Saturday, December 31, 2005

December 30 Flu Update

This is the last post of 2005. We'll put something up tomorrow for an initial 2006 post. Happy New Year!

In Indonesia, a 48M has died, very likely of bird flu.

The Poultry Board in India says there is no threat of bird flu there.

People in Nothern Ireland were given advice on how to prepare for the bird flu when they travel.

Turkey is bracing itself for new bird flu battles.

Vietnam announces reduced bird flu outbreaks...

and still calls for renewed vigilance.

CIDRAP on outbreaks in Romania and Turkey.

WHO Update 51 on the Chinese situation. (Does anyone else think its strange that the woman was sick for two weeks before she died?)

Here's an interesting article. Docs in NZ are afraid that if the flu hits and they and their staff work long "nightmarish" hours, they could be cited under Occupational laws. And they are looking for some protection.

Nice article on CIDRAP about the naming conventions for H5N1--and why sometimes H5N1 isn't really H5N1...

Vietnam concedes Tamiflu problems.

Billings, MT on the containment plan.

More insistence from Malawi that it is not bird flu there.

Promed on yesterday's Chinese case, where a doc has noted that others have been sick after retrurning from Fujian province, which is where the woman died, but where China claims there have been no outbreaks. This supports what Recombinomics wrote yesterday in terms of a lot of evidence there has been something going on in this province.

Recombinomics is back with evidence of why he thinks the Fujian case could be H2H.

Crofsblog found this on the MedPage Today--a summary of what we know now about the bird flu.

Excellent point from Crofsblog--maybe the most important thing on our site today. California ERs were jammed with the seasonal flu...we are left only to wonder what would happen in there was a pandemic.

Friday, December 30, 2005

December 29 Flu Update

China yesterday announced its seventh case of human bird flu, and the third death. The 41F died on December 21, although she became sick earlier in December. Here's the most interesting quote (CIDRAP).

The Chinese Ministry of Health said no poultry outbreak of H5N1 was reported near where Zhou lived, according to Xinhua. The report did not suggest how she might have contracted the virus.
Here's a wire story on the Chinese announcement.

WHO used the story of the announcement to renew its call for China to share samples, which it has not been doing.

"It means that there is a question mark that hangs over the progress of the virus in China," said Roy Wadia, the WHO's Beijing-based spokesman. "It's perhaps more significant to get animal viruses, because this virus is still something that is primarily in the animal sector."

ProMed with a short report on the death in China.

Recombinomics writes on the Chinese case, stating his view that the case raises questions about the true prevalence of bird flu in China, especially given past reports related to this province.

Yesterday we reported that New Zealand was planning to move flu victims onto some nearby islands--today, people on the islands protest.

Romania reports bird flu in six villages east of Bucharest.

The Ukraine says it has stopped the bird flu, and is lifting its state of emergency.

More on the migratory bird debate in the Chicago Sun-Times.

We're #1--Forbes reports that the bird flu was the top health story of the year.

In Australia, its called the Sounds of Summer--bird flu preperations.

A prominent virologist is warning China that substandard vaccine could be causing the recent outtbreaks there.

Developing a flu vaccine is one of the accomplishments in an annual report of the ministry of technology in Vietnam.

Effect Measure looks at the finger pointing between bird conservationists and everyone else on what carries the flu.

ProMed on cases that are H5N1 negative in Vietnam and Israel.

Wednesday, December 28, 2005

December 28 Flu Update

The migratory bird debate is back in the news. An example is this ABC story that says "experts" say that the disease isn't being spread by migratory birds--note however, he is from a conservation society, who never seem to have seriously considered a migratory role. I'm sure more debate is coming on this topic.

"There is more and more evidence building up that wild migratory birds do play some role in spreading the virus, but personally I believe and others agree that it's not a major role," said Ward Hagemeijer, a wild bird ecologist with Wetlands International, a conservation group in Wageningen, Netherlands. "If we would assume based on this evidence that wild birds would be a major carrier of the disease we would expect a more dramatic outbreak of the disease all over the world."

Effect Measure jumps in the deabte, notingg that migratory birds have a constituency. Here's his view.

Ultimately. I think the evidence implicating movement of the virus via migratory wild birds is fairly good, maybe even compelling. But I would have to agree there are many major uncertainties as well.

Crofsblog also notes that other authorities have supported the migratory theory as well.

In Russia, they say 700 wild birds have died since November.

Bird flu has been found in Turkey again, and there is a quarantine in place.

Recombinomics says this outbreak in Turkey raises concern about surveillance.

Buyer beware--there are now stock scams trying to find "investors" in companies with bird flu remedies.

WHO is still waiting for the Chinese to respond to its request for samples.

The United Arab Emirates says that its bird flu procesures are among "the best in the world."

The Chinese say they can produce their human vaccine in large quantities.

Is Fish Farming a flu risk?...UK Doc says no.

A public info request to the Council in Birmingham, England, finds documentation that a flu vaccine would come only after the first wave of the disease had hit.

In the event of a flu pandemic, islands around New Zealand could be used to house the sick.

The Georgia Poultry Federation has a bird flu update as well.

The EC is going to host a "pledging conference" to raise funds for the global flu fight.

CIDRAP on pandemic funding passing Congress, along with a liability shield.

Effect Measure wonders whether cooperation to fight bird flu could bring progress to peace in the Middle East.

ProMed on the migratory birds and the fish food debates.

ProMed on the Turkey outbreak.

ProMed on open questions about flu type in Malawi, and some potential cultural issues behind it.

Tuesday, December 27, 2005

December 27 Flu Update

More cases in Romania.

USA Today is doing a look back at the year in health, and notes the biggest health story may be about a disease no one in the US has.

First it was a new vaccine for birds, now China claims to have an antiviral more efffective than Tamiflu and one-third the cost.

This is not an uncommon occurence. A province in Central Vietnam is having to recant an announcement made recently that it is bird flu free.

Here's a letter to editor in WAPO disputing that it is known that migratory birds carry the bird flu..from a bird society.

Newsday covers fear of flu at New York poultry markets.

Still, some people who work in the local markets are worried. At the Richmond Hill market in Queens, manager Ricky Singh expressed concern for his own health and that of other workers. He said that they wear black rubber masks and gloves when they scrub down the 91st Avenue market with Clorox. "We're pretty scared," Singh said.
A British Medical site suggests personal stockpiling of Tamiflu could lead to resistance.

In Maine, they are concerned about the effect of the flu on the egg industry.

In Hong Kong, some people are calling for the curbing of chicken imports.

