The Coming Influenza Pandemic?: July 2005

Saturday, July 30, 2005

July 31 Flu Update

The Chicago Tribune writes on concern in Indonesia.

Recombinomics on the confirmation of bird flu in Siberia.

The Heath Protection Agency has its annual report which calls out bird flu.

The mystery in China continues. Recombinomics writes that if its a bacteria, anti-biotics should work. Boxun has news like this:

A boxun interview indicated a recombinant Ebola strain was isolated from a patient. Plague bacteria was also found, as was another "dangerous" virus The viral components would help explain the poor response to antibiotic treatment as well as the rapid spread.

Recombinomics with more info on China, and an Ebola recombinant.

More promed on Siberia.

Friday, July 29, 2005

July 30 Flu Update--this is a big news day.

The Washington Post is reporting that the flu found in Siberia is H5N1, despite earlier Russian denials.

The Daily Mail adds its take to the Russian admission.

And a Russian version.

And, finally, ProMed

In Indonesia, people are wondering if the country is slaughtering pigs, which represent a minor industry, in order to protect poultry--a major industry.

Pig farmers are not the only ones scratching their heads. International experts are bewildered as well. They say there is no evidence pigs have been infected with avian flu despite the government's insistence that the animals are contributing to the recent outbreak in Indonesia, the world's most populous Islamic country.

Critics say the government is going after pigs because they are an easy target and may divert attention away from fears about the infection in poultry, a staple food for millions of people throughout the country.

The two dead in Vietnam we reported yesterday is now being reported more widely.

Washington Post on Vietnam.

The Jakarta Post notes different regions in that country are handling the flu differently.

The Post also has a story on hospitals preparing for bird flu patients.

The Saturday Evening Post (which I did not even know still existed) has this article on how lawsuits killed the capacity for vaccine response to the pandemic.

In Malaysia, ministers are noting the importance of a pandemic preparedness plan.

WHO has a situation update on a second confirmed case in Indonesia. This is the 8-year old daughter of the man previously confirmed. You will recall the chickenshit theory that Indonesia brought forward. WHO writes as follows.

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.

ProMed also has this story. Note the mod comment that she was the initial case, and that there is no known route of exposure.

Recombinomics on this story as well. Its odd--the pet bird was caged....never went outside.

CIDRAP on Russia and Vietnam.

Recombinomics on the two new deaths in Vietnam.

Promed on Vietnam.

Recombinomics writes on the China situation, with boxun translations of case reports. He continues to assert that the rampant illness is not being caused bacteria.

Recombinomics says the Chinese continue to stonewall.

ProMed has conflicting news from Japan.

Nature writes on a study that seems to support the recombination theory of flu genes, based on a recent study.

Crofsblogs located this human interest story on the economic toll in China to pig farmers.

Wrapping up, Effect Measure surveys the entire landscape. Four countries, four sets of troubling news today. Re: China, he notes that while the 1918 flu did present with symptoms similar to what is being seeing in China, there should still be predominantly respiratory symptoms in a flu outbreak, and those are not being reported. This is a must read.

Comments to this post are a must read, too. Includes reference to the flubola theory.

July 29 Flu Update

Reuters, via Crosfsblogs, is reporting two more dead in Vietnam. We await more information.

More news on Indonesia's selective culling plan.

A company in Singapore has released a flu test kit that it claims can detect gene specific flu in four hours.

WHO says N. Korea is bird flu free.

In Thailand, fighting birds are getting passports.

And they are doing the same thing in Australia.

CIDRAP on the "puzzling pig disease" in China.

Recombinomics raises concerns that the "pig" disease has spread, and that its a secondary infection.

ProMed on the new Vietnemese bird cases reported yesterday.

Crofsblogs has the news that CNN is mis-reporting the Chinese outbreak as swine flu, which is a disservice to people who are all to eager to file the whole flu pandemic in the swine flu folder.

Wednesday, July 27, 2005

July 28 Flu Update

Diane Rehm featured Anthony Fauci on her NPR program. Here's a link to the audio.

There's a new report of bird flu in the Mekong in Vietnam.

Here's a quality blog picking up on the flu story.

Sales of live chickens are slumping in Indonesia.

Retuers says the US continues to work on its pandemic plan.

CIDRAP writes on the so-called chickenshit theory.

Recombinomics on a quarantine in Siberia.

ProMed on the Japanese outbreak we reported yesterday.

New Scientist on the reports that a highly rare swine bacteria is causing massive death in China.

Crofsblogs comments on the swine bacteria.

Tyler Cowan on avianflu cites an article that cites reasons why the Chinese claims are dubious.

Tip O' the hat to Crofsblogs for finding this, an editorial in the Brattleboro Reformer on US pandemic preperations.

July 27 Flu Update

AP is reporting that Indonesia has found a link between birds and the three cases in their country. The link was not with the birds directly, but with their feces. Of course, this feeds the desire to show no human-human transmission. Exect others to weigh in on this.

And they do....Effect Measure refers to it as the chickenshit theory.

Note--the officials do say they don't know if the victims were infected by the feces, and note confounding data as well about why farmers aren't getting sick.

ProMed weighs in. Note the mod comment that the infected people live in an upper class neighborhood.

Effect Measure on dwindling confidence in Indonesian reports.

A lab is closing in China due to Chinese flu restrictions.

Recombinomics looks at the closed lab, and wonders what it might be hiding (keyword: raging epidemic.)

Here's something I never thought of before. Question 1: What do you need to make flu vaccines. Answer: chicken eggs. Question 2: Who dies by the tens of thousands from bird flu. Answer: Chickens. See the problem.

