Monday, January 30, 2006

January 30 Flu Update

Well, the news is in from Iraq. To no one's surprise, the 14F who died is now confirmed H5N1, and that makes it likely her uncle died from it, too.

Effect Measure has his take, calling it an "obvious" conclusion to the story.

So there you have it. The Fourth Horse of the Apolcalypse is cantering towards a war torn area with a destroyed civil infrastructure, overwhelmed medical facilities and 160,000 foreign occupiers poised to become global vectors.
CIDRAP also weighs in on this development. Here's the vital excerpt that says more is going on in Iraq than we may know.

A Reuters report from Geneva today said Iraq is investigating a possible third human case of H5N1 infection. That case involves a 54-year-old woman who was hospitalized on Jan 18 with respiratory symptoms and is still being treated, World Health Organization (WHO) officials told Reuters. She is from the same area in northern Iraq, near the city of Sulaimaniya, as the girl and her uncle.

In addition, the Times quoted health minister Dr. Abdul Mutaleb Mohamed Ali as saying that two other people in other parts of Iraq had been tested for H5N1 infection, but the story gave no results or details in those suspected cases.

Confirmation of the teen-aged girl's infection prior to discovery of poultry outbreaks in Iraq suggests that H5N1 may be spreading stealthily, under the radar of existing surveillance systems, the newspaper noted.

"We shouldn't be seeing human cases first, and this points to serious gaps in surveillance," WHO spokeswoman Maria Cheng said in that story. "But given the situation in Turkey, I don't think we'd be surprised to see isolated human cases in surrounding areas."

Recombinomics cites reports of a dozen people in isolation in Iraq.

Recombinomics on the Iraq situation. As always, he sees the tip of the iceberg everywhere he looks, and isn't always wrong.

Recombinomics also writes on the epidemic (as it were) of false negatives in the Middle East.

Algeria says a dead poultry breeder did not die of bird flu. We will have to wait for the real test results.

Partially driven by protecting tourism, Cyprus is mobilizing to head off the bird flu.

Question: has the virulence of the bird flu been overstated, based on experience in Turkey? Answer from Helen Branswell. Essentially, its too soon to tell. All 21 cases in Turkey are not lab confirmed yet. Even if all cases are correctly diagnosed in Turkey, you can't discount the virulence in Asia. I found the next part most interesting.

Even if the London lab confirms all 21, the evidence from the outbreaks in Southeast Asia and China paints a different picture: a high death rate and very little sign of the type of mild infections that might initially evade detection.

"The evidence for widespread asymptomatic infections is just not there," says Michael Perdue, a scientist with the World Health Organization's global influenza program in Geneva.

Certainly the odd case here and there probably went unnoticed, the experts assume. Mild cases are more likely to fall through the surveillance net than severe ones.

But a number of studies have been done in Vietnam, Thailand and Indonesia looking for antibodies to the virus in the blood of people who were exposed but who didn't show signs of being ill, including chicken cullers, relatives of known cases and hospital staff who cared for H5N1 patients.

"And they essentially found zero. They haven't found any," says Dr. Scott Dowell, director of global disease detection and preparedness at the U.S. Centers for Disease Control in Atlanta.


Dr. Bob Gleeson does the Math on the fatality rates, and I think his point is key. So what if the virus is less virulent than in Asia. 1918 happened at 2.5%.

WHO update on Turkey.

From Davos, David Nabarro echoes something that Michael Osterholm has been saying for months...pandemic planning has to look beyond hospitals.

Keeping the taps flowing, the lights glowing, and food on the shelves may be a higher priority than caring for the ill during an influenza pandemic, the United Nations' coordinator for avian and pandemic flu has said.

"It may be more important to concentrate on the essentials of life for those who are living than it is to focus on the treatment of those who are sick," said David Nabarro, as quoted in a Jan 28 Reuters report following a pandemic simulation exercise.


ProMed runs the table on Eurasian news. Mod comment notes that you have a lot of political boundaries, including autonomous districts, and surveillance and reporting is tricky.

ProMed on Saudi Arabia confirming their Falcon has H5N1, the first case in that country. The bird doesn't migrate, and they speculate that perhaps an illegally imported bird might be at fault.

Reuters has polling that shows America is more worried about lots of things than the bird flu. This is not a surprise, and some are even rational judgments.

Turkey is getting an 8.5M Euro subsidy to fight the bird flu.

The Lancet will hold a flu forum in Singapore on indentifying gaps in pandemic planning.

Gilead profits up on Tamiflu sales.

Dr. Peter Gott answers reader's questions on Tamiflu.

ProMed with OIE report from Hong Kong.

In South Dakota, a City and the State are working together to prepare for the bird flu.

Via Crofsblog, a Canadian reporter wonders if he caught avian flu in Turkey.

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