Illinois is planning a pandemic exercise in the Spring, including state and local health officials as well as hospital officials.

CIDRAP on FDA approval of Tamiflu for children...

CIDRAP on news from China, on openness and on medicine.

Crofsblog points us to this from Toronto Star--year in review looking at the flu. Note here the phrase "blogger frenzy."

I for one agree with Crofsblogs here:

Some of the rhetoric in the discussion forums gets heated at times, but the flu bloggers as a group seem more stolid than frenzied. Well, maybe the Star writer picks up our subconscious hysteria between the lines.

December 26 Flu Update--one year anniversary

December 27, 2006 represents the one year anniversary of The Coming Influenza Pandemic. We started with a post like like you see above. Since then, we've received tons of great feedback and encouragement, along with nearly 97,000 page impressions, and being featured on Yahoo! as site of the day on October 17.

I started the blog because I was planning on following the pandemic more closely. I got the Gina Kolata book for Christmas that year, and had it read in a day, after having earlier read the Malcolm Gladwell and New York Times magazine articles. I found and find the flu fascinating for its ability to be a perfect tracker for our human behavior, exposing our weaknesses with an elegant brutality. So, I thought as long as I was following it, I would throw some links up for others.

My goal was to put the facts into the blog, with some comments thrown in to keep it interesting...kind of like "The Note" for flu junkies. I try not to step over what I know, leaving the science to the experts. I do, however, have a layman's perspective, only with an upgraded self-education.

Thanks to everyone who reads and to those who comment and email. It is very gratifying. On to year 2!

Although that town in Australia was subsequently cleared of flu, fear is keeping tourism down.

Good story from the Boston Globe, which says that the US poultry industry is living in fear of a flu pandemic. They are increasing security measures, because they know what a panic would cost them---not to mention the culling.

Placing the chick on the ground, he checked automated food and temperature controls in the cavernous henhouse west of Modesto, then returned to his truck and unzipped his full-body biosecurity suit.

Instinctively, Carlson reached for a bottle in the door pocket, squirted a dollop of clear gel into his calloused hand and rubbed it in.

''Farmers using hand sanitizers," he said. ''Crazy, huh?"

In the age of bird flu, the ideal poultry or egg farm would be more controlled than a prison, more sanitary than a hospital, and more remote than a desert island.

Reality is not far off. The new tools of the trade are locked gates, visitor logs, and antiviral truck washes. Failure to wear biosecurity gear is a firing offense.

Similarly, in Taiwan the EPA is putting into place protective measures.

Up until now, Taiwan has taken the work of defending against bird flu seriously, stockpiling Tamiflu as well as ingredients to produce Tamiflu, requesting "coercive authorization" to produce Tamiflu, tightening up defenses against bird smuggling, providing funds for farmers to put up wire fencing, increasing sampling of migratory birds for the HN virus family, holding conferences to increase the flow of information and holding large-scale drills.

A local health official in Japan details his region's plans for fighting the pandemic.

More sick birds in Romania, and the culling goes on.

Here's a perspective on a debate you often hear--can technology and science deliver us from a pandemic? A Chinese offical says that China should insist that it do so.

The Chinese have a new live vaccine for birds, as reported earlier. It is remarkably versatile--it can be injected or used as a nasal spray.

ProMed has various reports on this as well...note the very faint note of skepticism in the mod comment.

Provided the vaccine has been found safe (for the vaccinated birds as well as for the vaccinators) and efficacious, as should have been convincingly manifested in the laboratory and in controlled experimental vaccinations in the field, this has the potential to become a significant step forward in the combat against avian influenza. Applying the oral (drinking water), nasal or aerosol routes for mass-vaccination is a time and labor saving application mode that might enable achieving China's ambitious undertaking to vaccinate its 14 billion domestic poultry.

Hopefully, careful testing has preceded the official go-ahead approval announced on 23 Dec 2005.

The Anti-Influenza Task Force in The Philippines says migratory birds have arrived, been sampled, and do not have bird flu.

Charleston SC paper tells readers not to ask for Tamifu if they aren't sick.

Crofsblog points us to this Chinese blog that says Chinese media have no evidence of a cover up and takes strong shots at Boxun.

Monday, December 26, 2005

December 25 Flu Update

Hope everyone had as good a holiday as we did. The blog is being updated on the new G5 that was under the tree! Anyway, a week of R&R with full flu updates is on the way. Tune in tomorrow for our one year birthday celebration.

Bird flu scares reportedly were keeping poultry out of nativity scenes in Poland.

More on the sigh of relief in Australia, where a farm has been found to be bird flu free.

There was bird flu found in Romania again.

ProMed on Romania.

An editorial in Bangladesh calls for more protection against the bird flu.

The tourism industry is carefully preparing for bird flu--maybe more than any other industry, but they aren't seeing an effect as of yet.

A bogus drug alert has been launched in Bahrain against fake Tamiflu.

Norman OK paper says the Tamiflu resistance news is a setback to the bird flu fight.

If you're on the "China doesn't have the surveillance to be fully transparent about the flu" side of the argument, here's an editorial supporting that position.

Fighting Bird Flu is a 2006 priority in Vietnam...a "resolution" in fact.

The St. Louis Post Dispatch has an excellent FAQ for readers, including a short talk with the local health director.

Crofsblog found this on a poultry farmer in China who has found another line of work.

The government in Malawi says that the birds there died from "heavy rain." Samples were sent to South Africans labs as a "formality." ProMed mod comments note this one stays in the suspected category.

Recombinomics on the how the genetic makeup of the bird flu reflects the inherent instability of the virus.

Saturday, December 24, 2005

Christmas Eve Flu Update

Merry Christmas and Happy Holidays to everyone who reads this! This will be the last update of this site until Monday, December 26, as we celebrate the holiday in our home. May you have blessed times and memories with those you love.

In direct contrast to yesterday's news that China was being open, WHO today has told them to stop hoarding bird flu samples. Apparently, they are sharing human samples but not bird samples.

Here is the official transcript of these remarks.

ProMed digests the stories from China.

Effect Measure comments on the matter of Chinese transparency.

WHO says that Tamiflu resistance is not a cause for concern.

Europe is bracing for another wave of bird flu with spring migration.

There's a sick chicken in Australia, but it does not have the bird flu.

Bird flu in Romania, on the other hand, continues to move toward the capital.

Here's a reminder that if the bird flu comes, it could hit pigs, too.

Columbia says it is bird flu free.

Dow AgroSciences is going to partner with an Australian university to produce "plant made" vaccines.

The Biotechnology Industry spokesman comments on Congress passing the funds for the Bush pandemic plan.