Here's another story on Russia saying the flu in Siberia is not threatening to humans.

Forbes says Japan is finding more sick birds.

WHO is urging Indonesia to fight bird flu better.

The BBC reports this from the NIH. Newly published research shows that the flu virus mutates faster than anyone ever thought, complicating vaccine efforts.

Scientists previously believed that gene swapping progressed gradually from season to season.

The National Institutes of Health team found instead, influenza A exchanged several genes at once, causing sudden and major changes to the virus.

The findings in PLOS Biology suggest strains could vary widely each season, making it potentially harder to treat.

CIDRAP writes on this as well.

Bandladesh is banning poultry imports from five countries.

CBC reports they are ready for the flu in Northern Canada.

Forbes has an often repeated story--did the 1918 flu begin earlier than previously thought.

Recombinomics on the very high fatality rate in China from the "mystery disease."

Although some boxun reports have suggested Ebola, the proximity of Sichuan Province next to Qinghai Province suggests H5N1 may be responsible. All of the H5N1 isolates from Qinghai Lake have the PB2 polymorphism, E627K, which has never been previously described in H5N1 isolated from birds. Passage of isolates from Hong Kong or imported duck meat through a mouse brain yield an isolate with E627K, and such isolates were found in tigers that died at a zoo in Thailand had neurological symptoms, which may be related to the meningitis seen in patients in Sichuan.

Thus, the sudden increase of 37 patients reported above, the widespread distribution of cases in at least 75 villages, the high case fatality rate, and the neurotropism, all point toward H5N1 involvement in the expanding outbreak.

Tuesday, July 26, 2005

July 26 Flu Update

Here's official confirmation of the dead egrets Recombinomics reported.

In Jakarta, they are asking for people who are sick with flu-like symptoms to report to a hospital for examination.

Forbes on the Chinese denials of flu or SARS in Sichuan.

A Russian news source says four new rural Siberian regions have outbreaks among birds. The article sounds like the outbreaks are H5N1, but I believe the public position is that it is H5n2.

CIDRAP weighs in on this, noting that a prominent scientist in Russia says the "N" part of the virus in Siberia has not been identified.

Crofsblogs, with help from Declan, has news on a flu conference in San Francisco.

Declan Butler at Nature has this must-read on China--thanks again to Crofsblogs.

Here's the post directly on this item.

Reuters says they are checking two people for bird flu, even though they are sure they have typhoid.

CIDRAP summarizes the situation in Jakarta.

Recombinomics on Jakarta...

and more on Indonesia....

More from the Jakarta Post, which details the economic impact of the discovery of bird flu there. Just think of it as a microcosm.

Canada says it is as ready as it is going to be.

In Malta, private doctors are preparing for the bird flu's effect on their practice.

The Times of London has an op-ed piece from a physician which is rational and well-written, though nothing new.

The mystery in China continues. Recombinomics reports that boxun says it is ebola, and this report dubiously claims strep.

Effect Measure looks at recent statements by Roche, in which they cloke their production capacity in confidentiality.

Sunday, July 24, 2005

July 25 Flu Update

Today's lead story comes from China, where the WaPO says that the official news agency says 17 people are dead and 41 ill from a myserious disease.

Here are the reported symptoms:

Those affected had symptoms including high fever, fatigue, nausea and vomiting, and "became comatose later with bruises under the skin," Xinhua news agency said.

Recombinomics reads this as many people will---with an eye toward the way many people died during the Spanish flu, and an equally concerned look at reports of flu in China already. Here are two excerpts.

The proximity of both sets of cases to H5N1 outbreaks is cause for heightened concern. The 1918 pandemic had many mis-diagnosed cases, including those with neurological complications. H5N1 has been shown to be neurotropic in the lab

As birds at Qingahi Lake and nature reserves in Russia begin to migrate to the south, west, and east, there is concern that such a migration might lead to a catastrophic spread of H5N1.

Human deaths in the adjacent province of Sichuan may indicate that such spread has already begun.

Later, Reuters wrote that Chinese officials were denying the disease could, in any way, be SARS or bird flu. (Thanks to crofslog for this.)

There are sketchy reports that there has been a fourth flu death in Indonesia.

In Indonesia, they're culling only positively infected birds, backing off a more aggressive earlier plan.

ProMed on the Indonesian cull.

Flu Vaccine orders are already being placed for the US Flu season.

LA Times with a good overview of pandemic, though nothing new to those who read here often.

Yesterday, we noted the the UK had changed its tamiflu plans, abandoning a plan to use it for first responders and health care workers, and had decided to only use it for people who were very sick. Effect Measure weighs today with a critique of this plan, and why its bad medicine as much as bad policy.

The comments to this post on Effect Measure are great. An excellent debate and some additional Revere material.

ProMed on CDC updating its influenza section.

ProMed follows up on Siberia--H5N1 risk seems to be dialing down, though not out here.

Saturday, July 23, 2005

July 24 Flu Update

Marin County, CA, is making bird flu plans.

From the UK, an interesting tidbit. Most flu plans seem to plan to use Tamiflu to prevent the spread of the disease...healthcare workers, first responders, etc. But UK ministers announced today that they were only going to give Tamiflu to people who are sick...seriously sick.

Effect Measure criticizes WHO's unwillingness to take the pandemic about a 3...

ProMed casts a (mildly) skeptical eye toward Russian pronouncements that bird flu in Siberia was H5N2.

Here's the latest WHO update.

The Telegraph in London says China is witholding vital information from the world on bird flu...all this, and they aren't even acknowledging the boxun reports.

July 23 Flu Update--What's going on in China?

