The Coming Influenza Pandemic?: April 2005

So far, no sustained human-to-human transmission of the H5N1 virus has been identified, and no evidence for genetic reassortment between human and avian influenza virus genes has been found; however, the epizootic outbreak in Asia poses an important public health threat.

If these H5N1 viruses gain the ability for efficient and sustained transmission between humans, there is little preexisting natural immunity to H5N1 infection in the human population, and an influenza pandemic could result, with high rates of illness and death. In addition, genetic sequencing of influenza A (H5N1) virus samples from human cases in Vietnam and Thailand shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza. This would leave two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 virus. Efforts to produce a vaccine that would be effective against this strain of influenza A (H5N1) virus are under way. Vaccine reference virus strains already have been made and provided to manufacturers to produce pilot lots for human clinical trials as well as to produce a larger quantity of H5N1 vaccine, but mass production and availability of such a vaccine is some time off.

Monday, April 18, 2005

April 17 Flu Update

The Sunday Times of London writes that pandemic fears are subsiding.

Check this out.

There has not been a single confirmed instance in Vietnam, which is regarded as the epicentre of the disease, of people spreading the virus between each another. Only two such instances have been confirmed elsewhere in Asia. Scientists at the WHO are describing figures given in prophecies of doom as just “a mathematical exercise”.

Recombinomics with WHO officials commenting on human-human transmission.

Recombiomics writes that CDC promises to be more careful with live viruses.

Saturday, April 16, 2005

April 16 Flu Update

Wendy Orent in the Washington Post with a must-read article on the flu and the risk of pandemic. Her theory is that messing around trying to recreate the bird flu is what is putting people at risk.

Here's a quote.

Evolutionary biologist Paul Ewald of the University of Louisville points out that influenza is normally a relatively mild disease: It keeps its hosts up and moving in order for it to spread. But the precise conditions of the Western Front allowed the virus to evolve unprecedented virulence. Without those conditions, lethal pandemic flu cannot evolve. Says Byerly, "The 1918 flu epidemic most likely will not happen again because we won't construct the Western Front again."

WHO concerns that bird flu pandemic is drawing closer.

Scotland article on ducks and their role in flu.

April 15 Flu Update

Eight new bird flu cases in Vietnam.

In Ireland, they say that bird flu is the top health threat.

Two Koreas to meet next week to discuss bird flu.

Daily Telegraph on pandemic fears.

Seattle says think globally, prepare locally. Is that classic Seattle or what?

And where have we seen this before, an ACTION plan in Vietnam for the flu.

Yesterday, we noted an interesting report from Vietnam that the virus had clearly changed since it began. Here, Recombinomics talks about what that means, and tells us the samples are on their way to the US for testing.

Recombinomics on old flu viruses rattling around.

EU bans import of some North Korean products.

ProMed on the veterinary response to the bird flu.

Friday, April 15, 2005

April 14 Flu Update

CIDRAP on 3 new cases in Vietnam, and a scientist there who says the disease has changed to a less virulent, easier transmitted disease.

Gee, where has anyone heard that before.

Official flu update from WHO.

AIDS victim in Vietnam gets bird flu.

Recombinomics says that makes Quang Binh cluster six cases.

In what will be one of only 100 major controversies if this pandemic happens, WHO says it doesn't want borders closed to protect against flu spread.

Another article on the role of cockfighting in speading bird flu.

UN and WHO say culling won't work against bird flu spread.

I think I've heard that somewhere else, too.

New Scientist says reports on Indonesian pig with flu.

Speaking of which, here's ProMed on the New Scietist article. VERY INTERESTING, MUST READ. The articles says that the idea that pigs, who can be infected by bird and human flu and are a good mixing bowl is only a theory and hasn't been proven.

First flu story in the Economist.

Transcript of WHO official on Australian TV. Very informative.

Europe will have scenario based planning exercise on flu pandemic.

Story on race to wipe out 1957 flu.

Recombinomics on the lab debacle.

ProMed mail surveys the bird flu situation in each country.

ProMed Mail on the new Vietnam cases.

Effect Measure with a good article on the 1957 debacle.

Wednesday, April 13, 2005

April 13 Flu Update

The world is laughing at the 1957 flu virus debacle. It was the lead story on--at least--the ABC Evening News last night. Here's some more.

The world continues its shock as public health professionals attempt to reintroduce a deadly flu virus into the population.

WHO's official response to the debacle.

CIDRAP on the company's explanation for the screw up.

