The Coming Influenza Pandemic?

March 31 Flu Update

[1] Indonesia, Papua: suspicions denied
[2] Cambodia, south-west, ducks: new outbreaks
[3] Thailand, dogs: suspected
[4] Denmark, wild birds: update
[5] Cameroon, wild duck

"We have animal studies which indicate it gives good protection."

It is made by injecting the wild H5N1 virus into animal cell cultures.

The vaccine is then fermented in large steel tanks before being purified.

posted by Orange @ 3:21 PM 0 comments

March 30 Flu Update

"The unique feature of this model is that it challenges conventional wisdom, which says that flu is spread by children bringing it back to the household," Miller said. "That may be true at the household level, but regionally it is spread by adults."

[1] Israel, poultry: 8th outbreak
[2] Pakistan (Bamyan): wild birds and poultry, suspected
[3] Czech Republic, swan: H5N1 confirmed
[4] Denmark, wild birds: H5N1 confirmed
[5] India (Madhya Pradesh)

"Having a vaccine that would require 90 micrograms times two (doses) in and of itself would not and cannot be the answer to where we want to be," Fauci, whose institute funded this research, said in a teleconference for journalists.

"It's a step towards that but it is a small step."

The company said it will base the application on lab studies showing that Neugene antisense drugs are effective in stopping the replication of influenza viruses, including the bird flu virus strain H5N1. Antisense drugs interfere with genetic processes to stop the manufacture of harmful proteins.

He noted that infectious diseases are caused by biological agents in the environment. Blatherwick said people can reduce the risk of infection by frequently washing their hands. “You are the one who decides if you are going to get infected,” he told the audience. “One of the things is that happy people don’t get sick. So be happy. That’s one of the solutions. Besides washing your hands, get happy.”

--clip

McNeil also reported that in a pandemic, there wouldn’t be nearly enough potentially life-saving hospital ventilators, which pump oxygen into the lungs. U.S. health-care providers would choose whose life would be extended with a ventilator and who would be denied access and, inevitably, die.

“To some experts,” McNeil wrote, “the ventilator shortage is the most glaring example of the country’s lack of readiness for a pandemic.”

posted by Orange @ 10:39 PM 3 comments

March 29 Flu Update

A dose 12 times the amount used in a standard flu shot protected just 54 percent of the people in a study being described Thursday in The New England Journal of Medicine.

That level of effectiveness is "poor to moderate at best," in the opinion of Dr. Gregory A. Poland of the Mayo Clinic, who wrote an editorial accompanying the report.

I suggest he read the Nature paper before commenting on it (or he can read the Effect Measure post on it if reading the paper itself is too arduous). I would love it if he would explain the meaning of a "large mutation" and a "small mutation" and where in the article it says that we are two of each away from the next pandemic virus. I have just re-read it and it says no such thing. I would love it if he would explain where it says the virus attaches deep in the lungs of birds, since only human tissues were used in the study. I would love it if he would tell me where the paper says we can't transmit the virus to each other.

i dare you to allow me to answer your posts in print or to engage me in an open debate. your distortions of what i write are childish and extremely unprofessional.
you are discrediting yourself as a physician and as a public health expert.
FYI - i have received many congratulatory letters on my latest articles from scientists all over the country.

Ontario’s influenza plan aims to free up overwhelmed hospitals by providing telephone and Internet home care to less vulnerable patients.

Four large, placebo-controlled studies have shown the effectiveness of Relenza for preventing flu, the FDA reported. In two trials, the incidence of flu in households whose members received the drug was 4.1%, versus 19.0% in households where people received a placebo.

posted by Orange @ 10:12 PM 0 comments

March 28 Flu Update

“This is horse serum (blood),” Dr. David Fedson, a retired vaccine industry executive and virologist, said from his home in France.

“You couldn't get any regulator authority, certainly in a developed country, to allow any horse serum preparation to be used for anything. It would be with great reluctance that they would do that.”

So why did the ``flu hunter,'' world-renowned Tennessee virologist Robert Webster, say of bird flu on ABC that there are ``about even odds at this time for the virus to learn how to transmit human to human,'' and that ``society just can't accept the idea that 50 percent of the population could die . . . I'm sorry if I'm making people a little frightened, but I feel it's my role.''

I'm sorry, Dr. Webster, but your role is to track influenza in the test tube, not to enter into broad speculation on national television. By your way of thinking, we should all be either building an escape rocket ship or killing every bird we see before it can kill us.

posted by Orange @ 10:09 PM 0 comments

March 27 Flu Update--"Nature is in control"

On avian flu, he notes, he predicted a range of 5 million to 150 million deaths - the same range the World Bank was using - but headline writers quoted only the higher figure. And how many does Nabarro now say could die? "I don't know," he said. "Nobody knows."

But he repeatedly said that he is more scared than he was when he took the job in September.