The big story today might be a story....or it might not.

You are no doubt aware of boxun.com, a website/message board community which has posted a great deal of information on the bird flu in Qinghai province. They told of thousands of dead birds, human cases, arrests of people for talking about bird flu, etc. How reliable are they? This is a province with a high percentage of ethnic Tibet, so are they just making trouble for the government? The dead birds were more or less confirmed, the human cases have not...in fact, WHO looked into them and says they did not happen.

So, for what it is worth, the latest from Boxun is grim.

Epidemi.ca has an outstanding post on this. I'm excerpting just the part that concerns current activities, but the entire article is a must-read.

The past few days, postings on boxun.com go a lot further. On July 15, a possible connection between H5N1 and Chinese bioweapons research is mentioned. On July 18, there are, again very detailed, descriptions of an ebola outbreak in two provinces in southern China. The past two days bring reports of troop movements near Qinghai, of areas being quarantined, people being taken away and fights breaking out between farmers and doctors, and ultimately the military.
For now, all boxun.com reports remain unconfirmed, except for the bird deaths at Qinghai Lake. And there is still a chance that these are a bunch of people who want to discredit their government. We do not even know if the postings are written by the same sources. But the wealth of specifics and details makes it harder to dismiss them offhand. What seems clear, even without boxun.com, is that H5N1 is widespread in China, probably more so than in any other country. Add that to the fact that about 60 people have already died from bird flu in other Asian countries, while China claims no human infections whatsoever, and we can not help wondering.

Recombinomics has written on this as well. Here, he posts machine translations of chilling (if true) posts from boxum on Chinese military activity.

Excerpts

"Hey, are we going to war? Something's not right. I can see many armoured vehicles and soldiers with guns on the road. I can ever hear planes in the air. Rumor has it that they're from Yushu (i believe that this's a location, but i'm not sure which) Can someone please clarify what's happening?"

"They're over here too. I can see hundreds of troops, many of whom are in full battle order. I'm from Yushu"

"I'm from Chengdu. Are you from the region where the bird flu was found?"

"I'm seeing the same thing here too, in LaSuTung (translation, i think it's a mongolian city). I've never seen so many planes in my entire life."

"It must be related to the bird flu."

"I thought "it" (the bird flu) was from the Qinghai region? It's here now? That's really fast."

"We'd better keep a low profile. My parents are asking me not to venture out. I can see troops in full battle order grabbing people. But I'm not sure why so."

"You're right, I can see troops and planes too."

"Hey, I can see troops in "white suits" and planes flying at low altitudes. If you can see them too, can you please acknowledge?"

"I see people being snatched out of their houses"

"The troops are finally here. They're walking through the village (or town), checking the houses. I should be fine since I don't breed any birds."

This second Recombinomics post contains some additional information that indicates more unconfirmed reports of quarantines enforced on the ground.

I hesitate on passing along this information in this manner. I did it because you should be able to decide for yourselves what it means.

In other news....

Newsweek says people in Indonesia are not worried about the bird flu.

In Russia, they say the bird flu found in Siberia is not dangerous to humans.

The Calcutta Telegraph on the rising fears from new information on bird flu.

In case you were worried, Nicaragua is bird flu free.

Malaysia says its bird flu free as well....where have we heard that before?

Hygiene efforts in Thailand are underway to fight the flu.

Indonesia and China are going to cooperate on fighting the bird flu. They will work together by sharing experts and bird vaccine production.

In Australia, they are putting money toward a local vaccine.

This story says the Australian vaccine is on the fast track.

In Wisconsin, they have a bill that would let retired Doctors practice again in a flu pandemic.

You will recall the Trust for American Health report that made news due to its modest but awful death toll projection and its criticism of US preperation. Here, they commend US for a recent tamiflu order.

Recombinomics has other boxun.com data, including an unconfirmed report about bird flu in Chengdu in Sichuan.

Recombinomics also has boxun news of 300 dead birds in Guangzhou Guangdong

CIDRAP has further information on the Siberia reports.

Effect Measures comments on the US pandemic plans, which are finally coming together. He notes that the plan calls for high government officials to get rationed Tamiflu.

Effect Measure comments on the rapid change in the Indonesian situation.

ProMed on Siberia.

Finally, I feel a little remiss in not doing this earlier, but here is some data on Qinghai .

Qinghai Lake (qīnghăi hú) is another great trip, albeit further from Xining than Kumbum. The lake is the largest saltwater lake in China, and is also located on the "Roof of the World," the Qinghai-Tibet plateau. The lake itself lies at 3,600m elevation. The surrounding area is made up of beautiful rolling grasslands and filled with Ethnic Tibetans, making for an authentic experience. Most pre-arranged tours will stop at Bird Island (niăo dăo), but check to make sure if admission is included in any tour package. A Tour from Xining, around the entire lake, and back with stops for lunch, shopping, and sightseeing can easily run 12 hours (more for Bird Island), so it may be wise to allot an entire day for this side trip.

Thursday, July 21, 2005

July 22 Flu Update

The unstoppable flu continues. There are now sick birds in Russia. BBC reports.

Somewhat humorously, the Russian government is demanding answers as to who let the bird flu in.

Recombinomics says there has been bird flu in Siberia before.

Indonesia is "on alert"...

...which they should be, given that 21 provinces have been found to have bird flu.

CIDRAP notes that WHO is saying that only one of the Indonesian cases is H5N1.

Official WHO release...

The Daily Mail (UK) notes flu as serious a threat as terrorism--Expert in the story is predicting 50% infection rate, 30% fatality, for a grand total of 1 billion deaths. Given that the Spanish Flu only had a 2-3% fatality rate, 30% would seem a little high.

