August 27-28 Flu Update
Point one. A civet is not a cat
. My apologies.The Chicago Tribune has the civet story today.The Finnish Gulls are suspected to have bird flu, although the Finns continue to say it was LPAI.The Financial Times of London has the skinny on what stocks can be expected to do if the bird flu hits--hint: sell your airline and travel stocks.The Sunday Times points out--as we did here some time ago--that elites in theUK government are slated to get scarce Tamiflu.The Sunday Times has another story--nothing new--laying out the nearly inevitable steps.The Independent has a couple of interesting bird flu stories. The first compares flu to BSE, which caused a massive upheaval in the nation. The article criticizes what it sees as the government's repeating of the "false reassurance" policy from BSE. In the second, an on-the-scene reporter says there isn't enough petrol to burn the birds in Siberia.The United Arab Emiates is certainly on the ball.Italy is clamping down on its borders to attempt to keep the bird flu out. (Stage One of the Osterholm scenario....see "We're Screwed."
The Sunday Herald (Glasgow) has an intelligent, must-read on the vaccine situation, and how the US vaccine will be difficult to ship around the world. Among the reasons are (emphasis added):
US scientists are genetically modifying H5N1 to “remove the lethal features” and then injecting it into embryos to extract antigens. Tests have been carried out on humans and the drug appears to provide immunity. However, all this scientific endeavour could be futile. If H5N1 mutates when it starts to pass between humans directly, the American vaccine will be useless . Even if the new vaccine did work against human-to-human bird flu, the WHO warns it will still take “ possibly years” before it is available to patients. Also, until the USA stockpiles enough of the drug to protect its own population, America is unlikely to distribute the drug to the rest of the world. That’s not inhumanity on the part of the US, says the WHO any country on earth would do the same.
The USA could pass the science behind the new vaccine to the rest of the world ... but every country in receipt of the technology would have to first master it, develop the drug, test it, regulate it and license it – and that will take a very long time. Also, the quantity of antigens being produced for the new vaccine is very low. For every dose of this new vaccine, doctors need up to 12 times the amount of antigens that are required for regular flu vaccines. Two jabs are also needed, rather than one. “We are really talking about years before Joe Smith in New York can go to his health clinic and get a shot for avian flu,”says a WHO spokesperson.
On a similar point, ProMed has this on a recent study released by the WHO on the genetics of the flu. Note the following mod comment (Emphasis added):
Perhaps one of the most significant aspects of this analysis is the finding that antigenic drift is occurring and that some recent isolates are distinguishable from virus isolates that were chosen as the candidate vaccine antigens. This identifies a need for continued surveillance of poultry for the appearance of antigenic variants which may compromise the effectiveness of the current vaccine under development. A rolling program of vaccine development may be required to take account of possible changes in the antigenicity of the virus.The Sunday Herald (Glasgow) also warns that crossing fingers won't help.Flu gets a little ink in Galveston.
Recombinomics on the situation in Finland
and in Bulgaria
.Effect Measure on Finland.Effect Measure on the civets--look closely, I think he said they were cats!You will recall the challenge on Promed which said that dead birds don't migrate, and the charge to find one sick bird actually migrating. Some responses are here.ProMed notes that the Finnish claim of LPAI does have some merit to it.Another farm in Japan is H5N1 positive. (ProMed)Crofsblog has a story on nine unexplained deaths in Nepal, consistent with Spanish Flu symptoms.Crofsblog has this on WAPO saying that the US is tripling quarantine at the borders, and then notes an inherent problem with this approach.Crofsblog has an NPR interview with Margaret Chan on WHO.Russia is saying that it could have caught the bird flu earlier, with more money.Recombinomics has the story of concerns about two types of flu circulating in Europe, and the chances of them combining.Recombinomics says the pandemic is looming, and notes that the reservoir of flu in healthy birds could be a problem for years to come.
No real link, but in conclusion, Crofsblog has pointed us to the coverage of the hurricane in New Orleans, which I have watched all evening. Let's watch how a society provides food and water in the midst of a crisis.
August 26 flu Update
The EU has its conclusions on the bird flu meetings. This is the kind of document that can be really painful later.
