The Coming Influenza Pandemic?

November 30 Flu Update

"What I am afraid of is the low level of competency and technical expertise of hospitals, clinics and medical personnel at the grassroots level, who may not detect cases as quick as they should."

Most doctors say thimerosal is safe and studies have shown there is no association between vaccines of any type and neurological diseases such as autism. Experts say the type of mercury used in thimerosal does not affect the body in the same way as mercury found in pollutants. But several groups dispute this and some high-profile books have claimed that mercury is causing an epidemic of neurological disease. They claim that U.S. health officials have covered up evidence of this.

posted by Orange @ 10:22 PM 0 comments

November 29 Flu Update--More Flu in China

A 16-year-old boy confirmed as Indonesia's 12th human case of bird flu had two brothers who died from similar symptoms days before he was taken to hospital, the World Health Organisation (WHO) said on Tuesday. The brothers died on Nov. 11 after being diagnosed with typhoid fever, but they were never tested for the deadly H5N1 bird flu virus, leaving questions hanging over the cause of death, WHO spokeswoman Maria Chang said. "They had similar symptoms, fever and respiratory distress, but we don't have samples. We'll probably never have a definite diagnosis," Chang said, adding that the possibility of human-to-human transmission of bird flu could not be ruled out.

WHO experts made an inspection in the hospital, where a 35-year-old female farmer surnamed Xu died of bird flu infection. They also visited Shandou Village where the dead lived, inquiring about the details of the victim's condition before and after getting infected.

posted by Orange @ 10:06 PM 0 comments

November 28 Flu Update--Is North Korea hiding a bird flu outbreak?? Meanwhile, China says the flu virus is mutating.

Family clusters don't necessarily mean the virus is spreading from person to person, the report notes. They may simply mean that relatives were exposed to H5N1-infected poultry at the same time.

However, in three family clusters, all in Vietnam, the first and second patients fell ill more than a week apart, which suggests that they probably didn't acquire the virus from the same source at the same time, the report says.

The report concludes that flu pandemic plans universally need to address four key issues, including health workers' duty to provide care during a communicable disease outbreak; restricting liberty in the interest of public health by measures such as quarantine; priority setting, including the allocation of scarce resources such as medicines; and global governance implications, such as travel advisories.

posted by Orange @ 10:42 PM 0 comments

November 27 Flu Update

The outbreak occurred in the local mayor's farm.

Work on the Siena Cathedral wall never resumed, and the once-flourishing medieval city faded just as the Renaissance dawned. To this day, Siena has about half the population it had in the mid-14th century. Infectious diseases take a toll that is greater than just the life lost at the moment, Rappuoli said.

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Siena, he says, was once very much like California. "People wanted to get there, because the future was there," he said.

Artists and architects flocked to Siena to build and embellish its ornate cathedral, the Duomo di Siena. The sculptor Giovanni Pisano designed its lower facade, and his father Nicola Pisano produced its massive pulpit. Construction began on the wall for a towering new nave that would have completed the cathedral's cross-shaped design.

But the plague killed many of the cathedral artisans, Rappuoli said, depleting the resources and the expertise needed to finish the wing that would have made the Duomo one of the largest church buildings of its time. "They'd lost the knowledge," he said.

Rappuoli said he now sees the AIDS virus rolling back the clock in Africa to the Middle Ages, as life expectancies drop and a generation is left orphaned. "They have no mentors," he said.

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"Fatti non fummo per viver come bruti ma per seguir virtute e conoscenza," Rappuoli quotes Dante. "We (mankind) were not born to live relaxed in ignorance like animals, but to explore the universe to learn its secrets ... and improve our knowledge, and use it to improve the quality of life," he interprets the passage.

posted by Orange @ 10:50 PM 1 comments

November 26 Flu Update

Health authorities yesterday intensified an information campaign on prevention of human infections, using prime-time TV slots and major newspapers urging people to maintain a hygienic and healthy lifestyle and process poultryproducts with caution.

posted by Orange @ 9:59 PM 0 comments

November 25 Flu Update

Toronto does not have the capacity to deal with the number of patients that would flood into the city's health-care facilities if a flu pandemic struck, the Toronto Board of Health says.