In Australia, officials are taking the presence of flu in Australia in stride.

The SF Chronicle editorializes on pandemic planning, calling for early detection.

The Economist, the world's greatest magazine, covers the Indonesia development.

The Scotsman notes that health care workers are in the front of the "queue" for vaccine.

Crofsblog notes that the headline in the Scotsman story was badly misleading.

Roche says 25 countries have placed Tamiflu orders--30 months or its free.

Wednesday, July 20, 2005

July 21 Flu Update

The news is in from Indonesia. The three deaths are confirmed bird flu.

Recombinomics follows up on this story...

...as does CIDRAP

and ProMed.

Recombinomimcs says that the pattern is the same in each country, and that WHO's pandemic level 3 is too low.

Nature.com notes that while governments continue to protest that the bird flu is under control, it is crossing borders often.

Bird Flu found in Chinese frozen duck meat from two years ago.

UK is stocking up on 2 million flu vaccines

Another story on Vietnam inoculating chickens.

Medindia says flu is more contagious, more dangerous.

Roche had a good quarter financially.

Work began today on the new vaccine plant in Pennsylvania.

There's a report of talks between Roche and the US Government on Tamiflu.

US News and World Report on what the US vaccine distribution plan really means--"rationing"

Thailand says there's no need to vaccinate its fowl---the flu is "controllable"

Recombinomics on the flu strains on the loose, and some interesting duck data.

CIDRAP has the WHO story--no change to the official H5N1 vaccine.

Effect Measure runs a letter from the man who invented the culling machine.

Tuesday, July 19, 2005

July 20 Flu Update

The big "news" today is that the National Academcy of Science says that ducks might spread the bird flu--silently, like trojan horses (or ducks, says the wags). And their migratory patterns make them excellent spreaders of virus.

CIDRAP on the ducks.

The Indonesians are talking about containing flu on farms where it has been found.

Meanwhile, the nation's leader is downplaying the threat.

And in the Philippines, they say they have the flu under control.

This report says 5,000 birds have died in Tibet from the flu. Reliability is unknown.

In Indonesia, there's 9.5 million dead chickens in the past couple of years.

Even in China, the Wall Street Journal is the voice of the establishment, here allowing a high government official to respond virtually unchallenged to stories of supressing information.

As if on cue, Recombinomics steps in and notes that China is avoiding requests for H5N1 flu information.

Chiron is scaling back vaccine production for this year...highlighting a critical weak link in any pandemic response plan.

Another report says US supply of antivirals is "totally inadequate."

I could have posted a dozen links proudly proclaiming that Tamiflu is effective against H5N1, but we did that yesterday. Recombinomics says it isn't so simple.

ProMed also has this story. The Mod comment contains a caution at the end about how practical it really is, giving the dosing requirements, to use a neuramindase inhibitor on pandemic protection.

Effect Measure on an interim report from Indonesia.

Effect Measure also details the flu planning in Seattle--which could be a model.

Crofsblogs has a nice post on what it will take for MSM to pick up the flu story, and what role we can play.

Monday, July 18, 2005

July 19 Flu Update

Dateline MSNBC: Tamiflu works in mice with the flu.

Recombinomics begs to differ, with a divergent interpretation of the results.

Recombinomics jumps in on Amantadine as well.

CIDRAP weighs in on the data as well.

Reuters says Indonesia is having a hard target search for every outhouse, doghouse, etc, around the house where the family caught the bird flu.

There is confirmation that the flu in the Philippines was not H5N1.

Vietnam is ordering 415 sets of bird flu vaccine.

The debate from Vietnam. In some quarters, criticism for not doing better. In others, a grudging admiration for getting so much done with so little.

The Indonesian tests on bird flu are due soon.

The Federal Government has prioritized who will get scarce vaccines first. It would start with healthcare workers, and move to drug manufacturers next. Then, elderly and pregnant.

The ghouls among us who have been entranced by searches in permafrosted graves for the 1918 flu virus will like this. From Alaska, melting permafrost has exposed graves from a Russian Orthodox cemetery, and locals are afraid what might be in there.

ProMed has the news of an article in The Journal of Virology. It includes the following.

The authors of the Journal of Virology paper conclude that their data
challenges the view that adaptation to land-based poultry is a prerequisite
for the replication of aquatic avian influenza A viruses in humans. This is
a novel and significant conclusion that challenges current dogma.

Saving the best for last, we have Recombinomics tying it all together, in his view. You get a lot of news here...developments in China, Indonesia, Vietnam. Some from official sources, some from unofficial sources. Here is how Recombinomics summarizes all this. (Emphasis is mine)

The latest boxun report describes 10 strains of H5N1 circulating in China. Eight of the ten have some evidence for human infections, but there is no direct independent confirmation of the data. The data suggest that the 2005 pandemic is well underway and a wide range of catastrophic events will continue to make news. The report also suggests H5N1 in China is diverse and evolving, expanding a trend that will likely culminate in an event that may make the 1918 flu pandemic look tame.

Although the specifics of the report are not directly confirmed by third parties, the actions of China and the sequences of the H5N1 emerging from China, strongly support the descriptions of the strains in the boxun reports.

--clip--

The boxun reports are indirectly supported by the Nature and Science reports, as well as sequences in human cases in countries adjacent to China. There is much more reason to doubt statements by China on the lack of human infections in China or statement by WHO on the lack of mild H5N1 cases in northern Vietnam.