This legislation does not provide for the same level of liability protection that the industry received as part of the smallpox vaccine program passed by Congress two years ago. However, I am hopeful that the provisions passed in this bill will reduce the risk of frivolous lawsuits, while ensuring that bad conduct is appropriately punished through both government enforcement action and private civil lawsuits for damages.
US State Department article highlights the challenges facing Africa in a pandemic.

Vietnam says bird flu remains only in ten provinces.

WHO update on the two recently confirmed deaths in Indonesia.

Canadians are urged not to buy "generic" Tamiflu.

Tamiflu has been approved for use in children under 12.

Malaysia is still going to use Tamiflu to fight bird flu.

Long-time readers have noted that a critical element to Tamiflu is shikimic acid, which comes from star anise in its natural form. This article says it can be found in the needles of....Christmas trees.

Recombinomics notes that there are at least three strains of bird flu in Europe.

ProMed has current situation reports on bird flu from a number of countries.

Thursday, December 22, 2005

December 22 Flu Update

Two Indonesian deaths from earlier this month are now lab-confirmed H5N1.

ProMed on the two deaths. Note that these are not "new" in that they have been reported previously.

Its safe to say that the story of the two patients who were Tamiflu resistant was all over the news today. We're not going to link to each one--suffice it to say this was typical--special emphasis on the word "alarm."

Roche's reaction, captured here, is to say that it may need to adjust its dosage and duration...alarming in its own way, since there were shortages at the previous dosage and duration.

The currently approved dose and duration of Tamiflu therefore remains the minimum required for the treatment of pandemic influenza. However when a pandemic strain emerges, it will be vital to test the susceptibility of the pandemic strain to Tamiflu to determine the optimal dose and duration

A news story on the Roche reaction.

CIDRAP has a report, which takes the story from the NEJM to the comments by the relavent parties.

Effect Measure comment on the science of the report, the "fitness" of the resistant virus, and then what may be the salient point: that too much hope was placed in Tamiflu in the first place.

ProMed on the Tamiflu resistance. Here's a mod comment:

The development of resistance to any antiviral agent, such as oseltamivir, which targets a specific viral protein (the viral neuraminidase), is not an unexpected event. It does suggest, however, that Tamiflu should be used primarily for pre-exposure protection of healthcare personnel and others in vulnerable occupations, rather than for treatment of patients exhibiting early or late symptoms of influenza virus infection.

Finally, Recombinomics says that sub-optimal dosing could be creating the resistance.

There's a new drug which could soon be on everyone's lips--especially on the heels of yesterday's Tamifu news. Its called peramivir, and its made by a small company called BioCryst in Alabama.

Pre-clinical testing in mice has shown that the injectable drug could cure victims of the avian flu virus with no side effects, said Nugent, and the National Institutes of Health is providing funding for the tests. The government has not offered Biocryst a contract at this time.
The Russian Ag Ministry says there are no known cases of bird flu in the country.

On the other hand, bird outbreaks continue to be announced nearly everyday in Romania.

ProMed on Romania.

Russia says it has a miraculous flu "antidote" that it will begin to make in 2006.

"We have developed a brand new disinfectant made of natural ingredients that can kill the virus in the air, in the water and on any surface," Ishchenko said.

The quarantine has been lifted in Yongzhou, a heavily hit Chinese region.

Effect Measure on the Chinese "openness."

Wednesday, December 21, 2005

December 21 Flu Update--New England Journal of Medicine reports Tamiflu resistant flu is costing lives.

Today's big story...New England Journal of Medicine says two people died in Vietnam recently of flu because the disease resisted the Tamiflu. Note that this reflects statements from a local physician we ran a few weeks ago. It goes without saying that, if it continues to be true, this blows a major hole in containment strategies.

"Improper use of personal stockpiles of oseltamivir [the medical name for Tamiflu] may promote resistance, thereby lessening the usefulness of our frontline defense against influenza, and should be strongly discouraged," wrote Moscona, a medical professor at Weill Medical College of Cornell University in New York who specializes in pediatrics, microbiology and immunology.

Roche disputes the report:

Earlier today, Roche held a news briefing to respond to the findings on Tamiflu-resistant avian flu. Dr. David Reddy, influenza pandemic task force leader for Roche, said the case reports confirmed that Tamiflu is effective against the virus, because four of the eight treated patients experienced a drop in their viral levels in response to Tamiflu, and they survived. The virus progressed in the other four patients who received Tamiflu, and they later died.
Finally, here's the prescription:

"We need to work on a variety of countermeasures — not just Tamiflu — in the hope that some, and ideally many, will indeed be effective," said Bittner, chief of infectious diseases at the VA Medical Center in Omaha, Neb.

For a broader approach, he suggested widespread dispensing of pneumonia vaccines to prevent a common complication of the flu; urging smokers to quit to help them have the healthiest possible lungs and hearts; developing new ways to manufacture the flu vaccine; testing new theories to slow the spread of infection; and formulating plans to keep essential services, such as emergency medical care, running.

The Journal reports indicated that a similar drug, Relenza, might not be prone to the same problems, although there is little evidence to confirm that at this point.

Recombinomics agrees on the combination approach, and also says that the Tamiflu resistant H5N1 seems quite "fit," a bad development.

Helen Branswell has her usual outstanding piece on this situation. Two key pieces:

Research studies are currently being set up in Southeast Asia to try to determine whether higher doses, for longer periods, are needed to treat H5N1 infections.

Should that prove to be the case, governments would face the unwelcome realization that national stockpiles of oseltamivir, or Tamiflu, will not protect as many people as they had anticipated.


Dr. Keiji Fukuda, an influenza expert with the World Health Organization, listed some of the questions posed by the findings, published Thursday in the New England Journal of Medicine.

“How frequently will we see resistance arise? What is going to be the full impact of that? Is that just going to be on individual patients who are under treatment or is it going to escalate and become a larger problem for other people who may get infected by antiviral-resistant viruses?” asked Dr. Fukuda, who was not involved in the research.

“I think these are all open questions.”

Reuters says Turkey sales actually down for Christmas in Britain.

The Ag Secretary (AgSec) is asking Congress to approve bird flu funding.

A journey of a million miles....they've started human trials on a bird flu vaccine in China, with six volunteers.

North Korea, of all places, says it has developed a way to detect bird flu.

New Zealand details potential cost to the nation in a pandemic.

Romania finds bird flu East of Bucharest, in the 22nd village since October.

Effect Measure says that WHO has a handbook for journalists in covering the bird flu, but in his view is misleads them on the question of a vaccine.