It considers that taking into account the existing knowledge on the migratory routes of the species of birds proceeding from central and western Asia and that might pose a risk of spreading the H5N1 avian influenza virus into the EU, the immediate risk of introduction of AI via these birds is probably remote or low (this also depends on the different areas of the EU).As if in counterpoint, Finland is reporting it might have a dead seagull from bird flu, though they say its LPAI.Recombinomics on the Finland story.ProMed praises Finland for rapid response and surveillance.Germans say they have a flu test that gives results in hours.In China, officials are now saying that bird flu is more dangerous than SARS.The Asian Development Bank has approved US$38M to Vietnam for fighting the bird flu.The EU is looking into whether the Dutch flu moves (keeping chickens inside) violated EU regulations, since, apparently, animal health is an EU matter. Also, there was problems with using the "free range" label.A nice editorial on the flu from UAE--this guy is ahead of many prominent MSM observers.Here's a transcript of a radio show in Australia talking about the bird flu in Europe. Note, as always, the confidence of the government bureaucrat.Manchester is preparing for the flu.Meanwhile, health officials in Manchester are urging people to ignore "scare tactics" about drug shortages during a flu pandemic, and not to buy Tamiflu over the Internet.As if in counterpoint, here's a very interesting story about Australian Nobel Laureate Peter Doherty. He has a new book called "the Beginners Guide to Winning the Nobel Prize." He says he is asked often about the bird flu. Here is his answer, emphasis added:
Hong Kong is viewed as crucial to containing bird flu by this expert.A month late, a Thai paper is informing its readers that major journals say the flu can be contained.The Mirror on the bird flu---"Are our lives in Danger?"The Telegraph (UK) has a Q&A on the bird flu.CIDRAP on the civets, from yesterday. Civets are cats, and it represents a jump to mammals, though not the first.ProMed on the civets--"interesting, but not surprising."WHO experts are going to Mongolia to study bird flu there. Recombinomics covers it.ProMed has another of a series of what seem to be regular updates from Russia. If only China was this transparent.Via Crofsblogs, we have an analysis for a flu pandemic on European economies.
The question he is most asked now is whether bird flu is going to cross over to humans and become the killer pandemic many scientists fear.
Here science fails. It's a roll of the dice, he admits. He quotes figures estimating that 70 million lives could be at risk if the virus does mutate to allow rampant human to human transmission — a circumstance many of his peers fear is inevitable.
The toll was at least 40 million when the last flu pandemic struck in 1918, when the world population was about a third of its present size and did not have aircraft to help its spread.
He suggests people should consider asking their doctor for a script for the antiviral flu medication Tamiflu — the drug governments around the world are stockpiling against a catastrophic influenza outbreak.
He always has his vial of Tamiflu — his $56 "insurance policy" — on hand. Should everyone be hoarding a stash? "It depends how scared you are. But if the flu epidemic hits, the Tamiflu will run out fast."
August 25 Flu Update
EU Veterinary Experts are meeting, and they are split over the necessity of Dutch plans to keep birds indoors.The Head of the British Veterinary Association says that it is inevitable that migratory birds will bring bird flu to Britain.A UN expert paints a scenario where the Balkans are the gateway where bird flu comes to Europe.
Birds heading south for the winter from Siberia may carry a deadly strain of avian flu to the Balkan peninsula and mingle with other flocks from northern Europe, experts said on Thursday. The Russian agriculture minister says bird flu is under control there.Russia says there have been 91 villages effected by the bird flu.In France, Chirac says France will spare no expense to protect its people from the pandemic.In Australia, a government minister says hunting fowl is safe.New Scientist has bird flu knock-knock-knocking on Europe's door.Indiana has released its bird flu plan.The Ft. Wayne paper has the Indiana story, too.
Millions of birds migrate each year to Black Sea neighbors Romania and Bulgaria for the milder winter climate, making the area a potential gateway to central Europe for the bird flu virus, which has already swept into Russia from southeast Asia.
There were lots of stories today about WHO getting the Tamiflu from Roche, which I am not repeating here. But, Helen Branswell is a different case. Her story we run. And she lays bear the internal conflict on the "containment" strategy.
Here's the WHO perspective.
"We want to nip a pandemic in the bud - if we can do it," Dr. Margaret Chan, the agency's special representative for influenza said at a news conference in Geneva.
"Even knowing we may not be successful, we need to try. Because the potential damage of a pandemic of influenza is so devastating not to try it we would be failing the world. And that's the sentiment of many of us who are working in this area."
Here's Dr. Osterholm's perspective.