The data in the boxun report is considerably more believable and the data suggests a catastrophic pandemic will expand, as birds migrate away from Qinghi Lake and summer nesting sites and return to Europe, India, and southeast Asia to spread a variety of new and old H5N1 strains capable of causing lethal infections in humans and a variety of other species.

Sunday, July 17, 2005

July 18 Flu Update

The President of Indonesia demands that bird flu not be covered up.

Thailand is tightening up flu controls.

There's a clean bill of health for bird farms in New Zealand.

Thunder Bay, Ontario is preparing for the bird flu.

Recombinomics has some data from the Boxun which says there are 10 H5N1 strains running around China. He goes on to note:

China is limiting research, publication, and distribution of the data and WHO is issuing press releases offering reassurances using unscientific analysis which selects useful data and discounts data that conflicts with conclusions that allow WHO to maintain that the 2005 pandemic is a stage 3 instead of the true stage, which is clearly at 5 or 6.

Saturday, July 16, 2005

July 17 Flu Update

From Sunday's New York Times, an editorial on the bird flu and what should be done. Don't expect too much. It seems to say the best we can do is hope it doesn't happen.

In Australia, the flu is a national security issue.

The Scotsman recounts the Indonesian story, and fresh fears of bird flu.

The (London) Telegraph on the Indonesian deaths.

Recombinomics has the story of 122,000 dead quail in Thailand.

ProMed with the data on Thailand.

July 16 Flu Update.

If you look on the July 14 Flu Update, you see Indonesia denying that 3 people died of bird flu.

If you look at the July 15 Flu Update, you will see that they are admitting it is bird flu.

Effect Measure comments on the about-face.

Recombinomics on the human-human transmission in Indonesia.

Recombinomics also notes there has been swine flu in Indonesia, which opens up the track for the virus to acquire mammalian characteristics.

CIDRAP has its take on the same story.

Consensus from Recombinomics, Effect Measure and CIDRAP is this:

The virus has not yet shown any consistent ability to spread from person to person. Experts concluded that the virus probably passed directly from a 11-year-old Thai girl to her mother and an aunt in September 2004, and some family clusters in Vietnam this year raised suspicions of person-to-person spread.

The New Scientist has this on the Chinese denial of the recent results published in Nature.

In the spirit of the 1930s Soviet biologist Trofim Lysenko, China is ignoring science it finds inconvenient.

The Philippines says that the flu might be LPAI.

Science Magazine says Vietnam battles flu and critics.

Here's a disaster management article detailing challenges to the public sector of many disasters, including bird flu, and what role IT can play.

WHO is upgrading is pandemic team, says Science Magazine.

The Defense Department has ordered around 1.5 million courses of Tamiflu from Roche, deliverable in February.

Recombinomics notes geese dying in Brunswick, Georgia, and the "ominous" similarity with reports from China.

Recombinomics cites Boxun reports that say there has been widespread, mild forms of bird flu in China since last year.

Recombinomics follows up with more on the reports from China.

Finally, Recombinomics reports on unconfirmed reports of bird flu in China with strongly mixed human transmission and lethality.

ProMed on the Philippines.

ProMed on Indonesia. Note the mod comment at the end that spells out some confusion in the facts of this case.

Courtesy of Epidemi.ca, here's Science Daily with this quote: "Its like watching a train wreck in slow motion."

Friday, July 15, 2005

July 15 Flu Update

A minister in Indonesia says bird flu implicated in 3 deaths.

BBC has this story as well.

Another flu death in Vietnam.

Effect Measure looks at the Indonesia and Vietnam stories.

Meanwhile, the official report from Vietnam says no new cases since June 4??

Yet another story about imminent widespead immunization of chickens in Vietnam.

I hope the photos are good--Thai fighting cocks to get passports

Risk Communication of the flu---co-authored by Peter Sandman, who is featured in the Freakonomics book...very well-known risk communicator.

Yet infectious diseases are unpredictable, and this presents a serious problem for risk communication. Health authorities know that if they sound the alarm too softly, it won't be heard; it's not easy to overcome people's apathy and add another problem to their already long list of daily concerns. At the same time, too loud a warning can provoke excessive and premature fears, economic damage, and even an every-man-for-himself attitude that can result in chaos. And if no pandemic materializes, members of the public are less likely to take future warnings seriously.

A happy medium, say the authors, is to build mutual trust, "involving the public early, arousing an appropriate level of public fear, and helping people bear it."

Here's the direct link to the article.

South Africa fears "no defense" against bird flu.

Letter to Editor in Boston-area paper on threat of bird flu

Article in Japan suggests the flu is a security threat.

In Ontario, they are warned not to hoard Tamiflu.

Recombinomics states emphatically that the Indonesian family cluster is bimodal and human-human transmission.

He also writes that the Indonesian death is very likely to be bird flu.

Officials in Guangdong, Hong Kong and Macau are setting up response mechanisms for the flu.

Thursday, July 14, 2005

July 14 Flu Update

Yesterday, news hit the street that two people had died in Indonesia of the bird flu. If true, this is news. However, Effect Measure notes it is a rumor with a denial handled badly. The basic PR point is this. Saying it isn't true isn't enough. You have to demonstrate it isn't true, or no one will believe you.

Here's the official denial from the government.

A WHO team is headed to Indonesia to help nail this issue down.

Recombinomics has an interesting angle on the Indonesian cases, noting that one person involved had been active in Tsunami relief. Everyone worried briefly in December that the tsunami could help speed the spread of the flu, and if this is the case, as Niman says, it would have "serious consequences." (My note: Could this explain the unusually rapid dispatch of WHO officials to the site.

There's new information on cases in Vietnam, and maybe two new deaths.

A differing report on Vietnam cases.

Reuters on Vietnam.