ProMed has reports on surveys of migratory birds in Denmark.

Sussex County, NJ has been declared ready for a pandemic.

The UN says that Indonesia needs to be better prepared for a pandemic.

Tuesday, December 20, 2005

December 20 Flu Update

More on the debate over whether China is open or not. The NIH says that the Chinese are being completely open and sharing data with them.

"There is a definite willingness to be completely cooperative, be completely transparent and to exchange samples with the WHO and with other partners so we can track the genetic changes," he told a news conference in Beijing.

"I think it is remarkable as compared to the situation before SARS, where transparency and cooperation was less than optimal," he said. "At the time, we had a real difficulty in collaborating, getting samples and explanations."

ProMed on China sharing samples, which are different from the flu in Vietnam. Not suprising, says the mod comment, since it is RNA, and not itself proof of H2H.

More openness, the WHO regional director for Western Asia is going to make a trip to China.

Apparently, the first mainland Chinese death--from early October--is now lab confirmed.

Vietnam says flu remains in 12 provinces.

A province in the Philippines is organizing its flu program.

In the middle of January, there will be a "pledging conference" in China where nations will come and...well...make pledges to help fight the bird flu.

Dr. Nabarro is in India, talking to that country about what each nation should do to help monitor for bird flu and stamp it out where it occurs.

Recombinomics says a Hunan H5N1 has a "novel" cleavage site, which indicates a virus which continues to evolve.

As the fight in Europe continues over farm subsidy payments, the EU has agreed to higher payments to poultry farmers for preparing to fight the bird flu.

In the UK, Christmas turkey sales are not effected by bird flu fears.

Indonesia will now go door to door in its capital to do bird flu surveillance.

Tests on dead and sick birds in Ethiopia are negative for bird flu.

The UN wants to help the Ukraine fight bird flu.

And down the stretch they come! Piegon racing is back in the UK.

186 swans killed by bird flu in Kalmikia, Russia.

Medscape says that by combining flu control measures, they strongest part of a pandemic could be blunted. This is a must read. Note the basic strategy is the same: hang on until a vaccine shows up.

Because of the specter posed by avian influenza and the devastation caused by the 1918 influenza pandemic, experts have wanted to know if control measures would be of any benefit. Such measures include restricting travel in affected areas; "smart" vaccines that target avian influenza specifically, rather than the typical trivalent vaccines; and using antivirals only in people who have actually been infected.

"Such measures could delay the arrival of epidemic waves so that vaccines could be available in time," said principal investigator Antoine Flahault, MD, PhD, during a presentation. Dr. Flahault, a professor of epidemiology at the University of Pierre and Marie Curie in Paris, France, noted that this synergistic use of control measures would reduce the effect of a pandemic.

The investigators developed a model to assess both the global geographic and temporal spread of pandemic influenza and the potential effect of control measures. The system takes into account disease spread at the city level by considering both population in and air traffic among 52 of the world's major cities according to air traffic data from 2000. The system also allows for assessing the effect of 4 control measures: isolating infected individuals, reducing air transportation into and out of infected areas, strategic use of antivirals, and vaccination.

The system draws on data from a more recent influenza pandemic, the Hong Kong pandemic of 1968-1969. In affected areas, the average rate of infection was 26%, with a range of 6% to 33%, and the fatality rate in infected individuals was 2.6%. Using these data, in the absence of control measures, with the air traffic common to contemporary life, 500 million people could be infected in 5 months and 4 million infected people would die, according to Dr. Flahault. The projected mortality rate is less than was seen in the Hong Kong influenza pandemic because of the availability of antiviral medication. Dr. Flahault commented that even without a pandemic, 250,000 to 500,000 people die annually from typical outbreaks of influenza.

Is it generic or is it fake?---US FDA testing alleged Tamiflu.

If you have stockpiled Tamiflu for your family, ABC news wants to interview you.

ProMed on Vietnam, Romania and the Ukraine.

Finally, Crofsblog reports this from Declan Butler of Nature. Robert Webster of St. Jude's and others write about the state of play in the flu evolution...comparing to a flu pandemic as a global tsunami. Must read. Here is crofsblogs post.

Here is the full article.

We cannot wait and allow nature to take its course. SARS was interrupted by early case detection and isolation, but influenza is transmissible early in the course of the disease and cannot be controlled by similar means. Just 1 year before the catastrophic tsunami of December 2004, Asian leaders rejected a proposed tsunami warning system for the Indian Ocean because it was too expensive and the risk was too remote. This mistake must not be repeated in relation to an H5N1 avian influenza pandemic.

December 19 Flu Update--UN Says Battle with Bird Flu being lost

David Nabarro, of WHO, says the world is "losing the battle" against bird flu. One thing about Nabarro is clear--he knows how to make a headline to draw attention to what he is trying to do.

"This H5N1 virus is slowly changing though genetic re-assortment or mutation. The change is slow, but if this virus undergoes the change that leads to sustained human-to-human transmission, then we have a major problem. Then we probably will have the next human pandemic influenza. This is (a) serious risk.

"Virologists who study these things say do not get complacent. It is quite feasible that H5N1 could mutate. The fact that it has taken some years should not lead you to believe that we are through the worst.

"We believe that it is starting to spread into Africa. I do hope that the Malawi case is not H5N1. If they are, then it's very serious."

Recombinomics on why H5N1 in Malawi is likely, in his view.

There's another death in Indonesia. An eight year old boy died there, local lab confirmed H5N1, WHO tests not in yet.

ProMed notes that actually there are reports of two deaths in Indonesia, but one may be a duplicate.

More bird flu outbreaks in Romania.

A new flu detection test has been cleared by the FDA.

Korea reiterates: no pathogenic bird flu.

ProMed has a news collection on Korea.

How do poultry farmers make our after the cull? Nice story about a Chinese farmer who took his settlement, bought date trees, and now sells them.

Kirin shares up on yesterday's news (see below) about a flu antibody.

Vietnam says seven more provinces have bird flu under control.

Kuwait received its first Tamiflu shipment.

The US House approved pandemic funding at only a little over half what the President requested. CIDRAP reports.

Effect Measure has his take on the Congress and what actually happened. Apparently, liability remains a big issue. I don't know how you get vaccine production ramped up without some liability protections.

Effect Measure also has an interesting post on the possibility of intradermal injection of flu vaccine to help boost immune response.

Finally, for all the talk of the bird flu hurting business, The (Toledo) Blade has this on a business gaining--sauerkraut. Reports from Korea that pickled cabbage can fight the flu can be seen in sales results. Read on...

