September 29 Flu Update
Nightline is kicking off an avian flu story as I write...Effect Measure has a report on the number of cases in Indonesia (63), and a full accounting of the definitions of cases (confirmed, suspected, etc) and how discrepancies can emerge.Here's a Forbes report confirmed the 63 number.ProMed on the four new cases.Along the same lines, VOA has this report where a WHO spokesman says flu cases in Indonesia may actually be overstated.Recombinomics takes on the testing reliability issue.Here's the WHO source report VOA was using.WHO appoints Brit David Nabarro to lead world flu efforts.CIDRAP on Nabarro appointment.Nabarro says the potential exists for 150M deaths from bird flu.
He said this, too:
"We expect the next influenza pandemic to come at any time now, and it's likely to be caused by a mutant of the virus that is currently causing bird flu in Asia," he said. Where have we seen this before? Indonesia embarks on eradication effort.People in Asia are still eating chicken....Vietnam says it is going to build two bird flu labs, constructed to International standards.In Thunder Bay, Ontario, they are gearing up for the bird flu at local agencies.The Pan American Health Organization released its pandemic response plan...don't expect too much.Eureka, CA asks if its ready for the bird flu.FoxNews has the news on scientists in a "desperate" race on the bird flu.Very interesting article in MacLeans, saying that the real enemy is "fear." Without endorsing its claims, it is a thoughtful piece, especially where it talks about how secure societies actually seek out theoretical things to be afraid of.
Oh, and he had some comments on flu blogs.
Helping to accelerate bird flu mania is a growing band of flu bloggers -- techno-agitators and armchair epidemiologists who see each new flu report or update as a call to arms, and use their blogs as a medium to inform and scare the daylights out of each other. "I got on the pandemic flu beat in 1997 when H5N1 was first identified," says Virginia-based Melanie Mattson, a 51-year-old writer and the proprietor of the flu blog Just a Bump on the Beltway. Mattson feels the mainstream media isn't doing enough to warn the masses. She and others say we can't trust our public institutions to save us. (Just look at what happened in New Orleans!) "What we're trying to do," Mattson declares, "is save lives."
The amount of effort that goes into flu blogging is astronomical: one of Mattson's regular posters is a woman named CanadaSue, a nurse from Kingston, Ont., who has constructed a 23-part scenario that details what her city of 112,000 would look like during a pandemic. "Flu bloggers have developed a kind of online community," says Crawford Kilian, a 64-year-old communications teacher from Vancouver who started out blogging about SARS, but has since switched his focus to H5N1. "But now, after watching what's happened in New Orleans, I began biting my lip about 'what if' and 'what's more,' " he says. "What if we get something like a hurricane and we get avian flu? How do we cope with it then?"
Note that Crawford Killian is Crofsblogs. And there are no arms in the chair I use!In Australia, they are pushing for over-the-counter tamiflu sales.Recombinomics says there's a cluster outside Jakarta, which could indicate more evidence that Stage 5 is here.Effect Measure has some very interesting news from a few scientific journals. What they say is that statins (cholesterol medicine) could help to prevent the cytokine storm that is believed to be a major factor in the bird flu virulence.Majority Leader Bill Frist wrote this on bird flu in Washington Times--its not his first. The Senate passed avian flu spending bill tonight (for tamiflu), and this is not the first Frist has written on it. (Crofsblogs)Helen Branswell of CP on the US vaccine article from yesterday.