As many as 14,000 people could require hospitalization during the first wave of an influenza pandemic, according to the draft version of the health board's pandemic plan, released yesterday.

But a survey of Toronto hospitals found "there is no surge capacity to deal with the expected volume of patients who will seek medical attention during a pandemic influenza. There will be a shortage of health-care providers to keep the doors of Toronto hospitals open," the draft plan states.

posted by Orange @ 4:54 PM 0 comments

November 24 Thanksgiving Flu Update (Here in US)....Is the expert recanting on Chinese cases?

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November 23 Flu Update--Second Death in China Reported

"There is no proof of human-to-human transmission of bird flu in the world so far," Chen Xianyi, head of the contingency office of the Ministry of Health, told the Xinhua News Agency in an interview.

A critical phase in the evolution of a bird flu pandemic could play out in China in the coming weeks, world bird flu expert Robert Webster said in Dunedin yesterday.

The University of Otago-educated virologist is in Dunedin at the New Zealand Microbiology Society's annual conference this week.

He said a campaign in China to vaccinate its 14 billion poultry flock could precipitate a worst case scenario.

The doomsday scenario was that the Chinese would use a poor-quality vaccine that did nothing more than force the virus to mutate into something more lethal.

"The international community has no way of knowing whether China will use a good one," Professor Webster said.

"There is a big argument that they will simply help the virus to evolve to become a human pathogen."

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The recent discovery of the virus in flamingoes in Kuwait indicated it was moving down toward Africa, which could provide the perfect environment for the critical mutation to human-to-human transfer.

"If it gets into the backyard flocks in Africa...that's a real worry," he said.

People whose immune systems were already compromised by HIV, which is widespread in Africa, either died quickly or went on shedding a virus for weeks.

If the former happened, that was tragedy, but if it were the latter, it might be even more dangerous, Prof Webster said.

"It gets the chance to adapt to the human and pick up the characteristics of receptor specificity," he said.

In addition to allotting insufficient funds for areas like surveillance in Asia, the UPMC document argues, the plan places too heavy a burden on U.S. state and local authorities with minimal funds, personnel, and political influence. The plan calls for states to handle the bulk of the response, from identifying influenza strains to monitoring hospital admissions, and makes them responsible for individually stockpiling anti-viral medication, bearing 75% of the cost at an estimated $500 million. "There are some parallels [with Hurricane Katrina]," Inglesby said. "Assuming that the states can mount the kind of effort that's required I think is not very realistic," said Monto.

Chinese researchers obtained the seed virus from the World Health Organization (WHO) and planted it in chick embryos in seven-day-old eggs. They then ensured the embryos grew normally in the eggs before the embryos were extracted after three days of growth.

posted by Orange @ 8:04 AM 0 comments

November 22 Flu Update--China calls flu a "serious epidemic"

One of the goals is to effectively prevent bird flu from jumping to human beings, and the other is to maintain the normal order of production and living of the people, Gao said during a meeting with French Health Minister Xavier Bertrand in Shanghai on Monday.

But Hong Kong herbalist Wong Chi-sun is putting his trust in what looks like a plastic zip-lock bag full of some really bad weed. He's selling a blend of some classic Chinese fever-fighting remedies: squiggly yellowish buds of honeysuckle flowers, brown seed shells from the weeping forsythia, crumpled black Dyers Woad leaves and dried chips of Isatis root.

It's not a bunch of mumbo jumbo and quackery, the Chinese medicine practitioner says from his store-front clinic filled with earthy, musky smell of herbs and other things like dried sea horse and deer antlers.

"Western medicine is about treating symptoms," said Wong, who wears his hair slicked back and walks around in flip flops. "Chinese medicine is about treating the person."

posted by Orange @ 3:41 PM 0 comments

Breaking News--Official calls flu in China "serious epidemic"

posted by Orange @ 3:03 PM 0 comments

November 21 Flu Update--China Crisis is "severe," and getting worse

posted by Orange @ 3:44 PM 0 comments

November 20 Flu Update--Human Death toll continues to rise

MR. RUSSERT: ...but there is no vaccine to deal with the bird flu, correct?