Recombinomics on the screw up.

ProMed writes about the distribution of live virus.

Study shows 71 percent of ducks in Mekong Delta have bird flu, obviously a stunning number.

CIDRAP comments on the infected poultry.

ProMed on the infected poultry. Note the comments section that says that there appers to be an internal debate in Vietnam between culling and vaccinating.

Washington Post on the Asian cultural practices that encourage bird flu, like cockfighting.

Effect Measure found an odd little post
where a blogger tracked his flu symptoms. Nice discussion of the phsyiological triggering and function of a fever.

ProMed posts an interesting query. Does the emergence of the flu in pigs mean that pigs were fed culled chickens?

April 12 Flu Update--Update

When I did the update this morning, I underestimated how big this first story is. Its been the second most widely emailed story on Yahoo! Read carefully, following up tomorrow.

Effect Measure on lab screw up that could reintroduce the 1957 virus to a largely naive population

The Rest of the news is also interesting and compelling today:

WHO releases new pandemic plan, replaces 1999 plan. CIDRAP summarizes...

WHO's press release on the new plan.

And a .pdf of the actual plan.

WHO update on Cambodia.

CIDRAP on the possibility of asymptomatic ducks in Cambodia.

EU plans bird flu emergency fund.

Vietnemese News Agency Cites French Vet as "expert" who says no flu in pigs, no human-human transmission.

Nobel scientists warns on bird flu.

EU speech on bird flu which, I guess, is slated for 14 April delivery.

Physician from Canadian Medical Association says that rich countries should pool funds to fight bird flu in Asia, and stop its spread.

Trust for America's Health report says US flu pandemic planning is falling short.

Effect Measure reports on the 1,000s of sick children in Ho Chi Minh City from yesterday, notes that news source also reported the 195 cases earlier that may have been overblown.

Tuesday, April 12, 2005

April 11 Flu Update

Here's a Recombinomics link on 1,000s of Vietnemese children in the hosptial with respiratory disease. Hot weather has caused them to sleep with fans on, which distributed whatever they have very nicely. Yet another example of how tightly coupled the flu is with humans. If this is the flu, the pandemic has clearly begun.

Recombinomics comments.

Though it may seem beneath the radar, the bird flu is being reported in pigs in Indonesia. This could be significant because pigs and humans can swap the same flu virus.

This story represents a common theme, that SARS taught Asia how to fight the flu.

China continues the PR offensive in support of North Korea's flu fight.

Hong Kong had birds die recently, but it says here it wasn't the flu.

CIDRAP on bird flu death in Cambodia.

Here's a Recombinomics link on 1,000s of Vietnemese children in the hosptial with respiratory disease. Hot weather has caused them to sleep with fans on, which distributed whatever they have very nicely. Yet another example of how tightly coupled the flu is with humans.

Effect Measure on yesterday's development in Cambodia, and blog-within-a-blog on Recombinomics.

ProMed on the Cambodian situation and the likely suspect--a Duck.

For reference, here is the CDC data on the role of the pig in an evolving flu virus.

Pigs can be infected with both human and avian influenza viruses in addition to swine influenza viruses. Infected pigs get symptoms similar to humans, such as cough, fever, and runny nose. Because pigs are susceptible to avian, human and swine influenza viruses, they potentially may be infected with influenza viruses from different species (e.g., ducks and humans) at the same time. If this happens, it is possible for the genes of these viruses to mix and create a new virus. For example, if a pig were infected with a human influenza virus and an avian influenza virus at the same time, the viruses could mix (reassort) and produce a new virus that had most of the genes from the human virus, but a hemagglutinin and/or neuraminidase from the avian virus. The resulting new virus would likely be able to infect humans and spread from person to person, but it would have surface proteins (hemagglutinin and/or neuraminidase) not previously seen in influenza viruses that infect humans. This type of major change in the influenza A viruses is known as antigenic shift. Antigenic shift results when a new influenza A subtype to which most people have little or no immune protection infects humans. If this new virus causes illness in people and can be transmitted easily from person to person, an influenza pandemic can occur.

Sunday, April 10, 2005

April 10 Flu Update

A slow Sunday, as usual.

Recombinomics on the radio silence from Vietnam on data and what it might mean if you read between the lines.

Cambodia has a fourth fatal case.

ProMed on Cambodia.

Saturday, April 09, 2005

April 9 Flu Update

North Korea accepts aid from South Korea in fighting flu. This is bigger news than it seems.