After reports reached the United States in October that scientists at Seoul National University in South Korea had fed an extract of kimchi, a spicy variation of sauerkraut, to 13 chickens infected with avian flu and 11 of them started to recover, sales of sauerkraut have jumped.

The family-run Fremont Co. in Sandusky County, which sells fermented white cabbage under the Frank's and Snowfloss brands, has been a prime beneficiary of rising demand.

Sunday, December 18, 2005

December 18 Flu Update

Through a public access request, Canadian Press has access to Canadian Finance memos which say that the nation could lose $14B to a flu pandemic, or 1.2%--about 40% of its anticipated growth for a given year when the economy is going well.

Chicago Sun-Times on the story we ran yesterday on experimental nasal vaccines for the bird flu.

More bird flu in Romania.

Gary Butcher, a poultry vet in Florida, has emerged as a leading flu naysayer. He says the chances are basically zero, and that the flu hype is all to generate grant funds....a "golden goose" he calls it, with no apparent sense of irony.

WHO is concerned about the potential for bird flu in Nigeria.

The Tennessean reminds people to not forget about AIDS in the bird flu fear.

A woman in Singapore has been cleared of bird flu--keep in mind that often these results "reverse" themselves.

Malaysia flu preperation is detailed.

Bird flu reported here in Korea--says "most" strains are not pathogenic. Probably more to come out here.

Crofsblogs pointed us to this from Knight Ridder. When smallpox was beaten, the US decided that infectious diseases were a thing of the past, and shifted public health priorities. Now, infectious disease is on the comeback trial. Must read.

Again, via Crofsblogs. David Nabbaro in the Detroit News. He makes flu news wherever he goes.

Don't know what to make of this---Kirin Brewery says it has developed an "antibody" to fight against the bird flu.

December 17 Flu Update--Is the NIH considering a live virus vaccine, US Market Says 65 Percent chance of someone IN US catching bird flu by March 2006

You may be familiar with INTRADE, a website where people can "bet" on upcoming events. Its a sort of futures market that has successfully predicted several items during 2006. Well, they say there is a 65% chance that someone in the US will have bird flu by March.

On the vaccine front, NIH is studying a nasal vaccine for flu that uses live virus.

And if it works, this new vaccine frontier may not just protect against the bird flu strain, called H5N1, considered today's top health threat. It offers the potential for rapid, off-the-shelf protection against whatever novel variation of the constantly evolving influenza virus shows up next _ through a library of live-virus nasal sprays that the National Institutes of Health plans to freeze.

"It's high-risk, high-reward" research, said Dr. Brian Murphy, who heads the NIH laboratory where Dr. Kanta Subbarao is brewing the nasal sprays _ including one for a different bird-flu strain that appeared safe during the first crucial human testing last summer.

As the flu continues to break out in the Ukraine, they are considering stepping up flu controls.

Meanwhile, Romania had its 18th outbreak.

12 more dead Swane were found in Astrakhan, Russia.

Want to see the private sector get involved in fighting the flu? About 60 food companies, including Tysons, McDonald's, and Yum were in Thailand to help share their expertise on food safety. Their goal, protect their business by stemming the tide of bird flu.

“The McDonald’s people and people from Cargill and others are very focused in response to all of us from the U. N. and government people saying we would like to work with you,” David Nabarro, the U. N. ’s New York-based avian flu coordinator, said in an interview Thursday from Bangkok, where he addressed the meeting. There is cooperation from companies which “have a vested interest in responding better to avian influenza and preparing properly for the pandemic.”

Food companies have a financial interest in curbing the disease’s spread. A nationwide survey of 1, 007 U. S. adults on Oct. 14 by Opinion Research Corp. for the Center for Consumer Freedom found nearly half of Americans mistakenly believe that they can contract bird flu by eating chicken.

Vietnam says the number of communes hit by bird flu has been cut in half.

Fake Tamiflu was seized at customs in San Francisco.

A reader sent me this link to the Lac Du Bonnet Leader, of Lac Du Bonnet, Manitoba. They're doing the hard planning work there now, but, like most people, struggle with where bird flu falls on any specific model of Federalism.

Finally, a must read from Helen Branswell, who writes one of those 2005 year in review pieces.

The world seemed unimpressed. That is until a vicious tempest named Katrina taught a humbled American administration how little it could do to mitigate the crushing impact of Mother Nature's wrath.

Suddenly the experts' warning – there's no greater potential natural disaster than a bad flu pandemic – began to resonate with frightening clarity.

And just about then, migratory birds began to die on the fringes of Europe, stricken by the same virus that had sickened nearly 120 people in four Asian countries, killing roughly half those who fell ill. A month later, the world's most populous country, China, admitted it had joined the list of nations – now numbering five – with confirmed human cases of H5N1 infection.

A backburner issue was white-hot news.

Friday, December 16, 2005

December 16 Flu Update--Vaccine News May Not be as good as reported

The New Scientist reports on the vaccine news from Sanofi, and their take is not as positive as the official reports earlier in the week.

Scientists had hoped that very low doses of vaccine virus would make humans immune if injected along with an immune-stimulating chemical called an adjuvant.

But on Thursday, French vaccine company Sanofi pasteur announced that in tests on 300 people in France, they did not. “The prospects for adequate global supplies of an effective pandemic vaccine of any kind are dimmer now than they were last week,” David Fedson, founder of the vaccine industry’s pandemic task force, told New Scientist.

Helen Branswell, as usual, gets it right, saying that results are disappointing to anyone hoping for a "fish and loaves type miracle."

I think most people wonder what's going on in that virus. Is it moving toward H2H, or is it stuck? Is it a sudden movement, or will it be gradual. David Nabarro of WHO says that people should not be complacent, that the virus has made mutations already that could tend to point to H2h.

"There are some subtle changes in the genetic makeup of H5N1 which suggest that it is making some of the mutations that would enable it to have a higher likelihood of being able to become a human-to-human transmitted virus," said David Nabarro.

"Virologists who study these things say do not get complacent. It is quite feasible that H5N1 could mutate. The fact that it has taken some years should not lead you to believe that we are through the worst."

WHO officially confirms the sixth human case in China.

CIDRAP on the Chinese case.

Human death reported in Indonesia.

ProMed on China and Indonesia.

ProMed on Taiwan and Romania, as well.

There are also more suspected outbreaks in Romania.

Reuters on the most recent human cases.

More Ukranian villages have been hit.

Health experts warn Tamiflu is not a panacea

Clinical data supports Tamiflu's success against H5N1. Not all human victims of avian flu have been treated with Tamiflu - it has to be taken within 48 hours of the onset of symptoms to be effective - but most who have taken it survived.