DR. FAUCI: That's--in some respects, correct, but in others not. We do have a vaccine that was developed from a virus that was isolated from a Vietnamese patient about a year and a half ago. At the NIH, we've been in clinical trials with this H5N1 vaccine. It has been shown to be safe and it has been shown to be able to induce an immune response that would be predictive of being protective. We're doing the studies in individuals who are healthy. We're moving to elderly. The critical issue, and this is the constraining issue, is that we don't have the vaccine production capacity at this time to make enough vaccine for the people who might need it. That's really the problem.

But John Oxford, a professor of virology at Queen Mary's University of London, who said he would receive a fee for speaking at the Roche briefing, insisted much of the burden rested with Tamiflu.

"We need plans and ammunition and Tamiflu is at least half of our ammunition," Oxford said, adding there was a clear relationship between the current H5N1 strain and the deadly Spanish flu virus of 1918-1919. "Without Tamiflu, we would be going into this naked."

He also warned that bird flu was "like the Scarlet Pimpernel: You never know where it's going to appear. And it's got a greater spectrum of variety than any other flu virus we've ever seen before."

The South Coast Times (MASS), is taking flu seriously, and hopes the current vaccine might be partially effective.

ProMed with reports of birds and all manner of other living fish and mammals comingling in Vietnam, Taiwan's accusation that the birds that died in quarantine in Britain were Chinese birds smuggled through Taiwan, and an answer to how the Kuwaiti flamingo got the flu (migratory bird droppings).

Crofsblogs notes this from the New York Times--an editorial on the inadequate Bush Flu plan. Apparently, Secretary Leavitt made big news today saying the US was "unprepared" for the pandemic. It is surprising that this is news....he has said it over and over again.

Crofsblog also found this--the IHT notes that the ambitious Chinese efforts to vaccinate 14B poultry could actually make the disease worse by tracking the virus from farm to farm with the vaccination team.

He then pulls out a word I didn't know existed for something I have long been fascinated with--injuries caused by efforts to heal. I have called it dying from the cure--the actual word is iatrogenic.

Finally, Crofsblog says enterpising readers sent him this transcript of an 11/16 pandemic confernece sponsored by the Council of Foreign Relations, led by Laurie Garrett, one of our favorites here. I'm going to peruse it tonight, but here's the link for your own use.

posted by Orange @ 9:36 PM 0 comments

November 19 Flu Update--More Flu in China

Studies of past pandemics don't reveal how the switchover from bird virus to human scourge will happen in the next one. Instead, they illustrate there are two routes. The virus can make the genetic changes on its own. Or it can pick up genes from a human flu virus, perhaps in a person who became infected simultaneously with the bird and human viruses. This gene-swapping process is called reassortment.

Taubenberger, who is studying the genetic makeup of the 1918 pandemic virus, said that germ appears to have mutated on its own. In contrast, the viruses behind the other two pandemics of the 20th Century were apparently products of reassortment, he said.

Beijing is desperately trying to educate its local officials and health officers about the realities of the disease, but the first instinct of many Chinese bureaucrats is to conceal and cover up. The greatest danger is that those same bureaucrats might even conceal a case of human-to-human transmission, the potential trigger of a global bird-flu epidemic that could kill millions of people.

After repeated denials, China finally confirmed its first human cases of bird flu this week, including two deaths where bird flu is confirmed or strongly suspected.

Evidence of a cover-up has already emerged in at least two regions of China. In Hunan province, reporters were arrested when they tried to investigate rumours of a bird-flu outbreak. Officials declared last month that the case was "closed," and then were forced to admit this week that the outbreak was indeed caused by bird flu.

In Liaoning province, where three bird-flu outbreaks have erupted, it was revealed this week that a bureaucrat has been arrested for trying to cover up the illnesses of chickens at local farms.