China says North Korea fighting the bird flu.

ProMed on north and South Korea.

Recombinomics reports on a fourth death in Cambodia.

Recombinomics on continuing radio silence on the 195 Quang Binh cases.

April 8 Flu Update

We lead off today with Effect Measure, who says that global spread is inevitable.

The North Korea situation, as many suggested, is not over.

Paris conference discuses possibility of global spread.

Voice of America says that our clincial vaccine trials have begun. Question: Does VOA interest in bird flu signal a desire to project a more assertive US position to the world all of a sudden?

Another VOA transcript.

ProMed Mail with a relatively interesting account from Vietnam.

ProMed Mail on the North Korean request for help.

Friday, April 08, 2005

April 7 Flu Update

Global animal health organization speaks frankly on flu fears.

Thailand ready to declare itself flu free.

Text of US HHS Secretary Leavitt speech on bird flu in Paris.

Recombinomics asks whether bird flu has left Asia.

Recombinomics on the HHS speech, the direct link between the US Quarantine order and the sick physician in Vietnam, and others.

ProMed on the low pathogenic bird flu in Mexico.

Thursday, April 07, 2005

April 6 Flu Update

Recombinomics lays it on the line. Clusters are merging, human-human transmission has begun, an that caused the April 1 Quarantine order from President Bush. "The flu pandemic has begun," he says.

Bird flu causing banking jitters in Asia.

Bill+ referred this one to us. With both H5 and H7 running around, if the viruses mix, you could get H5 lethality and H7 transmissability. A WHO official comments on that prospect.

Dead Vietnemese girl is confirmed to have bird flu.

The BBC writes on the girl being a mileston 50th bird flu death.

Despite less than chilly relations with N. Korea, the US is sending bird flu testing kits to that nation. Is this just diplomacy, or a signal something more is feared?

Seoul is strengthening its bird flu precautions.

Vietnam trumpetting two days with no outbreaks.

Additional cases in Vietnam announced--these may be duplicates.

US purchasing 2.3 million doses of tamiflu.

Recombinomics corrects media accounts that say H7 new to Asia.

CIDRAP on the day's developments.

Effect Measure connects the dots where others will not. Links quarantine and bank warnings cited above.

ProMed on the dead Vietnemese girl.

Tuesday, April 05, 2005

April 5 Flu Update

This report from the New Scientist says that initial reports appear to show that the flu in North Korea is H7 not H5...albeit indirectly.

Recombinomics on the H7. Notes co-infection of H7/H5 is more likely with two viruses running around.

Effect Measure on the H7 reports.

CIDRAP says its the first H7 in Asia.

Promed on the North Korea situation

Reuters says that two more are in the Haiphong Hospital

Reader Bill+ points out this article...could it be a case of human-human transmission. Another health care worker was infected earlier, but this could be evidence as well.

CBC reports on US flu vaccine trials.

Flu expert calls for Hong Kong flu containment methods to be adopted elsewhere.

Presentation at Paris flu conference to focus on a new type of vaccine treatment that would provide universal protection.

Recombinomics on the 27 year old female in Vietnam reported here yesterday.

Recombinomics on the possibility of bird flu in Vietnam.

Official copy of President's Bush quarantine order...suitable for framing.

ProMed on the Vietnam cases.

Monday, April 04, 2005

April 4 Opening Day Flu Update

WHO confirms the Haiphong Five

WHO says 5% of flu funds should be saved for bird flu.

CIDRAP on the new case and the WHO report.

CIDRAP on HHS funding cell-based vaccine development.

Bird flu has cost Asia $8M-$12M.

Woman in Vietnam has bird flu, likely to survive.

Bird flu victim (5M) discharged...first case in Central Vietnam.

Banks in Hong Kong warning about the costs of bird flu.

CDC with an outbreak update.

Effect Measure covers the waterfront. Questions whether Bush administration actions, like those of Kim Il Sung, mean it must be REALLY bad.

Promed/Sgt. Friday on today's news.

Sunday, April 03, 2005

April 3--Slow Sunday Flu Update

Even Recombinomics is quiet today.

Effect Measure writes about the large amount of cross-border traffic between North Korea and China, and its implications for the bird flu.

Vietnam unleashes hygiene and sanitation awareness on the virus.

Article from Dubai on bird flu taxing the bureaucracy in Vietnam.

Saturday, April 02, 2005

April 2 Spring Ahead Flu Update

Verryyyyyyyyy Slow. Is anything else in the news?