Some research also indicates that in controlled environments, people who take sustained treatments of Tamiflu may be protected against avian flu. Coupled with the drug's ability to stop the spread of the H5N1 virus within the body, experts say it will prove critical in saving lives during the early stages of a pandemic.

"These antivirals are tremendously effective in a pandemic," said Dr. Kathleen Neuzil, head of the pandemic influenza task force at the Infectious Diseases Society of America.

An interesting step forward...Indonesia and Thailand are essentially going to pool their Tamiflu each a greater rapid response capability.

Australia is ordering $60M worth of Relenza, another antiviral.

Biota boss Peter Cook welcomed the deal, saying it proved the company had an "excellent" product - superior to the rival Roche drug Tamiflu, which has also been stockpiled by the Government.

"Relenza has not demonstrated the resistance that Tamiflu has and appears to be efficacious in conditions where Tamiflu is not," he said.
Indonesia says it will have human vaccine in one year.

The Chinese vice-premier says that despite initial success in fighting bird flu, it remains a long-term task.

A similar message from Vietnam, where the Deputy PM said that the fights goes on, and people have to remain vigilant.

The UN's David Nabarro is in Cambodia, where he told people that the flu pandemic could start anywhere.

The British House of Lords has told the government it should being doing more on an international basis to fight the flu.

Businesses in British Columbia have been told to make a plan and check it twice....

Thousands of dead birds were found in Malawi, and AI tests are being done. Note the mod comment calling for caution.

Thursday, December 15, 2005

December 15 Flu Update--New Case In China

The Chinese have confirmed their sixth case of bird flu. It is in new area for human infection--but is adjacent to an area with known problems. He is a peddler.

The news from the vaccine front is good, says Reuters. Note, its still a two-dose deal, though the doses are each 1/3 as large as the ones tested without an ajuvant.

A 30 microgram dose with an adjuvant -- an additive that boosts the immune response -- in a two-dose regimen showed an immune response consistent with the requirements of regulators to approve seasonal influenza vaccine, Sanofi Pasteur said.

Effect Measure picks up on this story, noting ongoing uncertainty, and that the vaccine is still four time weaker than the seasonal flu vaccine.

The Esteemed Helen Branswell has her take on this story as well. As always, this is the best read available.

That dosing regime would be a political and public health nightmare, reducing the combined global output to enough vaccine to protect 75 million people in the first year of a pandemic. At two doses of 30 micrograms, the combined output would be enough to protect 225 million people in the first year.

"It's a lot better than two doses of 90," said British vaccine expert Dr. Iain Stephenson said of the Sanofi findings. "(But) it's still pretty worrying, isn't it?"

CIDRAP on the vaccine story as well

Yesterday, we quoted a Russian doctor telling people in that country they had nothing to fear for the bird flu for two years. Effect Measure notes that his track record is not too good.

16 ASEAN countries pledge to overcome the bird flu.

Interesting story. Expert says "frenzy" of unilateral national efforts is hurting the overall attempts to fight the flu.

"It's fragmenting the ability to create a global strategy for the purposes of protection and response," Fidler told a teleconference organized by the American Society of International Law.

Chicago Tribune covers story we ran earlier--Ukraine confirmation of H5N1 in Crimea.

USDA is working to protect US birds, including testing migratory birds on the West Coast.

Romania is seeing the bird flu Bulgaria.

New Zealand is setting up flu clinics--primarily to keep their stock of GPs healthy themselves.

About half of Australian pharmacists surveyed feel the nation will be ready for bird flu.

Vancouver WA says its not ready for the bird flu.

The EU says Tamiflu safe in kids...

and it doesn't need special warning labels.

Montreal looks back on 2005...and the bird flu.

Wednesday, December 14, 2005

December 14 Flu Update--nearly 7 Billion birds in China vaccinated.

Holy Poultry! China says it has vaccinated 6.85 Billion birds.

ProMed says that initial tests of people around the 5 year old boy who caught H5N1 recently have "cooled fears of human to human transmission."

WHO Situation update on the death in Indonesia. Note especially the length of time since his death.

He developed symptoms of fever, cough and breathing difficulty on 6 November, was hospitalized on 9 November, and died on 19 November.

Family members and close contacts were placed under observation and tested for possible infection. No evidence of additional cases has been detected.

Investigations have been undertaken to determine the source of the man’s exposure. While he did not keep poultry in his household, chickens and other birds were found in his neighbourhood. Samples from these birds have been taken and are undergoing tests to determine whether they may have been the source of infection.

Indonesia is promising to cooperate with WHO to stamp out the bird flu.

ASEAN nations adopted an eight point plan for fighting pandemic flu, reviewable here.

The Kaiser Family Foundation did this webcast on the intersection between the avian flu pandemic and HIV/AIDS. You can view it here.

A Gaithersburg MD paper interviews local businesses on their preperation for the flu, than wonders if it isn't just an overhyped threat from bureaucrats protecting their funding.

In the US, CIDRAP has the story of the first of 50 planning meetings--one in each state--across the US. The first was in Minnesota.

The general theme of the half-day conference was that much, if not most, of the real work of preparing for a pandemic must be done at the local and state levels.

An audience that nearly packed the auditorium at the Minnesota History Center in St. Paul heard that pandemic preparedness consists of much more than a plan on paper or an intention to stockpile antiviral drugs.

"Hope is not a plan," said Minnesota Gov. Tim Pawlenty.

Health and Human Services (HHS ) Secretary Michael O. Leavitt said, "A plan represents our aspiration; being prepared is what we've demonstrated in the context of an exercise."

The Reuters report is a little more alarming about the state of preperation in Minnesota.

Minnesota only has 10 percent of the hospital beds it would need if a flu pandemic broke out and has nowhere near enough drugs or ventilators to treat the sickest patients, Minnesota Commissioner of Health Dianne Mandernach said on Wednesday. And her state is being praised as one of the most prepared for a pandemic or other emergency.

Washington County, Wisconsin is also preparing for a pandemic while it prepares for season flu.

11 Flu outbreaks in the Ukraine.

Two countries have banned poultry imports from the Ukraine.

Meanwhile, Europe announces it will be ready for the bird flu by 2007.

Meanwhile, a Russian expert says a flu pandemic will come within two years.

Still meanwhile, as migration end, Europe restricts bird flu measures.

Here's an AP story with a new chapter in the "China: Open or not Open" debate.

Health workers arrived 30 minutes after Qin Zhijun reported finding dead chickens. Within 11 hours, tests confirmed it was bird flu and his flock of 7,000 birds was destroyed.

