations outside of Asia, with the next stop likely the
Indian sub-continent and Europe. The longer it circulates in
birds and perhaps other species, the more likely it will be
to adapt to humans, the most widely dispersed species on
earth.



China: Finally,
the spreading outbreak in Sichuan, China
. The Chinese
have steadfastly maintained that this is just a huge
outbreak from the bacterium Streptococcus suis, Type
2, a known pig pathogen that occasionally infects humans,
causing meningitis. While it is capable of causing the type
of sepsis presenting in these cases, the large number and
continued spread together with the hemorrhagic presentation
seems quite atypical for S. suis and more like a
viral etiology. There are now over 150 infections with new
ones occurring daily. The death toll stands at 51 as of
Thursday afternoon. While bird flu remains a possibility (we
are continually reminded that a significant proportion of
cases in 1918 presented like this) there is no mention of
respiratory symptoms which should still predominate. This
one remains a puzzle, and while the pig bacteria may turn
out to be the cause, it sounds at this point like something
else is going on (although my intuiution tells me it isn't
bird flu, but of course I may be wrong).



But with so much else going on elsewhere, "something else
going on in China" is the last thing I want to hear.



 


 


Saturday, July 30, 2005 3:02:14 AM -







MaxedOutMama


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A gift
from a dear friend
(.wmv file).



Okay. Now, if that didn't shake you up a little, here's
today's bird flu (H5N1) update. The reports of
H5N1
in Novosibirsk, Russia prompted a massive
quarantine. However, the virus was almost certainly spread
by migrating wild birds, so the quarantine may delay but
can't prevent further spread.

Newsday/AP
:

 

Investigators have determined that a strain of bird flu
virus infecting fowl in Russia is the type that can
infect humans, the Agriculture Ministry said Friday.



The virus caused the deaths of hundreds of birds in a
section of Siberia this month, but no human infections
have been reported.



In a brief statement, the ministry identified the virus
as avian flu type A H5N1.

Worse yet, earlier there were three human deaths in Jakarta
from the virus. It was three members of one family who lived
in the suburbs (two children and their father). The only
evidence they have found is that pigs around the area seem
to have been infected - however, the only local source of
infection that has been found was a pet bird across the
street. (Recombinomics)
(WHO):

 

Extensive epidemiological and environmental studies are
ongoing around this family cluster. The Minister of
Agriculture stated that laboratory results detected
H5-infected bird faeces in a bird cage opposite side of
the road of the family's house; cloacal and throat swabs
of the pet bird inside the cage were negative for H5.
This is the first, and, thus far, the only, indication
of a possible source of exposure. Other environmental
sampling was negative.



The Ministry of Health is continuing to monitor over 300
contacts. None of the contacts have shown any symptoms
to date. Seroprevalence results are still pending.
Surveillance has been intensified in affected areas and
throughout the country. Forty-four referral hospitals
have been identified and are being prepared to receive
possible cases. Health education campaigns are being
conducted nationwide.

Again, this appears to be a very contagious virus. Earlier
Boxun reports from China also commented on strains of the
virus that were infecting entire ponds through virus-laden
feces. Last year

over 100 tigers died
from the virus.


Saturday, July 30, 2005 12:49:21 AM -





 


Avian Flu - What we
need to know


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xml:lang="en-US">


Investigators have determined that a strain of bird
flu virus infecting fowl in Russia is the type that can
infect humans, the Agriculture Ministry said Friday.


The virus caused the deaths of hundreds of birds in a
section of Siberia this month, but no human infections
have been reported.


In a brief statement, the ministry identified the
virus as avian flu type A H5N1.



That story is from today's

Washington Post
, thanks to Jon Rundle for the link. The
news comes one week after initial

reports
of birds dying in a Novosibirsk village.




 


 


Saturday, July 30, 2005 12:37:05 AM - 

Pale Horseman

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It's interesting that it's a Chinese state secret. Does
this mean that it was an accidental release from a Chinese
military lab?

I kind of hope it was. That means there might be a vaccine
for it. Or perhaps the fact that it started in China means
that it was an attack from someone else.

CHINA's official Xinhua news agency confirmed this week
earlier wire reports about the mysterious deaths of 27
farmers in several villages around the cities of Ziyang and
Neijiang in Sichuan province.

Another 41 people in Sichuan have also fallen seriously ill.


All victims had been exposed to swine and developed high
fever, fatigue, nausea, vomiting, and 'became comatose later
with bruises under the skin', according to Xinhua. The
provincial health authorities insist that 'the disease is
absolutely not Sars, anthrax or bird flu'.

Instead, they ascribed the outbreak to a common swine bug
called streptococcus suis. Based on information from the
Chinese, the World Health Organisation (WHO) agrees that the
symptoms 'seem consistent with' the diagnosis.

Could the WHO be wrong? Are the provincial authorities
prevaricating?

But, first, what is this bug and why are these Sichuan cases
less likely to be it? According to The Merck Veterinary
Manual, this is a bacterium that lives in the noses,
throats, guts and genitalia of pigs. Thus, farmers exposed
to droplets of swine saliva, as well as slaughterhouse
workers, butchers, and cooks who have open wounds who handle
pork and pig innards could become infected.

Yet, despite its prevalence in pigs - up to 15 per cent of a
herd could be carriers - human cases are rare as only one
out of a total of 35 serotypes of the bacterium causes
serious infections in people.

In humans, the bug invades the membranes covering the brain
and spinal cord causing meningitis, with severe headaches,
high fever, vomiting, confusion, stiff neck, loss of hearing
and coma. There can also be bleeding from blood vessels
beneath the skin, and the patient can go into toxic shock,
with damage to the heart.