Zhao Yonghe, head of veterinary services in a village in Liaoning, was allegedly giving certificates to local farmers to verify that their chickens were healthy, though he knew they had contracted the bird-flu virus.

Lubroth says China's slowness to share viruses reflects a concern there that the country's researchers do not receive adequate credit for their scientific contribution.

Brown can understand that point of view, saying scientists the world over hoard their data in order to ensure they get credit for their findings, which is key to ensuring ongoing research funding.

"You don't give away your data because the big labs will take it, they'll take the credit and you're sitting there writing a grant application without having the work published by yourself," he says.

Firstly, although the majority (but not all) of the human cases can be related to contact with diseased poultry, the number of human cases of illness must be a very small proportion of all contacts between humans and diseased poultry. Other as-yet-unrecognized factors must be involved.

Secondly, nucleotide sequence analysis is useful in unravelling the epidemiology of separate outbreaks. But sequence variation has to be correlated with biological experiments to make predictions about the imminence of changes in transmissibility and virus virulence. Mutations tend to be deleterious unless there is some external selective pressure favouring survival of a particular phenotype.

posted by Orange @ 8:49 PM 0 comments

November 18 Flu Update

"But if governments are to avert widespread panic, they must admit to uncertainty, act transparently, issue guidance on disease protection, and make sure information is disseminated to the public as quickly as possible.

posted by Orange @ 4:14 PM 2 comments

Breaking News--FDA says no evidence Tamiflu tied to deaths in Japan

posted by Orange @ 9:09 AM 0 comments

November 17 Flu Update--Roche denies upgraded Tamiflu victim toll and WHO issues warning on vaccines being developed.

"Roche doesn't believe there's a link between Tamiflu and those deaths, and we are confident that Tamiflu can be used safely both by children and adults," a spokesman for Roche in the United States, Al Wasiewski, told AFP.

'The current virus is not able to become a human pandemic. Even if H5N1 might become the precursor of a human pandemic...it has to go through some changes,' Bekedam told a news conference.

'Those changes might be so substantial that this current virus -- the vaccine (for which) they're working on, might not work,' Bekedam said.

'On the other hand it might work... We hope it might work.'

posted by Orange @ 7:07 PM 0 comments

Breaking News....FDA probing Tamiflu, potential 14 deaths in Japan

posted by Orange @ 2:36 PM 0 comments

November 16 Flu Update--China cases dominate the news

It's proving harder than anticipated to type the avian flu viruses wild ducks sampled in Canada were carrying because a number were co-infected with several strains, creating a viral "soup" that is difficult to separate down to its basic ingredients, government officials have admitted.

They say, however, that it appears that none of the viruses are highly pathogenic, a finding that would support the suggestion none of the birds were carrying the worrisome Asian H5N1 flu virus, which is a so-called high path virus.

posted by Orange @ 4:40 PM 0 comments

Breaking news--China reports three human cases

posted by Orange @ 8:02 AM 0 comments

November 15 Flu Update--China confirms its first human case, and says it will vaccinate 14B poultry,

Here is the executive summary:

To combat a possible avian flu pandemic, we should consider the following:

1. The single most important thing we can do for a pandemic—whether avian flu or not—is to have well-prepared local health care systems. We should prepare for pandemics in ways that are politically sustainable and remain useful even if an avian flu pandemic does not occur.

2. Prepare social norms and emergency procedures which would limit or delay the spread of a pandemic. Regular hand washing, and other beneficial public customs, may save more lives than a Tamiflu stockpile.

3. Decentralize our supplies of anti-virals and treat timely distribution as more important than simply creating a stockpile.

4. Institute prizes for effective vaccines and relax liability laws for vaccine makers. Our government has been discouraging what it should be encouraging.

5. Respect intellectual property by buying the relevant drugs and vaccines at fair prices. Confiscating property rights would reduce the incentive for innovation the next time around.

6. Make economic preparations to ensure the continuity of food and power supplies. The relevant “choke points” may include the check clearing system and the use of mass transit to deliver food supply workers to their jobs.