Then China's normally slow, secretive government did something even more unusual. Instead of imposing an information blackout, it flew foreign reporters to the northern region of Inner Mongolia to meet Qin and see his farm.

Taiwan finds bird flu near the capital, but its not H5N1.

ProMed on China and Taiwan--including an extensive story about the state of flu regulations in China, and the coming lunar new year.

A local health authority in Alberta is preparing for the pandemic.

They are discouraging the prescribing of Tamiflu in Arkansas.

Pregnant women and babies in Singapore are being advised to stay away from Tamiflu.

Effect Measure has this on FDA warnings to sham flu cures.

Effect Measure also has this--Burlington ON will have a community meeting tomorrow to simulate a flu pandemic and get everyone in the community talking.

In this press release, Alnylam says it will begin to study using RNA Interference to fight pandemic flu.

RNA interference, or RNAi, is a naturally occurring mechanism within cells for selectively silencing and regulating specific genes. Since many diseases are caused by the inappropriate activity of specific genes, the ability to silence genes selectively through RNAi could provide a new way to treat a wide range of human diseases. RNAi is induced by small, double-stranded RNA molecules. One method to activate RNAi is with chemically synthesized small interfering RNAs, or siRNAs, which are double-stranded RNAs that are targeted to a specific disease-associated gene. The siRNA molecules are used by the natural RNAi machinery in cells to cause highly targeted gene silencing.

December 13 Flu Update--9th flu death in Indonesia

A ninth person has died in Indonesia of the flu.

CIDRAP on this story and others in the news. Note that Indonesia says that better surveillance could be behind the perceived increase in cases. (My note: by implication, that must mean there were more cases before than we thought.)

ProMed on the ninth death--noting contact with sick chickens.

Crofsblogs notes that other stories tell us six more people are sick, which is news.

There's fear of civil war ramping up in Sri Lanka again, and WHO warns about its impact on health, including bird flu.

GPs in Australia say they have been left out of the flu planning process, and that in a pandemic there would be no way for them to get accurate and reliable information in real-time.

Bird lovers continue to object to the characterization of wild birds as "carriers" of the flu---they are "victims."

Germany is relaxing its poultry restrictions--the birds can come back outside.

In contrast, Madrid has extended its restrictions.

FDA has warned nine companies selling purported bird flu remedies--it must stop.

CIDRAP on the FDA Warning.

Ukraine outbreak extends to 12 areas in the Crimea.

Gartner research urges clients to prepare for bird flu pandemic. They say by mid 06, companies should:

Monday, December 12, 2005

December 12 Flu Update--Thai Officials Denounce Flu Coverups--and is the US not vaccinating poultry to protect exports?

Thai officials are denouncing coverups of bird flu, calling for real cooperation between nations.

The next world pandemic will begin precisely in this way: A family with no information will fail to recognise the danger of an illness, and influenza will spread unchecked for days or even weeks. It will be out of control before local authorities act. And there is just one way to prevent this. Luckily, it's not that difficult: Inform the country _ the entire country _ about avian flu, and stress the incredible dangers of a cover-up. If a local official tries to suppress news of a possible illness, his co-workers must blow the whistle. If a villager falls sick, neighbours must intervene if the family does not.

This Wall Street Journal story (via UPI) says that the US has poultry vaccine, but is hesitant to use it for fear of sparking export fears.

But poultry-industry executives say importing countries would likely close their borders to chickens from states where poultry had been vaccinated. That's because the screening tests many importing countries use for bird flu can't tell whether chickens have been treated with a vaccine or infected with the disease itself.

Roche has announced 12 partners for Tamiflu production.

A Chinese company has a sub-license to produce Tamiflu.

Malaysia is proposing a WHO Bird Flu Centre.

Farm Canadians are urged to keep fears about flu in perspective.

The PM of Thailand is asking ASEAN members to stock up on vaccine--a chain is only as strong as its weakest link.

Japan is pledging $135M to the bird flu fight.

Less specifically, China says it will put money and medicine into the bird flu fight outside its borders.

A top EU medical expert says flu pandemic can be expected in ten years, but Europe is ready now.

Northern China village has its quarantine lifted.

The WHO has been invited into the Ukraine to look at flu--and they've arrived.

One of the economic fears is that flu panics will cut down on tourism. Reuters says to date it hasn't happened, but its still a concern.

Canada has a contract with ID Biomedical to develop a prototype vaccine.

Recombinomics has this from Libya--reports suggest bird flu may have been present there for months.

ProMed notes that the Libyan case has yet to even be identified as H5--and could be another variety.

Via ProMed, a report an OIE report on HPAI in the Ukraine. Note that a symptom is that the chickens get depressed.

Sunday, December 11, 2005

December 11 Flu Update

Farms in BC have been shown to be bird flu free.

India continues to work for a Tamiflu build up.

Thailand is having budget problems, and some say that the proposed 3B Baht cut in health services would hurt flu fight.

In contrast, Australia is pumping its dollars into fighting the bird flu.

A poll shows that 70% of Koreans fear bird flu--some are eating less chicken.

This article says that the bird flu has changed the way of life in Vietnam.

Dr./Senator Frist urges Congress to pass the $7.1B bill to fund a flu pandemic.

"It had better pass" before Congress adjourns for the year, said Frist, R-Tenn. "We need to be prepared. I'm very hopeful that we will invest $7.1 billion to look at prevention, to look at care, to look at treatment."

The New Britain Herald (CT) has a nice article reminding people to look to the past for clues in fighting the bird flu--especially now, because our understanding of the 1918 flu is higher than it ever has been. 25% of this town was sick, with 19 to 25 deaths.

According to the April 1919 Connecticut Health Bulletin, 100 nurses and 48 doctors went to areas in the state that were most severely hit. Also, the state’s health department set up or helped supervise 35 hospitals.

The bulletin charts the influenza and pneumonia deaths in the state by age with the hardest hit being those between 30 and 39 years old. More than 2,200 in that age range lost their lives between Sept. 1 and Dec. 28, 1918. About 1,600 people between 25 and 29 years old died. Less than 200 over the age of 70 lost their lives, and approximately 800 young children aged 1 to 4 years old died. More than 400 teenagers died as well.

"Its sinister characteristic was that it took the strong and the able," the bulletin says. "It took the potential fathers and mothers. Passing lightly the very young and almost ignoring the old, it aimed straight at the very flower of the flock, selecting the ones on whom the race depends for its present economic strength and its future replacement."
Here an ethics advice column in the New York Times, in which one of the questions is from a Doc inundated with requests for Tamiflu.