"More than anything, I want to stop this in its tracks. But you know what? Feeling good and facing reality sometimes just don't mesh," said Dr. Michael Osterholm, a leading proponent of pandemic preparedness who fears a containment strategy will create a false sense of security that will undermine preparedness efforts. "I fear desperately by the mere presence of this activity it will give many others excuses to say: 'Don't worry. We'll stop it in its tracks. We don't need to prepare for a pandemic,' " said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Here's the Branswell analysis:Here's a more official report about what went on in Brussels.Here's a Q&A from Brussels on what the EU is up to with bird flu.Here's a timeline of EU actions.CIDRAP says Europe is relatively dismissive of the threat from birds. They feel protective measures such as in Holland are "disproportionate."ProMed has this same take.Recombinomics on the Swedish decision to also load up on cheaper Amantadine as well as the more expensive N-inhibitors.CIDRAP has this very interesting story on efforts to develop a universal, perennial flu vaccine by targetting the M2 protein, which shifts less than the H and the N parts. The article refers to it as the "Holy Grail" of flu protection.
Despite the widespread skepticism - even within WHO - over whether containment could work, the agency may have had no choice but to commit to such an effort after the publication earlier this month of two mathematical modelling studies that suggest an emerging pandemic could be snuffed out.
A scientists from Mayo College said this: Effect Measures notes that WHO continues to say that while the disease spreads (despite killing 100s of millions of birds), there is no evidence of human transmission. Revere isn't too sure, noting a tendency among pandemics for their to be a smoldering effect.ProMed has this from Russia, where officials say the sick bird in Altai was the only one (?). ProMed's mods continue to ask for evidence of disease in healthy birds.Avian flu kills civets in captivity in Vietnam, via crofsblog.
"We need a proof of principle at this point," he said. "There are a number of entities trying to develop a similar vaccine. I do think it's theoretically possible. From an immunologic point of view, the key will be choosing the right antigen [viral protein] and knowing that the antigen is displayed early in the infection, so that an immune response can be generated early enough to abort the infection. My concern is if you find antigens that are displayed late in the infection, you may generate an immune response too late to do much good."
August 22 Flu Update
While scientists in Britain are urging careful consideration of bird flu measures taken in Holland, the government is staying the course.Reuters has this story on US safeguards against the bird flu, which could be a little overconfident.
"I think biosecurity has been ratcheted up to a high level. It is very hard to get on farms these days," said Richard Lobb, spokesman for the National Chicken Council.
Does this count a dome to keep migratory fowl out? Bird flu was found on another Japanese farm.ProMed on the Japanese report, noting the new outbreak is 44 miles from the previous outbreak.The EU says it thinks the risk from migratory fowl is low.Russia reports no registered human cases of bird flu.More bad economic news...in UAE, pet shops are suffering.Meanwhile, a UAE medical study says bird flu is a risk.Klaus Stohr was in Bangkok, where he delivered a stark and bleak assessment of the world's preperation for the bird flu.Taiwan is preparing to fight the bird flu.Ongoing news about imminent (not long-range) shortages of Tamiflu, whose sales are skyrocketing.
"We are on a collision course to panic," warns Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"I think that what's going to happen is . . . that this drug - which has yet to really be demonstrated to have any clinical impact on H5N1 infection - is now going to become the 'I can't get product, therefore I must have it right away product.'
"The reality is going to come through that there is only so much available."
Financial Times--rapidly gaining in the MSM flu rankings--has the tale of two drugs, Tamiflu and Relenza.CIDRAP has the growing news that wild bird flu is gaining a foothold (or a clawhold) in Mongolia.Recombinomics asks if the bird flu is being covered up in India.Recombinomics on confirmed wild bird flu in Russia.ProMed on more reports from Siberia that still don't answer the questions. The final anonymous mod question is good. All of the sampling is of dead birds, which do not migrate. It asks if anyone has found a healthy, migrating bird that is capable of shedding HPAI?
August 21 Flu Update
In Switzerland, they are preparing to educate poultry farmers.In a related story, poultry farmers are just beginning to dig out in Thailand.The "hero" of the new flu virus is a man named Robert Webster of St. Jude's.
The Staunton News Leader of Virginia has this op-ed piece on what bird flu could do...and its written by a Doctor.Here's an op-ed from Jamaica, on bird flu and HIV and all kinds of things.The New York Times says that public health officials in NY have been meeting since February to plan for the pandemic. This is a must read, with excepts below. I ask my more learned readers this: they are working on the assumption there is no drug answer. They are preparing for that eventuality. Is this the kind of planning everyone should be doing?
If a pandemic similar to the one of 1918 occurred today, as many as 2.8 million New York City residents could be infected within months, sending more than 200,000 to the hospital and clogging the morgues with 400 deaths a day during the peak infection period.The Lancet recommendation of Relenza has been good for shareholders of the company that makes it.