Sounds like the mysterious illness in Sichuan?


Note, however, that most cases have been reported in
northern Europe and southern Asia, where intensive swine
management practices are used, perhaps at least on the scale
seen in the Pulau Bulan farm that supplies Singapore with
about 6,500 pigs every week, according to the AVA. That does
not sound like rural China.

Human cases have been seen in Singapore too, but they are
very rare. In fact, until this Chinese claim, less than 150
human cases have been reported worldwide.

A total of 68 patients in Sichuan sounds unlikely for
various other reasons too.

First, the bacterium is easily treated in pigs with
penicillin. Though it can survive for long periods, it is
also easily destroyed with soaps and dilute disinfectants.


Secondly, the high mortality also makes the cause somewhat
less likely to be bacterial in origin, as bacterial
infections are rarely as lethal.

Thirdly, the bug seems to spread between herds not only
through the introduction of apparently healthy carrier pigs
but also by flies, which can travel up to 2km between farms
on their own. If flies got on to vehicles, they could go
farther. Carcasses of dead pigs could also transport the
bacteria.

But up to 75 villages are affected in Sichuan. These are
clustered around 40 townships in different counties, which
represent large geographical distances. This suggests the
possibility of transmission by migratory birds.

Quite apart from the fear that pigs, which often carry the
human flu virus, could contract bird flu and act as a
'blender' to speed up the process of its mutation, several
facts suggest that the mysterious illness sounds a lot like
influenza, some scientists believe.

Far-fetched?


In December 1979, the British Medical Journal published a
letter from an army physician that had laid undiscovered in
a trunk in Detroit for 60 years. In the 1918 letter, the
doctor who was attending to soldiers in Boston during the
devastating pandemic that year described in graphic detail
how they were dying from the flu: 'Two hours after admission
they have the mahogany spots over the cheek bones and a few
hours later you can begin to see the cyanosis extending from
the ears and spreading all over the face, until it is hard
to distinguish the colored man from the white.

'It is only a matter of a few hours then until death comes
and it is simply a struggle for air until they suffocate.'
(Cyanosis is a bluish or purplish tinge to the skin.)


Note that reports described the Sichuan patients as having
skin that turned very dark. Some H5N1 bird flu
variants can produce bleeding under the skin. The index case
in Thailand's human cases of bird flu this year was
initially misdiagnosed as dengue hemorrhagic fever because
of that bleeding.

What about the meningitis seen in Sichuan?


The H5N1, in fact, already has genes that can attack
the brain. According to recent papers in Virology and The
Journal Of Virology separately, this ability is seen in H5N1 samples isolated in 2001 and 2002 from poultry and
birds in Hong Kong, and from a bird flu patient who died in
the ex-colony in February 2003. Thus, it is very possible
for any H5N1 circulating in mainland China to have
this (neurotropic) characteristic.

Supposing it was bird flu in Sichuan, where could it have
come from?

Probably from Qinghai province, just north-west of Sichuan.
There, a major outbreak of bird flu occurred in April at a
nature reserve, where 8,000 birds across five species - and
also some mammals - died. Only in May would the Chinese
authorities own up to it.

Now the weather has turned cold early at Qinghai, so birds
there may have already started migrating out. Indeed, in
June, China reported two outbreaks in birds at Tacheng city
in Xinjiang province, which lies northwest of Qinghai. This
week, there were wire reports about outbreaks in the
Primorie and Chany Lake reserves in Russia, where more than
500 birds have died.

Here is the cause for concern.


When it first happened in Qinghai, an Internet daily called
Boxun.com reported the outbreak, which the authorities
denied. Human cases and fatalities, involving six tourists
and 121 locals, were also detailed. Then, 17 of 19 Boxun
reporters involved were jailed.

In May, China reported to the international authorities that
there had indeed been an outbreak among birds in Qinghai but
denied any human cases. Yet, it effectively hindered the WHO
authorities from investigating the outbreak. Indeed, the 1.3
billion strong nation has never reported any human cases of
bird flu that, since 2003, has killed at least 57 people in
Thailand, Vietnam, Cambodia and, now, Indonesia.

The Chinese have also never reported any outbreak in Sichuan
- among poultry or people. But outbreaks in Shantou, Hunan
and Yunnan were not reported either.

However, we know these did occur.


A paper published in July in the journal Nature detailed the
genomics of H5N1 isolated in samples taken in 2005
from Qinghai and Guangdong as well as Hunan and Yunnan.


Dr Guan Yi, a University of Hong Kong scientist, told the
media that, soon after the Nature paper was published, the
mainland authorities accused him of stealing state secrets.


So China considers H5N1 a state secret - the Qinghai
isolates have been shown to be very virulent - perhaps
because people have already been infected?

If so, we have much to fear.


The city of Ziyang where patients are dying lies close to
Chengdu, the provincial capital which is 250km south-east of
Qinghai.

Should human cases emerge among Chengdu's 10 million people
- it has an international airport - bird flu could spread
even faster.

China may not be alone in under-reporting
H5N1.

In India, where pigeons died en masse on one occasion in
2004, the blood of poultry workers collected in 2002 shows
antibodies to H5N1. Officially, though, India has no
H5N1. This month's first human cases in Indonesia,
with two deaths, may be linked to trips made to India and
Hong Kong.

Alas, this stonewalling can kill as the H5N1 acquires
more lethal genes - like

Posted by dymaxion at August 1, 2005 06:07 PM

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