Bird Flu outbreak reported in Mekong Delta.

ProMed catches up on the April 1 news.

ProMed on flu vaccines in China.

Friday, April 01, 2005

April 1 Flu Update

Kim Il Sung has H5N1!

WHO Over-reacts to Flu Report

Potential Flu Pandemic pushes Terri Schiavo off the headlines. "Its just more important," says news exec.

I could go on and on. But seriously folks...

(This one is real--President Bush has signed an executive order allowing quarantines in pandemic flu situation. Just a precaution, says CDC.

China is eyeing North Korea nervously, and seeking to keep bird flu on their side of the border.

News release to speed up cell culture vaccine production from DHHS.

Recombinomics on mysterious disease outbreak in Vietnam, call for more info.

Recombinomics with a brief comment on WHO's statement yesterday on the Haiphong Five not necessarily meaning human-human transmission.

ProMed on the latest from North Korea.

March 31 Flu Update

Vietnam says the Haiphong Five in stable condition.

Vietnemese Official says Bird Flu is caused by ignorance, as government launches major campaign to eradicate it.

LA Times on the bird flu hitting North Korea in a vital area for their food production--poultry.

The Chinese say surveillance for flu still weak in Vietnam.

Hong Kng planning to use their major stadium as huge outpatient clinic if bird flu hits. (note...outpatient?)

This is a cool link from Harvard. Its called "Questions the media should ask" and the topic is the bird flu.

Recombinomics asserts that the Haiphong Five is proof of efficient transmission.

Revere at Effect Measure says that if N. Korea admitted the flu, it must be bad. He goes on to say that the WHO's eradication strategy has already lost, and we should prepare for a pandemic...even if it might not happen.

The Coming Influenza Pandemic?

Is a global influenza pandemic on the way that could kill millions of people? Are we going to relive the horror of 1918? If it happens, are we even remotely prepared to save ourselves? Scientists from around the world are concerned about bird flu...since 2004 our site has tracked news of H5N1 influenza from around the world.

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FluWiki online.
Wikipedia on Influenza
CDC Flu Page
WHO Flu Page
CDC Avian Influenza
New Yorker's Malcolm Gladwell on the search for the flu in permafrost
New Yorker's Malcolm Gladwell on Flu as our most deadly contagion
The Planning and Politics behind the flu from Greenhammer
Preparing for the Next Pandemic
Michael T. Osterholm, Ph.D., M.P.H.
New England Journal of Medicine, May 5, 2005
Is there anything we can do to avoid this course? The answer is a qualified yes that depends on how everyone, from world leaders to local elected officials, decides to respond. We need bold and timely leadership at the highest levels of the governments in the developed world; these governments must recognize the economic, security, and health threats posed by the next influenza pandemic and invest accordingly. The resources needed must be considered in the light of the eventual costs of failing to invest in such an effort. The loss of human life even in a mild pandemic will be devastating, and the cost of a world economy in shambles for several years can only be imagined.
ABC Primetime, September 2005
"Right now in human beings, it kills 55 percent of the people it infects," says Laurie Garrett, a senior fellow on global health policy at the Council on Foreign Relations. "That makes it the most lethal flu we know of that has ever been on planet Earth affecting human beings."
Dr. Robert Webster
Society just can't accept the idea that 50 percent of the population could die. And I think we have to face that possibility," Webster said. "I'm sorry if I'm making people a little frightened, but I feel it's my role.
Dr. Robert Fedson
"There is nothing in Darwinian evolution that says that our DNA has to survive compared to say the DNA of an earthworm. I mean Darwinian evolution is completely indifferent to which DNA happens to persist. We are not necessarily unique as a species as far as evolution is concerned and we can disappear like other species have already disappeared."

The Coming Influenza Pandemic?

Saturday, April 30, 2005

April 30, Final April Flu Update

Friday, April 29, 2005

April 29 Flu Update

Thursday, April 28, 2005

April 28 Flu Update

Wednesday, April 27, 2005

April 27 Flu Update

Tuesday, April 26, 2005

April 26 Flu Update

Monday, April 25, 2005

April 25 Flu Update

April 24 Flu Update--Typical Slow Sunday

Saturday, April 23, 2005

April 23 Flu Update

April 22 Flu Update

Friday, April 22, 2005

April 21 Flu Update

Thursday, April 21, 2005

April 20 Flu Update

Wednesday, April 20, 2005

April 19 Flu Update

Tuesday, April 19, 2005

April 18 Flu Update