With a vaccine for the strain of influenza referred to as avian flu A(H5N1) many months away from final testing and production, most of New York's planning is being done on the assumption that there will be no vaccine available to prevent illness and only limited drugs to treat patients and help protect essential workers.
Still, it is not clear how effective any drug will be against a mutated strain. Therefore, the response plans will set a framework for dealing with some of the more delicate issues that would have to be addressed in event of pandemic flu, such as when and where to establish quarantines and how to deal with sick people entering the region by airplane. Health officials are also thinking through the risks and benefits of measures like canceling public gatherings, ordering businesses shuttered and closing schools. The challenges are as basic as getting people to cover their mouths when they sneeze and as complex as increasing the capacity of laboratories to do testing.
Additionally, engineers are studying the ventilation systems in many hospitals to see if it is possible to create isolated sections so that an already difficult situation is not made worse by having the entire facility contaminated.
"The real issue is trying to control transmission," Ms. Waltman said.
Many hospitals have recently redesigned their emergency room entrances so that the acutely ill can enter without coming into contact with others in the building, she said.
Yesterday, we had a report of wild bird flu on a commercial farm in Russia. Recombinomics has his take.As does ProMed...This is interesting. ProMed summarizes a journal article that looks at wild fowl, the natural reservoir of bird flu. By looking at the range of virus within the birds, the authors suggest that by studying wild fowl proactively, you might be able to anticipate the range of the virus, and develop vaccine coverage.
August 17 Flu Update
Russia continues slaughter program to try and fight bird flu.As Recombinomics speculated yesterday, media reports in Russia say flu has spread to the Urals.WaPo on bird flu...interviewing experts. Here are some snippets.
"Will this make its way to Western Europe? I think most of us have no doubt," said Michael Osterholm, an expert on bird flu and director of the Center for Infectious Disease Research and Policy at the University of Minnesota in the United States. "Theoretically, because it's going to be stopped in its tracks, it's not going to infect humans because of the quick detection, and therefore it would have less of a chance to become adapted to humans," Lubroth said.
However, Osterholm noted that each time the virus passes from one bird to another presents another opportunity for it to mutate.
"This is genetic roulette," he said. "Every bit of spread just adds that much more potential for a mutation to occur that results in a strain that would be more readily transmitted between humans."
In Russia, experts are calling for a federal flu program.The Washington Times (WaTi??) on the spread in Russia.Stepping up the pace of bird vaccinations in Vietnam.
In what could still be an optimistic assessment, the Russians say bird flu won't be contained until October.In Altai (Russia), hunting waterfowl is banned.Mother Jones asks if time has already run out for the pandemic (good articles).
The new U.S. Health and Human Services Secretary Mike Leavitt told the Associated Press in early August that an influenza pandemic was now an "absolute certainty,"Here's a canary in the mine...WHO is urging regional offices to have drugs stockpiled for staff.CIDRAP on the Russians ratcheting up their flu efforts.CIDRAP says the pig outbreak in China appears spent, and that WHO says all signs continue to point to a pig bacteria.Russia thinks it would take a year to develop a flu vacccine.A local task force is formed as part of comprehensive plans to fight flu in the Phillipines.In New Zealand, they are downplaying the dangers of flu coming in via migratory birds.Recombinomics says bird flu is confirmed in another part of Kazhakstan.ProMed has the same story.Crofsblogs finds this from Znet on the coming flu pandemic. Author is Mike Davis, who has a book coming out soon on the global flu threat.Crofsblogs pointed us yesterday to a Canadian financial analysis that said a flu pandemic could cause a global depression. Here's a link to a .pdf of the report, also courtesy of Crofsblog.
The Coming Influenza Pandemic will on on hiatus until August 14, 2005. Look forward to being back with you then....
August 4 Flu Update
CIDRAP has the news of two NIH funded studies that analyze containment strategies for the flu. The plan is to "nip it in the bud" with highly focused resources.
Michael Osterholm, Director of CIDRAP, had this to say in comment:
"I want these strategies to work," infectious disease expert Michael Osterholm, PhD, MPH, told CIDRAP News. "But in all my years in public health, I have yet to see mathematical models that have driven public health actions in meaningful ways." Osterholm used HIV and bovine spongiform encephalopathy (BSE) as examples of diseases for which there have been what he calls a "pandemic of modeling studies."
