June 30 Flu Update
Today's news...Dateline Cambodia.Avian Flu says two babies in Cambodia have died of the flu, 1,000 said sickened.Here's the media link
Here's an odd quote:
He said the illness appears to be a form of human flu, not the avian influenza that has killed dozens of people in neighboring countries and has health officials on edge over concerns the bird flu virus could mutate to more easily infect humans.Also, courtesy H5N1, Morton Kondracke (bigfoot columnist and McLaughlin group member) who says the flu could be major issue in the 2008 Presidential election.
The first paragraph below is the most perceptive thing I have heard from a US politician in a long time.
[Sen. Brownback speaking]"There will be 9/11-style commissions all over the place and hundreds of Richard Clarkes testifying that they warned about what was coming and higher-ups didn't listen," he said, referring to the former White House counter-terrorism aide who charged that the Bush administration initially ignored Al Qaeda.Singapore is considering travel restrictions if bird flu comes back....this is something Dr. Osterholm has been predicting.Globe and Mail on the Chinese reports...Vietnam announces mass vaccination program.Here's a CBC Story with a headline that will become the "take away" from yesterday's China news. Except a downturn in MSM coverage over the next few weeks as this becomes CW:
Frist, clearly, is not ignoring the problem. In his lecture at Harvard, he said that national leaders "will not be able to look away from what could be coming soon -- a front of unchecked and virulent epidemics, the potential of which could rise above your every other concern."
"For what the world could soon face it did not see even in the great wars of the last century," he said. "These epidemics ... could be devastating beyond imagination."
Frist said, "I propose an unprecedented effort, a 'Manhattan Project for the 21st century' to defend against destruction wreaked by infectious disease and biological weapons.
WHO says fear of global bird flu pandemic easingSingapore has masks and other flu staples on hand.CIDRAP on yesterday's China news.Effect Measure contrasts the US and EU flu responses.ProMed on the Chinese reports.Here's a good article from the Nation on the flu crisis and out government's inaction.Courtesy H5N1, another death in Vietnam. This was a 73-year old man.Here's the direct news link.Epidemi.ca pointed to this article about Portugal ordering Tamiflu...they are behind 25 countries and will take delivery in one year. Still hot on the tamiflu containment plan?Here's more on the Tamiflu fight between Gilead and Roche. A number of issues, one of which is (shockingly), the underpayment of royalties...and to think money was behind it all.
June 27 Supplement
Recombinomics on the silent spread of flu in North Vietnam, and looking ahead....
This H5N1 is silently spreading mild disease in human and asymptomatic infections in poultry, which would more the pandemic to phase 6. The seeding of the human population with H5N1 sets the stage for further recombination in the fall when migratory birds bring in new sequences, which will cause new problems.
(There is a consistent trend in people's writing that the thrust of the pandemic may still be three months or more away.)
June 21 Flu Update
China says it did not order misuse antivirals.The CBC has new information on an outbreak in China.Recombinominics on the new Chinese cases.And there are two new cases in China.Indonesian farmer with bird flu said to be "taking it in stride."CIDRAP on the news in China and Vietnam. Note this...
More information about the migratory bird outbreak may be forthcoming, as teams of experts from the World Health Organization (WHO) and FAO arrived in Qinghai province yesterday to inspect the outbreak area, according to Bloomberg news service. The teams obtained permission for the trip last week, but China rejected their request to travel to Xinjiang province. (Bold is mine).AMA Lobbying to get more pandemic funding from Congress.Recombinomics reports on a new clinical presentation in North Vietnam from the two cases listed above.
This is a continuing story. We noted a couple days ago on the autopsy results reported in CP, that said the disease might be located deep in the lungs, making it harder to transmit through cough. Then, Effect Measure picked up the ball yesterday with a solid analysis of the autopsy story.
Today, Recombinomics has this--ominous in its own right.
The two were among five people admitted to a hospital in Hanoi with sore throat or bronchitis, the Saigon Giai Phong daily quoted hospital officials as saying. <<Effect Measure covers the Recombinomisc news yesterday (flu timeline) and new cases today.ProMed on Vietnam.ProMed on the Chinese anti-viral story.
The above description may signal a new clinical presentation signaling efficient transmission of bird flu. A sore throat and bronchitis were not among the symptoms reported for 10 cases from last years outbreak, as reported in the New England Journal of Medicine. Similarly, a recent report on the autopsy of a patient who died of bird flu in Thailand last year also noted the absence of virus in the upper respiratory system.
The H5N1 from last season had a high case fatality rate, but was poorly transmitted. Sore throat and bronchitis are symptoms of human flu, which is efficiently passed from human to human. The alarming increase of human cases in northern Vietnam has suggested the pandemic may be evolving into phase 6.