September 26 Flu Update
Apologize for lateness, connectivity problems.They are saying 42 flu cases in Indonesia, with 10 lab confirmed cases. There are now a total of six deaths.Crofsblogs on the questionable translations of this report.ABC News on the sixth death.Recombinomics on the sixth death. Note also, that Recombinomics is always looking for 1918-style misdiagnoses that aren't in the numbers.CIDRAP on the new death reports, and other news across the horizon.The UN says that bird flu funding is perilously low, as countries focus on stockpiling Tamiflu rather than human and animal containment strategies.The Foreign Minister of Australia says that Indonesia has been caught off guard by the bird flu, but is making progress now.Hungary claims it could make 50M bird vaccines.In Iran, they fear wintering waterfowl will bring bird flu. (Apparently, it was illiteration day at Reuters.)In Russia, 14 towns are still under quarantine.Bird flu affecting share prices in Indonesia, though not too much.Time Magazine on how Indonesia's luck ran out on bird flu.Jamaica considers its bird flu response, noting that it doesn't expect help from major countries who are unable to help themselves.More communities could use this. The University of California-Davis is doing a community briefing on the bird flu today (Tuesday)Interesting little snippet, as Tourism New Zealand wonders what it would do with foreign tourists in the event of a bird flu outbreak.Countries are scrambling to track down tamilfu.Helen Branswell, as usual, hits the nail on the head with this probing, insightful story on factors that are keeping new, cheaper antivirals from market.
Formulas for new, inexpensive influenza drugs that could expand the world's tiny arsenal of weapons against pandemic flu are gathering dust because the pharmaceutical industry isn't interested in developing them, scientists say. Effect Measure on the Indonesian situation, and on actions finally being taken by that nation. (Note the quote of the day: "As long as you can't confirm something, it must not be happening.")Effect Measure also found this excellent BBC report on the cultural bias against culling in Indonesia, equating it to killing people's pet dogs and cats in the US.
They believe governments should fund the testing and development of the drugs, side-stepping big pharma and bringing them to market as cheap generic medications.
And they point to the story of Relenza - one of only four flu drugs currently sold - as evidence public-sector involvement will be needed if crucial new flu drugs are ever going to hit pharmacy shelves.
Mark von Itzstein, who led the team that invented Relenza, says he has three compounds that are ready to be tested in animals and could be available on a commercial basis in three to five years for about $10 a treatment course. (Relenza and the more popular Tamiflu sell for about $55 in Canada.)
But under the existing profit-driven model of pharmaceutical production, where the next sexual dysfunction drug is more highly prized than a new life-saving antibiotic, cheap flu medications simply aren't on the priority list.
As I have said elsewhere, the flu virus will always find our political, cultural and moral weaknesses, like water finds a crack in the ceiling.Crofsblogs on the problems with openness in fighting the flu--first Ibsen reference ever on this blog.Crofsblogs on a NEJM article on probably H2H in Thailand.Crofsblog has this on a National Geographic story on Killer Flu. Dateline Jakarta, bird sales down, fish sales up (Crofsblog)
September 21 Flu Update...is this it?
Big, big news day. Be sure to read all the way to the end...some of the biggest stories from today where not from Indonesia.Early today, the Indonesian Health Minister said bird flu an epidemic in her country.
"This can be described as an epidemic. These (cases) will happen again as long as we cannot determine the source," Supari told reporters, but she insisted it would be wrong to label it a "frightening epidemic".She later retracted that statement, saying if things worsened it would be an epidemic.Helen Branswell of CP says WHO is trying to "dial back" concern.
Despite reports of a number of suspect cases, there are currently no plans to convene the meeting of experts that would be needed before the organization could declare the world had moved one step closer to a flu pandemic, Dick Thompson said from Geneva.
"We're not anywhere close to that. We see no relationship between any of these ... suspect cases," said Thompson, communications director for the agency's communicable diseases branch.
"The level of anxiety is higher in Indonesia. It is not in Geneva."
Thompson also moved to dispel reports the WHO was getting ready to deploy a supply of antiviral drugs to Indonesia.
The WHO has been promised a stockpile of three million treatment courses of the drug oseltamivir or Tamiflu to be used as a pandemic fire blanket. The agency has committed itself to trying to stop or slow a pandemic once a strain emerges that seems to have the capacity to spread in sustained fashion from person to person.
Thompson said a small number of treatment courses were sent to Indonesia in July when a cluster of what were thought to be three cases in one family was identified. But there are currently no plans to draw down the stockpile for Indonesia, he insisted.
"No, definitely not."
Indonesia will cull where the bird flu is most intense.
Lost in all this is another bird flu death, a young girl.