In Hong Kong, they aren't putting all their eggs in one basket--herbalists are taking a more natural and traditional approach.

He sells 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.
Crofsblog adds some comments to the use of herbs in treating disease.

ProMed looks at Romania--including a couple of recent confirmations of disease in birds.

December 10 Flu Update--US flu simulation is complete

The US government's pandemic flu exercise is over. Reports are in from WaPo. The conclusion is that local governments need to be ready, because the Federal government can't do everything. I'm not sure if we needed an exercise to learn that, but if it brought the message home, than its still a good thing. Why can't we do an Internet-based simulation with state and local officials from around the country?

Health and Human Services Secretary Mike Leavitt said the federal government alone cannot handle a major flu outbreak. "State and local governments, state and local communities, schools need to have a plan, businesses need to have a plan, faith organizations need to have a plan," he said. "The public health community understands a pandemic. . . . It's now time to engage a broader community so that we have a true nationwide response effort that's not only planned, but exercised and ready."
In a related topic, the New York Times has editorialized that the US is not spending enough on flu surveillance in Asia and Africa, and is passing along the costs to the states.

At home, Mr. Bush's proposal would require the states to pay 75 percent of the cost of flu medicines, and give little help for surveillance or increasing hospital capacity. The states are apparently expected to plan a response and figure out how to pay for it. We know how that worked with Hurricane Katrina

The Indonesian government said that it wanted to vaccinate 47 million people who were in contact with birds, but doesn't have the money. Their stated goal is to prevent the mutation of the virus.

The Thai Prime Minister has urgently told his nation to be more alert to bird flu--right down to the family level after a recent death.

``The boy's relatives didn't inform the doctors that some of the chickens in their house were dead, so the doctor didn't know the risk of bird flu until the lab results came out, when it was too late to cure with medicine,'' Thaksin said in his weekly radio address today. ``We have asked all medical staff at hospitals nationwide to be more cautious of patients with flu- like symptom. We have to be more cautious to prevent any further bird flu deaths.''
The Ukraine bird flu has hit 19 Crimean communities.

In Romania, a new bird flu case has been a bird.

After bird flu was found in two ostriches in Zimbabwe, people in Zambia are on high alert.

19,000 birds are being culled in Japan, where only H5N2 has been found.

The Mankato Free Press is writing about pandemic flu planning in their area. Their experience is informed by a 1995 meningitis outbreak. My casual observation is that points of reference like this lead to better planning, because you can think "this would be even worse than that was." Finally, the author's name is Dylan Thomas. I can't get over that.

State health experts warn a worst-case flu pandemic would sicken so many so suddenly, it would cause a breakdown of the “human infrastructure.”

Hospitals would be overwhelmed, law enforcement agencies and public utilities would be short on personnel, and some businesses may close for short periods.
The Delaware News Journal says the worst case US Scenario is 2 million flu deaths.

In China, the "fifth" bird flu victim has recovered, and was back at the hospital for a checkup.

There is controversey in Canada, where a Vancouver flu-skeptic has accused the government of buying Tamiflu merely to reassure the public. He goes so far as to say that the government should buy the drug in a powder form, because it has more than a five year shelf life.

Here's a rarity--Japan has announced that it will give part of its Tamiflu stockpile to SE Asian countries to help prevent flu spread.

Effect Measure has an analysis of why no one trusts China, involving an arrest of someone who talked about bird flu.

Here's an optimistic look ahead at the bird flu vaccine from the Manchester Union Leader. Whatever you think on the topic, this is worth a read.

Recombinomics cites a report that says that the H5N1 is a version not seen anywhere else. This report seems a little hasty to be accurate, but time will tell.

ProMed on 2 recent outbreaks in Vietnam.

Crofsblogs pointed me to this...a preview of an upcoming report due from the House of Lords on the pandemic grinding Britain to a halt. I continue to think that the non-biological impacts of the flu are the most under-studied and we are most under-prepared for. The most traumatizing part of the pandemic will be how we react to it.

Note tonight, that the National Geographic Channel is going to have a show on the bird flu. 9 Eastern on Sunday, December 12.

Friday, December 09, 2005

December 9 Flu Update--Death in Thailand, and a leading virologist says China is hiding bird flu

A five-year old boy has died of bird flu in Thailand.

Part V of the debate over whether China is hiding bird flu. Guan Yi, a leading expert on bird fu says that the bird flu is in all parts of China. Note: he does not specifically address the issue of human cases, at least in this article.

"I don't know if they are brave enough to admit that they have the virus in every corner of the country," said Guan Yi, a virologist at the University of Hong Kong who has analyzed nearly 100,000 bird-flu-virus samples from across China.

"Quite honestly, some provinces have the virus and they still haven't announced any outbreak. I can show direct evidence, even though China is still trying very hard to block my research. The government doesn't do any surveillance studies, but they say there is no outbreak."

Recently, there's been some debate as to how much Tamiflu helps. A doctor from Vietnam said it didn't help at all. WHO is beginning to study whether the recommended dose--designed for a respiratory flu--is insufficient for a systemic flu.

``This virus may be causing them more systemic infection so the usual recommended dose of antiviral is based on our experience on usual human influenza infections which only causes respiratory infection,'' he said.

Under the planned schedule for the Tamiflu trial, 150 milligrams of the medicine would be given twice a day for five days, Horby said. That compares with the recommended dose of 75 milligrams twice a day for five days, he said.

CNN reports that the bird flu vaccine is akin to putting "all your eggs in one basket."

Meanwhile, Sen. Frist urges his colleagues to support the $7.1B administration request, using, apparently, an argument he thought they would listen to....that the bird flu would be bad for the economy.

Yesterday, Sen. Schumer said Roche was talking about increasing Tamiflu production. Today, Roche confirmed those talks.

There are fears that the bird flu is spreading across the Crimea.

With the passing of the Autumn migration, Belgium is going Holland and Germany is relaxing its bird flu measures.

Greece urges EU cooperation on bird flu.

This article from South Africa is urging the nation to prepare for bird flu now, rather than wait. It cites many pandemic preperation efforts around the world.

Here's a high quality article from Gaithersburg, MD, where people are thinking through what they would do....telecommuting, drive through get the idea.

Here's an update from Bhutan on the bird flu prep.

Brunei is attending a bird flu meeting in China.

CIDRAP on HHS urging businesses to think about the bird flu.

CIDRAP on the news from China and Thailand.

Yesterday, we ran ProMed with a report that said that research which showed widespread immunity to H5N1 in China was unfounded. Effect Measure follows up with an analysis of this report.