"My concern is that papers like these suggest more direction for planning than is warranted and may placate policymakers who believe the planning puzzle has clear solutions. . . . The issue of antiviral treatment, for example, has to be looked at against the whole system of disease occurrence and transmission. How well can we detect the disease when it starts occurring? How can we make sure travelers who appear healthy aren't unknowingly spreading the virus?" Osterholm, who is director of the Center for Infectious Disease Research and Policy at the University of Minnesota, publisher of this Web site, used as illustration the example of SARS' fast jump from the Far East to Canada in 2003.
Osterholm also made the point that since a flu pandemic will very likely be caused by a mutation of the H5N1 virus currently spreading among birds in Asia, we will be facing a "reloading" problem at the source—that since birds are a reservoir that is constantly replenished, "We are dealing with a moving target, not a static population like humans. . . . Culling [the birds] won't work. It's like throwing fresh wood on a fire."
Here's an NIH link to the study.Here's a WHO link.The Daily Mail in the UK has its take on this...something along the lines of scientists say it can be "stopped in its tracks."WaPo is a little more reasonable, on the order of a theory.The Times of London notes, correctly, that the key is "decisive action" would be required under the plan.Effect Measure drops the bomb on these studies, despite that he respects the people who did them.
Note these quotes:
...it must be said again: once this virus gains the capability of being transmitted from person to person like other influenza subtypes that circulate in human populations, there will be no way to prevent its global spread.As always, the comments are excellent on Effect Measure.Tyler Cowen on Avian Flu has a nice post, too.
So I hate to disagree with Elizabeth Halloran of Emory, an infectious disease epidemiologist of note and a genuine expert. In her view, as reported by the BBC,
"Our findings indicate that we have reason to be somewhat hopeful. There is no reason at all to be hopeful.
"If - or, more likely, when - an outbreak occurs in humans, there is a chance of containing it and preventing a pandemic."
Note that Thailand, or similar places, has not had the past facility to stop malaria, or even to provide clean drinking water to its rural populations. Measures of these kinds will limit deaths, and should be taken, but they are highly unlikely to stop a pandemic from spreading, should one get started.Here is a Reuters timeline that spells out the march of the bird flu through Asia.Reuters bird flu fact sheet.Roche is in discussions to donate a substantial amount of Tamiflu to WHO.In Vietnam, there were three news human cases in July.From Russia, flu threatens European Russia.Fiji is on the case to fight the pandemic.Vietnam is vaccinating poultry.Recombinomics on the spread of bird flu in Russia.Staggering....Recombinomics says 70% of waterfowl in Mekong Delta are bird flu positive.Crofsblogs points us to the disease section on boxun.
August begins with bird flu crossing into Kazakhstan with a human case.Recombinomics on the Kazakhstan story--and what it might say about China.Effect Measure on Kazakhstan, and what it means for Europe.ProMed on Kazakhstan. Note this:
The Chicago Tribune on Siberia.The Washington Post did this story on a potential pandemic that was picked up around the country. Its nothing new to anyone following the flu news.Effect Measure with a nice critique built off the WaPo story. As many have written, once the pandemic happens, we'll have congressional hearings on top of congressional hearings to find out why we didn't do anything.Indonesia was ready to say it was bird flu free a few weeks ago--not they only hope to reach that by 2007.Vietnam is beginning again to vaccinate birds.Australia continues to be justifiably nervous.
From an unofficial source in the vicinity of Golubovka, we have been
informed that 300 ducks and geese died there by Fri 29 Jul 2005, while
diagnosis was pending.
If confirmed, this will signal a dramatic extension of the range of avian
influenza virus capable of infecting humans. All previous human cases of
avian influenza have been reported from East and South Asia -- Cambodia,
Indonesia, Thailand and Viet Nam -- countries remote from the Pavlodar
region of Kazakhstan.
I have said before that the flu virus finds our weaknesses. Its if a World War that puts people in crowded trains, so be it. If its a withering public health system, as noted here in California, the flu will expose it.The Rocky Mountain News editorializes on the pandemic.
Effect Measure on mixed messags coming from Indonesia.Via Crofsblogs, the Chinese are confident of defeating their swine bacteria problem.Also via Crofslblog, the Chinese have banned journalists from the site of the "swine bacteria."Crofsblog has surveyed the landscape and found a shortage of MSM news on bird flu.Instapundit (also via crofsblog, who was busy yesterday) notes the WaPo article and urges concern, though I think he mistakes the fact that 1918 flu was aggrevated by TB.