ABC News has the story on the Indonesian crisis.
ABC News also has this--is it cause for alarm?
CIDRAP on the fears in Indonesia.
Effect Measure on whether Indonesia is boiling, or simmering.
Effect Measure on international experts converging on Indonesia.
Recombinomics has this concern on a false positive.
Recombinomics on three new admissions in Indonesia.
Not surprisingly, Recombinomics says the events in Indonesia are due to recombination.
Recombinomics says that a young girl was denied admission to the hospital in Jakarta, based on a machine translation.
ProMed on the Indonesian situation.
More from ProMed on Indonesia.
From Australia, the question over whether this is the start of pandemic.
Two of our favorites, Michael Osterholm and Helen Branswell, did a symposium last night at the Wilson Center in Washington. Here's the audio link, here's the video link, and here's the .ppt.
Here's a news story from VOA on the event. Every word is a must read.
In general terms, we are not much better able to handle acute respiratory distress syndrome, in any number of cases today, than we were in 1918," he said. "So, do not go back and say, well, it is different today, it is not 1918. Unfortunately, folks, it is 1918 all over again, even from a clinical response standpoint.
Outside Jakarta, the Irish decided to test their culling prowess by taking out 10,000 birds.
Malaysia says it is flu-free, despite being a neighbor of Indonesia.
Annals of Internal Medicine has this editorial, which is a reasonable assessment, if a little conservative. They note at the end that the recommendation is enough Tamiflu for 50% of the US population.
This might be the most important article today. For those who think (or whose friends tell you) that the vaccine is on the way, the New York Times has this from the vaccine front. Two studies in The Lancet point out the weaknesses of the approach.
Even so, the research is alarming because it demonstrates how quickly and unexpectedly flu viruses can become impervious to medicines once they are put into common use, as they would be in the case of a pandemic. Also, at their best, antiviral medicines do not cure influenza. They cut down on transmission of the disease and reduce somewhat the symptoms and complications in those already infected, including the high rate of associated pneumonias. Called for comment, a spokesman for the World Health Organization, Dick Thompson, said that the group could neither support nor deny the findings of the analysis of vaccine studies at this point, noting only that some experts criticized the researchers for "not including some important past studies" in their sample.
Helen Branswell has her take on the same story.
Reuters on bird flu fact sheet.
The Houston Chronicle says that the Bush bird flu speech was for the birds. Effect Measure has a Nature article from Declan Butler that says the US doesn't live up to the sharing of data called for in the Bush UN Address.
September 16 Flu Update
Yesterday's big flu news, really, was that ABC News Primetime did a story on the potential for tamiflu shortages.
UPDATE: This is nothing new for long-time readers, but this article is a must-read for anyone who wonders what the fuss is about. These people are not nuts--Bill Frist, Foreign Affairs
, Dr. Osterholm. These people in the mainstream are talking about casket shortages......Although Recombinomics still says they got it wrong
, it has driven people to seek info on the web about AI, including here. People in the blogosphere are negative about the MSM, but they still have the power to drive mass audience. Crofsblog wrote on this here
Speaking for ourselves, we had the most hits we had in a single day since we were linked on Rense.com in February of this year.
So, if you're here because of the ABC story, welcome. Feel free to look around, and check back often. We update flu news links every day. Thanks for your interest.The IHT notes that with repeated strong statements from WHO in the past week, and President Bush's address at the UN, the global drive on the bird flu is stepping up.Reuters has this on business preperation for the flu--companies may be preparing more realistically than government.As if on cue, Italy is stepping up its bird flu protection.In Australia, bird smuggling is discouraged.Russia has backed President Bush's flu partnership plan.Australia is also joining the global flu fight.Vietnam says September has brought no new cases of bird flu.WHO update 29 confirms that the Indonesian case was H5N1.Glaxo gets some local pub in Philly for being part of Presidential Pandemic Plan.The New Scientist says that trials of a low-dose H5N1 vaccine are underway. If you will recall, amidst the media celebration of August's vaccine news there was the cautionary tale that the promising results were generated by giving two 90-microgram doses four weeks apart. Trials today include doses as low as 3.5 micrograms.CIDRAP on the US flu plan.CIDRAP on the confirmed death in Indonesia.Recombinomics says 16 nations have hopped onto the President's plan.Recombinomics has the news of the concerns raised by the confirmation of H5N1 in Indonesia.Recombinomics also says the Indonesian case is a geographic cluster.Effect Measure comments on the Canadian flu conference story we ran a couple days ago.ProMed on the Indonesian confirmation.Crofsblog notes that Bloomberg has stories of a fifth case in Indonesia.