Denmark has thrown $500K US into the kitty to fight flu.

You will recall the Boxun-based controversey on whether people in China were dying of bird flu in Qinghai. Here's another for what its worth, that says China "officially" says its not H5N1, but something much worse.

Epidemi.ca has a story on Canada being asleep at the switch. Not enough Tamiflu stockpiled, although better than the US.

Here's a CBC story on the same presser.

Another Canadian angle, where a leading public health official points out, correctly, IMO, that declaring a pandemic isn't only the responsibility of the medical community.

Must read editorial from the Boston Globe on the flu pandemic. Try this lead on for size, then read on.

THE RISK of a global flu pandemic should have been, but wasn't, at the top of the Group of Eight's agenda in Scotland last week.

Recombinomics on the Chinese classification of the presence of the flu as a state secret.

Wednesday, July 13, 2005

July 13 Flu Update

Recently, we had a story about a Hong Kong scientist who said new rules in China were designed to hide the true flu issue in China. Today, he says that the Chinese are blocking use of his test kit in their country.

Japanese editorial calls for Japan to get involved in Asia's fight against the flu.

Canada's ID Biomedical has its flu vaccine placed on the fast track by the US FDA.

The Edmonton Sun reports on a new hospital protocol where coughing patients gets masks.

Recombinomics comments on a paper in Virology....and comments that H5n1 continues to pick up polymorphisms.

Recombinomics says he feels the flu in the Philippines is not H5N1.

Tuesday, July 12, 2005

July 12 Flu Update

Thai, Thai again edition.

Yesterday they were ready to say they were bird flu free. Today, its endemic in Thailand.

Reuters covers Thailand.

CIDRAP also has the Thailand news.

Recombinomics on Thailand.

Effect Measure joins in on Thai party.

ProMed on the Thai setback.

Note this on the seasonal nature of the flu bug:

Cases of avian influenza may occur year round, but there is a
seasonal pattern, since the survival and the viability of influenza A
virus are known to increase at lower environmental temperatures. Such
an upsurge is expected towards summer's end. For instance, since
2001, H5N1 viruses have continued to circulate in mainland China with
a seasonal pattern, peaking from October to March, when the mean
temperature is below 20 C. See Li, Guan et al, 2004: "Genesis of a
highly pathogenic and potentially pandemic H5N1 influenza virus in
eastern Asia," Nature 430, 209-213.

Malaysia has banned Philippine poultry. (I always wonder how much of this is protectionism).

The Philippines is checking bird sanctuaries for potential sources of infection.

Vietnam is beginning a bird flu vaccination program.

Yesterday, we noted that Revere was dubious about the Philippines official who said that the bird flu there was LPAI. Recombinomics is dubious too.

ProMed on Japan, where a fresh H5n2 case was found.

Sunday, July 10, 2005

July 11th Flu Update

Today's lead story is from Thailand, where they were ready to be declared flu-free and start exporting chickens again. Not so fast, H5N1 is confirmed.

Note this:

Checks are now taking place to determine whether bird flu has been the cause of the large number of deaths of fowl in six other provinces.

Six? That's a big jump from Bird Flu free.

Recombinomics comments on Thailand.

Apparently, Australia is looked at as a major flu donor...something about being first in the line of fire.

In the Philippines, residents are being advised not to put bird farms in the paths where migratory birds fly. Other than that, confidence is expressed in containing the virus.

In another story from the Philippines, Ag officials say they have "their eyes peeled" against the bird flu.

ProMed has the text of the story from the Philippines. The mod comments that its preamture to say its LPAI is extremely premature.

This Recombinomics article is entitled " Swine Mutation PB2 V649I in Qinghai H5N1 Bird Flu." Basically, he says that the isolates show "mammalian polymorphisms." Finally, that stories from Boxun about Qinghai are gaining credibility--and I'm not sure where that comes from.

ProMed on the recent stories on apparent attempts by the Chinese to limit transparency on bird flu. Contains both the original story in Nature, and the denial by the Chinese, and a mod "comment."

Finally, I'm not sure how interesting this is, but I found this mention by a Peace Corps volunteer in the Philippines who said she got a box of tamiflu for her med kit.

July 10 Flu Update

The Philippines are culling and preparing.

Calcutta is worried about the bird flu flying in...literally.

Recombinomics has the latest on the Qinghai testing. He says it shows it has the "PB2" mutation, which makes it more virulent and "human-like." He also notes that it is doubtful to him that it is amantandine resistant.

Yesterday, we announced a new drug being tried in Vietnam on the bird flu. Color Effect Measure skeptical.

Saturday, July 09, 2005

July 9 Flu Update

UK article on the possibility of geese bringing bird flu out of Asia the UK.

Note--I guess I shouldn't be surprised that the MSM coverage of bird flu has increased once the migratory geese element was introduced. It seems to be hitting a little more home.

Here's another story of the introduction of bird flu to the Philippines.

In the Philippines, the local experts are saying there is no "indication" its H5n1.

Recombinomics comments on the "no indication" story, and notes that there were other disease outbreaks in the Philippines (tracked closely here) that could have been misdiagnosed bird flu.

Recombinomics cites another story that says it is H5.

CIDRAP confirms this, as well.

Promed on the Philippines

Vietnam is testing VIRA 38 with birds in flu fight.

Ho Chi Minh City is bringing new bird flu restrictions on board.

Cumbria is developing bird flu plans.

The UN FAO is confirming that North Korea is bird flu free.

Effect Measure revisits the issue of Chinese information control, and finds it is a credible charge

Epidemi.ca has a compelling critique of the bird flu plan, equating it to throwing in the towel.