7. Realize that the federal government will be largely powerless in the worst stages of a pandemic and make appropriate local plans.

8. Encourage the formation of prediction markets in an avian flu pandemic. This will give us a better idea of the probability of widespread human-to-human transmission.

9. Provide incentives for Asian countries to improve their surveillance. Tie foreign aid to the receipt of useful information about the progress of avian flu.

10. Reform the World Health Organization and give it greater autonomy from its government funders.

We should not do the following:

1. Tamiflu and vaccine stockpiling have their roles but they should not form the centerpiece of a plan. In addition to the medical limitations of these investments, institutional factors will restrict our ability to allocate these supplies promptly to their proper uses.

2. We should not rely on quarantines and mass isolations. Both tend to be counterproductive and could spread rather than limit a pandemic.

3. We should not expect the Army or Armed Forces to be part of a useful response plan.

4. We should not expect to choke off a pandemic in its country of origin. Once a pandemic has started abroad, we should shut schools and many public places immediately.

5. We should not obsess over avian flu at the expense of other medical issues. The next pandemic or public health crisis could come from any number of sources. By focusing on local preparedness and decentralized responses, this plan is robust to surprise and will also prove useful for responding to terrorism or natural catastrophes.

But there are several reasons why it is impractical for individuals to stock up on flu drugs. First, we don't yet know what an adequate dose is. While 10 pills of Tamiflu -- two pills a day for five days -- is typically enough to battle regular flu, rodent studies suggest we might need more than that to battle H5N1. In August, the Journal of Infectious Diseases reported that the standard five-day dose protected only 50 percent of mice infected with H5N1. Eight days of treatment boosted survival to 80 percent.

In addition, the flu drugs protect you only as long as you are taking them. If you are the only one in your neighborhood taking Tamiflu during an outbreak, it isn't going to do you much good because you will be as vulnerable as everyone else the moment you stop taking the drug.

"You can't keep on using Tamiflu forever," says Suresh Mittal, a virology professor at Purdue University in West Lafayette, Ind. "It's not a vaccine. As soon as someone stops the drug, they are equally capable of getting the infection."

posted by Orange @ 4:38 PM 1 comments

November 14 Flu Update--Flu Outbreaks Continue Across Asia this morning

There are at least a dozen other suspected cases as governments in Asia struggle to control outbreaks in poultry to prevent more people from catching the virus, which experts fear could trigger a pandemic.

Vietnam and China say they have more suspicious cases in people, while Thailand says a toddler infected with bird flu is recovering.

In the Indonesian capital, Jakarta, a Health Ministry official says tests confirm the woman died from H5N1 and that tests are being conducted on samples from a 13-year-old girl.

Both died over the weekend in the Sulianti Saroso Hospital, Jakarta's hospital for treating bird flu patients.

Initial tests on the girl were negative.

Roche Holding AG (ROG.VX: Quote, Profile, Research) said it had reported the cases of two boys who had taken the drug to Japanese health authorities and that they had been listed as examples of so-called adverse events in the packaging supplied with the antiviral pill.

Concerns over the side effects of the medicine had weighed on shares in Roche and its Japanese partner Chugai Pharmaceutical Co. on Monday after local media said that health authorities in Japan were investigating the deaths.

One teenager died after falling from the window of an apartment block in February while another was killed after walking in front of a truck in February 2004, David Reddy, Roche's head of pandemic sales of Tamiflu, told reporters.

In the case of the boy who fell, there was insufficient evidence to tell whether he had intended to kill himself, Reddy said. The boy had been taking another drug, known to affect the central nervous system, before switching to Tamiflu.

"One of the issues faced in determining the background for any incident is determining the potential contribution of a drug or the contribution of the underlying illness," Reddy said.

"We do not see an imbalance in these types of neuro-psychiatric events for Tamiflu versus the background associated with influenza," he said. "We have not seen an increased rate (of abnormal behaviour)."

posted by Orange @ 6:07 AM 0 comments