September 14 Flu Update
In China, an expert is warning of a flu pandemic, and he's the same guy who blew the whistle of SARS.Jakarta is offering free medical treatment to anyone with the flu.The EU is urging governments to purchase flu medication before the pandemic hits.There's an herbal brew remedy to the flu in Jakarta.The BBC has a story which is very good. It talks about the rapid spread of the bird flu if clusters in Asia got large, and how, essentially, nothing could be done about it.
Dr Edmunds said: "This time we would expect it to be spread more quickly than it did last time because we have a lot more flights and there's a lot more contact between people these days.
"If it's spreading widely in south east Asia, then a few weeks is really all we could expect before the pandemic arrived here.
"So there isn't much time."
But he said analysis showed travel restrictions were likely to buy very little time, and be very expensive.
Screening people coming into the UK would be "very ineffective", and likely to pick up few cases because during a flu pandemic, people with symptoms would not be allowed to board a plane anyway, he said.
But many of those who did travel could be incubating flu but not showing any signs, meaning screening, say for high temperatures, on arrival in the UK would not stop cases getting through.
Dr Edmunds said: "There is only one thing that can be done to stop it, and that is to stamp it out at source and if you're lucky you can stop a pandemic developing at the source."
A Helen Branswell story is always welcome---this one is on a recently announced International Flu Conference in Canada.Good news--the ostrich population in South Africa is bird flu free.In Thailand, they feel like they are making progress on a flu vaccine.Recomobinomics writes that the lack of human cases in Indonesia could be a lack of testing.
September 13 Flu Update
Chapter 85 of the "dead birds don't migrate" debate resurrects the argument over whether migratory birds are spreading the flu. Recombinomics feels strongly that it is, and he's being broadly attacked on some message boards (ridiculed, really) for these beliefs.
I'm not here to sort it out. But let's look at what National Geographic (presumably a credible source) has to say (Answer: nothing definitive, but they clearly take the idea seriously).
But there is another possible carrier of the virus far more difficult to control than domesticated chickens: migratory birds.
Migrating birds may have caused the outbreak of avian flu that killed thousands of domestic fowl in Siberia this summer. Scientists have also found birds on Lake Qinghai in China, where many birds come to migrate, to be infected with the strain.
If avian flu is introduced to North America by migrating birds, "Alaska is the most likely state where it would first arrive, because that's where the … flyways intersect," said Hon Ip, director of the U.S. Geological Survey's (USGS) virology lab in Madison, Wisconsin. His lab is handling some of the tests.
Recent outbreaks of avian flu in Kazakhstan, Mongolia, and southwestern Siberia in Russia have been attributed to H5N1. The incidents mark the first time the virus has extended into the regions, though there is no confirmation that migratory birds brought the disease there. But a study of birds found sick or dying on China's Lake Qinghai last spring showed that they carried H5N1. The lake is a breeding center for migrant birds from Australia to Siberia.
So far, there is no evidence of avian flu in North America. But Ip worries that it might just be a matter of time before the disease spreads out of Asia.
"The longer the virus persists in poultry, the greater the chance that, at some point, it will spread to species of wild birds that can carry the virus to new areas," the USGS virologist said. "It is like playing Russian roulette—time is not on our side."
Reuters says that the bird flu exposes a rich-poor gap in the world.
Indonesia is aggressively checking people who had contact with dead woman for bird flu.
Italy is allocating more money to bird flu.
A quarantine remains in effect in Russia.
A researcher at Purdue has a novel vaccine delivery technique for the flu.