The sore throat and bronchitis in bird flu patients in northern Vietnam may reflect an improved ability of H5N1 to grow in the upper respiratory tract, leading to more efficient spread of the virus including human to human transmission.
Note this...I've said for a couple of days that it wasn't news that amantandine wasn't effective against H5. Here's a ProMed quote.
On top of that, the efficacy of such treatment is doubtful. According to Here's a link to previews of articles appearing in Foreign Affairs.
information included in posting 20050309.0697, the WHO Collaborating Center
for Reference and Research on Influenza and the WHO H5 Reference Laboratory
in the National Institute of Infectious Diseases, Japan found that all 9
tested viruses isolated from specimens collected from confirmed and
suspected H5N1 human cases in southern Viet Nam between 24 Dec 2004 and 29
Jan 2005 showed genetic resistance to amantadine. Previously, several avian
influenza virus strains of hemagglutinin subtype 5 were found to exhibit
resistance against amantidine (Wainright, et al Avian Dis 1991; 35(1):
June 19 Flu Update
We've had some good traffic here over the past four-five days, and I hope people keep coming back. Some came through blogdex, which claimed this site was part of what was "contagious" on the web, and also through a link on Saturday's Masslive "Blog Beat."
As always, thanks for reading.
Back to work....Today's lead story is from Helen Branswell of the Canadian press. Ms. Branswell may well be the most faithful and reliable influenza journalist today. This article is on an autopsy of one of bird flu's human victims. She adds her voice to the frustration of the lack of reliable, on-the-ground data.
Slated for publication in the July issue of Emerging Infectious Diseases, their findings of an atypical pattern of infection - deep in the lungs, away from the tracheal lining where virus could easily be coughed out at others - may help explain why H5N1 influenza doesn't yet spread easily among people.This article from the Phillipines reminds us that bird flu is a potential health problem.And this article says the Phillipines are prepared.Here's an idea--in Myanmar, they're recommending VIGILANCE.Recombinomics again tries to tell the complex story of the Amantadine resistance story that the Washington Post broke.Effect Measure with the latest on the fluWiki.
But the very fact that a paper containing autopsy data from a single case is still desirable to journal editors a year-a-half into the H5N1 outbreak underscores a problem that has been plaguing the scientific world's pursuit of knowledge about this dangerous strain of influenza.
June 17 Flu Update
Yesterday, Revere @ Effect Measure tantalized us with a promise of what he thinks needs to be done. Its here, and we're supportive. We'll try to continue to be a news resource to people. Don't forget, the web is about interaction...put your comments in.
The big news today is from Vietnam...Physician in Vietnam catches bird flu. (This is a Stage 6 hallmark).Just as alarmingly, Recombinomics reports that 23 new cases are in the hospital in North Vietnam.Here's the original media report about the 23 cases.WHO is reporting four additional cases.Effect Measure writes, effectively as always, that its hard to tell if these are four new cases, some of the six announced yesterday, etc. (I thought it was just me).
Here is the single thing that got me interested in the flu.
Under the surface, the serious public health situation of responding to an impending pandemic reveals a deeper connection with matters of war, peace and crimes against humanity. Something to ponder, even as we scramble to prepare for avian influenza.CIDRAP confirms that WHO doesn't know if these are new cases or not.Recombinomics has the same complaints. Note this interview snippet at the start of the article.
LIZ FOSCHIA: The World Health Organisation says news of the infections is being reported locally in Vietnam.Later in the day, Recombinomics wrote about wishful thinking at ProMed, and what could well be a "sudden explosion" of cases in North Vietnam.ProMed has an update on the Vietnam situation that includes a short discussion of the efforts to model a flu containment strategy.ProMed reports more on Vietnam.Finally, Recombinomics has the story of a bird flu outbreak (non-human) in South Vietnam and works to connect the dots.
Peter Cordingly is based in the organisation's Asia-Pacific headquarters in Manila.
PETER CORDINGLY: We've seen media reports of six people in a hospital in Hanoi being tested positive for H5N1. In fact we're not quite sure whether it's six patients plus one doctor, or five patients plus one doctor. The media reports are a little bit contradictory, and we don't have any official information from the Vietnamese to work on.
So basically we have to do our best guess work on this one. And this does worry us a little bit. If six people are infected in one hospital, this would be the first time we've seen this. There's no evidence so far, not even in the media reports, or anything we've seen to date, that suggests that there is human-to-human transmission going on in Vietnam.
But this one we will be looking at very carefully........