Thursday, July 07, 2005

July 8 Flu Update

When we are tested,
we are given strength.
July 7, 2005

North Korea says it is bird flu free.

The BBC says the bird flu has reached the Phillipines.

The Australians remain nervous.

Recombinomics on the genetic data in today's Nature.

CIDRAP's take on the small farm plan.

ProMed on the North Korean report.

July 7 Flu Update

More on the Asian plan. Focus is to be on small scale farms where 80 percent of flu is said to begin. This does strike at the grassroots cultural nature of the problem, and will be very difficult. Wet markets will also be a focus.

Flu efforts stepped up in Hong Kong...

And in Vietnam, the same thing is going on.

In a longer term, the country will raise poultry according to three modes, namely industrial scale, semi-industrial scale and household scale with a focus on the semi-industrial scale. Sixteen cities and provinces nationwide, including Hanoi and Ho Chi Minh City, must complete construction of concentrated slaughterhouses before 2007, while poultry must be transported by specialized vehicles, Anh said.

Bird Flu has reportedly been "ruled out" in a death in Cambodia.

Washington Post writes on the dire shortages of medication in flu stricken nations.

The Scientist (UK) reports a leading virologist is being stymied in his attempts to study the flu in China. Read on:

"God help me," Guan said, sounding exasperated, "they are trying to close everyone's lab." He said he believes the new rules are an excuse for authorities to exert tighter control over the dissemination of lab results, and are not aimed at protecting the wider population from bird flu outbreaks that have dotted the country in recent months.

He said the regulations will mean that the Animal Influenza Laboratory of Ministry of Agriculture in Harbin will become the primary lab sanctioned to carry out diagnostics on avian flu.

Effect Measure weighs in on new Chinese restrictions.

The Christian Science Monitor has this article exploring the fine line between warnings and false alarms...noting examples back to swine flu. I note what I view is the highly optimistic view of one man, who says people will react well if they have all the information.

CIDRAP on news from Nature and Science on the results of investigations in China.

The recent outbreak of H5N1 avian influenza among wild waterfowl in western China could provide a launching pad to spread the disease throughout Asia and beyond, according to two reports published by leading science journals today.

Thousands of birds have died in the past 2 months at Qinghai Lake, a wildlife refuge that is an important gathering site for many species of waterfowl. World Health Organization officials have described the outbreak as the first one to kill large numbers of migratory birds.

Two teams of scientists who studied the outbreak report some early findings today in online editions of Nature and Science. Both see a danger that the disease, confined mainly to Southeast Asia and East Asia so far, could vastly expand its range.

"There is a danger that it [the H5N1 virus] might be carried along the birds' winter migration routes to densely populated areas in the south Asian subcontinent, a region that seems free of this virus, and spread along migratory flyways linked to Europe," says a report by H. Chen and colleagues in Nature. "This would vastly expand the geographic distribution of H5N1."

In Science, a large team of Chinese authors under the leadership of George F. Gao of Beijing writes, "The occurrence of highly pathogenic H5N1 . . . infection in migratory waterfowl indicates that this virus has the potential to be a global threat: Lake Qinghaihu is a breeding center for migrant birds that congregate from Southeast Asia, Siberia, Australia, and New Zealand."

Recombinomics comments on this development.

ProMed has the story of the migrating geese as well. Their moderator raises this unanswered question.

There are some questions awaiting clarifications in this case, such as the exceptionally high mortality in wild waterbirds of different species. What was their respective susceptibility? Could other factors, additional to H5N1, have played their role?

Recombinomics cites evidence in Nature that the bird flu is more widely spread in China than previously thought.

Again citing Nature, Recombinomics says that the strains in China are amantadine sensitive, contrary to widely circulated media accounts.

Epidemi.ca comments on the WHO plan.

Wednesday, July 06, 2005

July 6 Flu Update--A Plan

In Malaysia, health experts have unveiled a comprehensive bird flu program.

CIDRAP has the story of the plan.

Think we aren't in this for the long haul? CBC has the story of the WHO saying it will take 10 years to stamp out bird flu, and $100M US (for 3 years), though that seems low to me.

UPDATE:Effect Measure weights in, agreeing that the $100 million is chicken feed.

Here's the official FAO press release.

The Japanese say they have confirmed their non-H5N1 outbreak.

Indonesia is cranking up its flu protection measures.

Cambodia is experiencing a major flu outbreak. Reports are sketchy, and include eating chicken prior to the illness. A health official there says its a B flu, but there are lots of people sick and this situation probably warrants monitoring.

FAO officials remain concerned about the flu.

The AMA has the first historical review of the effect of Spanish Flu on the military during WWI.

As the nation moves to upgrade flu vaccine production capacity, a Pennsylvania plant that is currently closed may be purchased and re-opened.

Recombinomics is continuing to look at the microscopic life of the virus. He finds ample ground for future recombination.

There is co-circulation of two distinct genotypes in the south as well as co-circulation of two distinct genotypes in the north. Co-circulation of distinct genotypes leads to more recombination via dual infections, which will create more new sequences and more new problems in the fall.

Effect Measure on the 9-day old flu wiki. Revere is calling on people to contribute their ideas to the wiki, which has some great content and some holes, which it is up to us to fill.

Here's a warning from H5N1 that you really need to read--a Flu book you want to avoid like the plague.

There's an Asian flu coalition pledge cooperation in the Greater Mekong Subregion.

A comment in the Effect Measure post pointed this, where there is a claim of a new flu drug developed by China. (Emphasis added).