Purdue molecular virologist Suresh Mittal and his collaborators are investigating a new way to provide immunity against avian influenza viruses, or bird flu, the most lethal of which, H5N1, has a 50 percent fatality rate in humans. Under a $1.6 million grant from the National Institute of Allergy and Infectious Diseases (NIAID), the researchers are focusing on using a harmless virus, called adenovirus, as a transmitting agent for a vaccine to fight off highly virulent strains of the avian influenza viruses. <>Current vaccines are designed for strains of flu found in local areas and are effective only as long as the virus doesn't change form. Existing vaccines will have limited success against new strains of avian influenza, he said. Every time a bird flu mutates, vaccines must be redesigned.
<>Australia says bird flu could kill more than terrorism.....I guess you have to put things in relevant terms.There's an influenza conference in Malta. They are worried.Vietnam media story on WHO Official Margaret Chan speaking out on flu.CDC Influenza Branch Chair Dr. Nancy Cox will chair the Options for the Control of Influenza VI International Conference in Toronto, Canada, June 17-23, 2007.Must-read from the Orlando Sentinel. Takes the Effect Measure message of Katrina as metaphor for flu preperation, and shows how unprepared we really are for things that upset our systems.Roche presented a paper at Malta, which said that two studies show Tamiflu reduces death from flu.Recombinomics writes that investigations in Jakarta are slow and incomplete, marked by false reassurances to the public.
CIDRAP reports on a European paper that, for the first time, shows that people can catch LPAI as well as HPAI.Effect Measure on the Chan comments.Crofsblogs has this from Marc Siegel, who says we always fear exotic stuff more than everyday stuff and that the avian flu today won't evolve like the 1918 flu, which took advantage of war conditions. I could swear I saw this somewhere before, but I can't figure out where.
September 9 Flu Update
Flu resistant to Amantadine is spreading, according to research published by the St. Jude Children's Hospital in SE Asia.In Australia, there is criticism of the government over its bird flu complacency.Here's an interesting one from Taiwan. This column makes the argument that Taiwan shouldn't prepare for the bird flu.An article in Science this week is calling for a global surveillance network for all animal infections. Article notes that as many as 70 percent of infections come from animals, and also notes slow reporting in Asia of SARS and flu.Holland has ordered more tamiflu. If they ever receive their order, they will have enough for 30 percent of their population.CIDRAP on the WHO warning from this week, more sick birds in Thailand, and the Netherlands Tamiflu order.CIDRAP writes on a CDC report that calls for more resources to quarantines--meaning, in this case, the entire nation at its ports of entry.
"CDC quarantine stations and the broader quarantine system serve as the nation's insurance policy against catastrophes that might arise from the importation of naturally occurring infectious agents, such as the SARS virus, or man-made threats like an attack using a dangerous biological agent," Georges Benjamin, executive director of the American Public Health Association and chairman of the committee that wrote the report, stated in the news release. "But no single entity currently has the responsibility, authority and resources to orchestrate all the activities of the quarantine system and the traditional responsibilities of quarantine personnel are no longer sufficient to meet the challenges posed by the rapidly increasing pace of global trade and travel and the emergence of new microbial threats."Recombinomics notes more wild bird flu in Tomsk, Russia.The ongoing ProMed "dead birds don't migrate debate" goes on, with NPR running a story which features the claims of some scientists that migratory birds don't present a threat. This link leads to a transcript which includes a direct audio link.
The Village Voice has a review of "The Monster at our Door" which is available through Amazon by clicking the link on the right hand side of this page.Silviu looks at a couple papers which show worrisome changes in the H5n1 virus.
Karesh: We picked Mongolia because it was right in the middle
of those 2 outbreaks, halfway in between, and we figured
same birds are in Mongolia that are in both Russia and China.
KNOX: Karesh's group counted 55 species of wild birds on
the Mongolian lake...about 65 000 individual birds.
Karesh: None of the healthy birds so far have turned
up to be positive. The live birds don't look like
they're positive. It's only in one dead swan that
we actually found the virus.