LIZ FOSCHIA: Is it the fact that it's a group of six people that's concerning?
PETER CORDINGLY: Yes. Clusters always send our blood pressure up. This is the biggest one. The previous one was five, so it's not an enormous jump, but they do catch our attention.
And we need to have very swift information on this, because while we don't know how a pandemic will start, it will almost certainly start through a cluster, so every cluster has to be very closely examined.
I should say that every one that has been closely examined to date has shown that poultry was the source of infection, and that may well be the case here as well. So basically we have to do our best guess work on this one. And this does worry us a little bit. If six people are infected in one hospital, this would be the first time we've seen this. There's no evidence so far, not even in the media reports, or anything we've seen to date, that suggests that there is human-to-human transmission going on in Vietnam.
Other updates from yesteday....I think the fact that tamiful was the only antiviral available for bird flu was well known, but the Washington Post today has a big story on how it got there. Apparently, the Chinese used it to treat chickens, against international convention. Interesting read, also provides historical context from SARS.Recombinomics says that the resistance issue is a little more complicated than suspected.The Guardian on flu incubators in pigs.Story on a swamp in the Phillipines that hosts many migratory birds, could be flu hotspot.India is wisely beginning meetings on the bird flu pandemic.CIDRAP has the news of the Infectious Disease Society saying US tamiflu stocks are woefully inadequate.WebMd picks up the Osterholm story from yesterday.
June 16 Flu Update--"We're Screwed Addition"
Dr. Michael Osterholm, Director, of Center for Infectious Disease Research and Policy, University of Minnesota, quoted in US News and World Report.Comments on Effect Measure...Minneapolis Star Tribune on the story flu on the same story.Canada.com follows up with an angle you might not have considered...food production. Consider this from Dr. Osterholm.
Osterholm said the "just-in-time" delivery model by which modern corporations operate means food distribution networks don't have warehouses brimming with months worth of inventory.
Most grocery store chains have only several days worth of their most popular commodities in warehouses, he explained, with perhaps 30 days worth of stock for less popular items.
He pointed to the short-term shortages that occur when winter storms threaten communities, then suggested people envisage the possibility of those shortages dragging on for somewhere between 18 months and three years as the expected successive waves of pandemic flu buffet the world.
"I think we'll have a very limited food supply," he said in the interview.
"As soon as you shut down both the global travel and trade . . . and (add to it) the very real potential to shut down over-land travel within a country, there are very few areas that will be hit as quickly as will be food, given the perishable nature of it."
Meanwhile, back in Asia...The news from Indonesia continues to reverbereate, here in USA Today.As does the news from Vietnam...here from inside Vietnam...And here from Canada.comAnd recombinomics notes that a small correction in Promed might make all the difference in determining if we've hit phase 6 of the pandemic. The recent outbreaks in China corroborate indigenous Chinese Internet reports and are located near an H5N1 geese cull.For reference, the six pandemic stages from wikipedia (note, six is the highest.)This time, from Nepal, Recombinomics notes that there are unexplained diseases in Nepal on the flightpath of the geese that died in China. As you will recall, Recombinomics reminds us that the 1918 flu often presented with aytpical flu symptoms.ProMed looks now at one step forward, one step back in China. Recently, a willingness to let the WHO in and research...here, a chilling warning.WHO says media reports of six news cases in Vietnam appear to be accurate.Effect Measure notes that there is silence in Vietnam from officials...And we close with an absoulutely fascinating must read on modelling from some people who know their stuff.
June 4 Flu Update
Slow day would be an understatement.ProMed mail with some reports from China.Here's a flu distribution map which gives you a nice idea of the geography. Hint! Its clickable.An interesting article from a new blogger, who is looking at flu as a wildlife issue. Here, he wonders, among many things, whether the H5N1, which is often in migratory fowl, was incidential to death of birds in China.Foreign Affairs has this excerpt on the potential pandemicForeign Affairs on preparing for the flu epidemic.
Here's an excerpt:
The pandemic-related collapse of worldwide trade and its ripple effect throughout industrialized and developing countries would represent the first real test of the resiliency of the modern global delivery system. Given the extent to which modern commerce relies on the precise and readily available international trade of goods and services, a shutdown of the global economic system would dramatically harm the world's ability to meet the surging demand for essential commodities such as food and medicine during a crisis. The business community can no longer afford to play a minor role in planning the response to a pandemic. For the world to have critical goods and services during a pandemic, industry heads must stockpile raw materials for production and preplan distribution and transportation support. Every company's senior managers need to be ready to respond rapidly to changes in the availability, production, distribution, and inventory management of their products. There is no model for how to revive the current global economy were it to be devastated.