The six countries have also made progress in cooperation in public health field as the new avian flu drug developed by China has been used in Vietnam in April of this year, which helped bring the disease under control as it killed 99.99 percent of avian flu virus in areas hit by the disease.

Tuesday, July 05, 2005

July 5 Flu Update

WHO leads the news with another game attempt to sound the warning after last week's misstep.

The evolution of the H5N1 virus which causes bird flu will dwarf the SARS epidemic, this according to Peter Cordingley, WHO regional spokesman for Asia, who spoke at the opening of an Asia-wide conference that brought together officials from national and international organisations like WHO.

The conference is designed to provide participants with an update in the situation and highlight possible strategies to prevent viruses leaping from animals to humans, and creating a mutated flu germ.

The Guardian reports on doctors calling for new vigilance to stop the bird flu.

Report from China says FAO says situation still serious.

French press release that notes that there is still time to stop the spread of the flu.

FAO is calling for poultry vaccines, saying its everyone's problem

IHT on the Malaysia conference.

Recombinomics says genetic data now at LANL shows that additional dual infection and recombination could bring new problems in the Fall.

Monday, July 04, 2005

July 4th Flu Update

The BBC has this on the bird flu summit in Malaysia.

The BBC's interactive flu guide.

CNN on the same story.

(Note: Both stories use the words "Tipping point" and say that the virus is not yet passing from human to human).

Effect Measure on the Malysia meeting. His take is that the WHO is acting less sanguine then they said they were last week, and that efforts to improve agriculture production in Asia are too little, too late.

More molecular epidemiology from Recombinomics.

Recombinomics on the unconvincing results from the WHO and China on the spread in their country.

Sunday, July 03, 2005

July 3 Flu Update

A bird club in the Phillipines is working to spread the word on bird flu, making them now more active in the fight than the US Government.

Vietnam take on the WHO announcement that they are still on high alert.

Outstanding Baltimore Sun article (must read) on the situation in China, a lack of transparency, and what effects that has.

A transparent flow of information is thus essential, critics say. Yet Beijing continues to delay providing information and access that, considering the fast pace at which viruses can move and mutate, could be essential to the WHO's efforts to combat the H5N1 virus.

After making the U.N. health organization wait for weeks to get permission to visit the region hardest hit by the bird flu, the agency continues to wait for permission to visit the neighboring region of Xinjiang in the remote northwest, where migratory birds have also died of avian flu.

For some time now, according to the WHO, Chinese government experts have isolated genetic sequences of the H5N1 flu strains that are killing the birds in western China, but the government has yet to make the information or samples of the virus publicly available.

The doctor-diplomats of the United Nations organization are constrained by diplomatic protocol and by politics, and critics say China has put considerable political pressure on WHO officials not to embarrass their Beijing hosts.

The result is that the health experts the United Nations relies on to lead the fight against avian flu must wait in Beijing for weeks, time could be used to help China track the virus. Beijing was first aware of deaths likely caused by the avian flu as early as the first week of May, but the WHO was allowed to visit the region only last week.

Malta preperations for bird flu.

Malaysia is hosting a bird flu conference to start tomorrow (through Epidemi.ca)

Saturday, July 02, 2005

July 2 Flu Update

China says, again, that bird flu is under control.

Malaysia forms a bird flu task force.

Another story on the House testimony. Committments will be kept, say Roche and Gilead.

Officials in Tasmania are calling for an Australian group to fight flu.

Slate.com says, if you want something to be worried about, forget mercury---think flu.

promed on Japan.

ProMed on the recent death in Vietnam.

Here's the mod comment on proMed.

[Temporal variations in the transmissibility of avian influenza virus
to humans and poultry have not been suggested previously. If true,
they might indicate differences in the routes of transmission of the
virus in the human and avian populations, or perhaps differences in
patterns of exposure. - Mod.CP]

Friday, July 01, 2005

July 1 Flu Update

The lead story today is a WHO statement on what apparently was a mischaracterization of WHO announcemnts on the flu. We reported here, in fact, that the take-away for the MSM was that the chance of a pandemic had lessened. A commenter to yesterday's update pointed me to this from WHO. Boldface is mine.

Some reports now circulating suggest that WHO has downgraded its assessment of the pandemic threat. These reports are unfounded. The experts were specifically asked to search for evidence that could substantiate concerns raised first at a WHO consultation of international experts held at the beginning of May in Manila. That consultation considered suggestive findings, largely based on epidemiological observations, that the H5N1 virus had changed its behaviour in ways consistent with an improved, though not yet efficient, ability to spread directly from one human to another. The specific epidemiological observations considered included milder disease across a broader age spectrum and a growing number of clusters of cases, closely related in time and place.

More recently, testing of clinical specimens by international experts working in Viet Nam provided further suggestive evidence of more widespread infection with the virus, raising the possibility of community-acquired infection. These findings have not been confirmed by the present investigative team.

Firm evidence of improved transmissibility would be grounds for moving to a higher level of pandemic alert. Because of the huge consequences of such a change, WHO is following a cautious approach that combines heightened vigilance for new cases with immediate international verification of any suggestive findings.

Effect Measure on the WHO report.

Helen Branswell on flu blogging.

Epimdei.ca comments on the WHO report.

Via epidemi.ca, the US is belatedly trying to get tamiflu supplies.

Reuters on WHO "calming fears."

CNN on the tamiflu shortage, with aggressive US efforts.

Chinese laud their flu prevention efforts which have netted "zero human death."

The other bird flu is spreading in Japan.

Flu planning going on...in Canada.
CIDRAP on the WHO "status unchanged" report.

Recombinomics on the recent genetic information on bird viruses in Vietnam.

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?