"We cannot contain this thing anymore," said Dr. Robert Webster, a virologist at St. Jude Children's Research Hospital in Memphis, Tenn., who has been studying the virus since it emerged in 1997. "Nature is in control."

"The ratio of meetings to patients is probably 10 to 1: Hawaii tomorrow. Geneva and Singapore next week," said Farrar, in jeans and carrying a red backpack, on a break from a conference where he was - naturally - speaking on the topic.

A bird flu pandemic could cost European life insurers as much as 20 billion pounds ($34.92 billion) in extra claims and U.S. insurers about $18 billion, a report said on Monday.

These payouts would likely be tolerable for the life insurance industry; and as long as an outbreak were temporary, the companies' credit quality would not likely change, but profitability could be hurt, the report from Fitch Ratings said.

posted by Orange @ 11:05 PM 1 comments

March 26 Flu Update

If it doesn't happen, that will be great. Anyone who says it couldn't happen or that we needn't be concerned about it yet because it has only killed birds and a handful of people is unbelievably irresponsible. I will name names: Marc Siegel and Peter Doshi.

Another issue, Prof. Levin said, is persuading policy-makers to act on academic results. "Getting recommendations across is difficult," he said. "Policy-makers are conservative because there are so many lives at stake."

And perhaps most importantly, the school is wrestling with several difficult questions before they are on our doorstep in an emergency: How would we enforce a policy of "social distancing" should a pandemic influenza break out? At what point would the school close its doors? How would students access curriculum through computers or other forms of distance learning?

Leah Kelly, the district's executive director for student support services and exceptional student education, said alcohol-based soaps and hand wipes -- which schools don't typically use -- are best when dealing with avian flu, so officials are looking to stock up on those.

posted by Orange @ 9:12 AM 0 comments

March 25 Flu Update

posted by Orange @ 8:50 AM 0 comments

March 24 Flu Update

At this point we don't know. The investigators speculate (in the news stories more than the papers themselves) that the reason bird flu is not as "catchable" as ordinary flu is that its residence deep in the lungs makes its transmission more difficult. There is no mucus in the gas exchange units so coughing and sneezing is less likely to create a virus-containing aerosol. Or so it would seem. In truth, however, we don't know the main routes of transmission. Gas from the alveoli (the deep air sacs) is certainly expelled on exhalation, likely contains virus, and once outside the humidified environs of the respiratory tract would rapidly dessicate (dry up) and could form droplet micronuclei. The assumption that virus deep in the lungs is less transmissible might be correct but it has not been shown. Other factors might be involved. Neither paper tested the transmissibility question, which remains pure speculation (although not implausible). The Japanese paper also points out that if the virus were to develop the ability to dock with α-2, 6 cells, either in addition to or instead of α-2, 3, we could have a nasty actor on our hands. One isolate from Hong Kong in 2003 seems to have this ambidextrous character, although most H5N1s do not.

posted by Orange @ 9:38 AM 0 comments

March 23 Flu Update

If 60% of those infected with influenza are expected to die, health-care officials should withhold treatment from those who aren't likely to survive, says Francescutti.

"Don't try and do anything heroic," he says. "Those people should be isolated and made comfortable but let them die because they're going to die."

posted by Orange @ 11:07 PM 0 comments

March 22 Flu Update

Scientists say they've found a reason bird flu isn't spreading easily from person to person: The virus concentrates itself too deep in the respiratory tract to be spewed out by coughing and sneezing.

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.

The bird flu viruses now prevalent share some of the crucial genetic changes that occurred in the 1918 flu, scientists said, but not all. The scientists suspect that with the 1918 flu, changes in just 25 to 30 out of about 4,400 amino acids in the viral proteins turned the virus into a killer. The new work also reveals that 1918 virus acts much differently from ordinary human flu viruses. It infects cells deep in the lungs of mice and infects lung cells, like the cells lining air sacs, that would normally be impervious to flu. And while other human flu viruses do not kill mice, this one, like today's bird flus, does.

Any work done with China's viruses will have to credit the lab that supplied samples, and WHO has promised to help China negotiate terms of any commercial gain from them, she said.

"We hope that this is now the start ... of regular sharing that doesn't involve the degree of negotiations that we've had," she said.

Michael T. Osterholm, PhD, MPH, a leading pandemic preparedness advocate and a skeptic on the possibility of containment, said the revised WHO plan represents "a more realistic approach" to containment than the previous version. "However, the activity of the last 2 months in countries throughout Asia, Europe, and Africa only further supports the fact that early recognition and documentation of an emerging pandemic is going to be difficult if not impossible," he added.

Ian Gust, from the University of Melbourne in Australia, told The Scientist that the Hungarians employed a method that most of the developed world has not used in at least forty years. “It is a relatively crude process that was associated with a lot of reactions in people who received the vaccine in the past,” he said. “I don’t think developed countries would revert to this.” Most of the developed world’s manufacturers are working onHN1 vaccines, containing split and whole viruses, but are “using more sophisticated production processes.”

At the University of Chicago Hospitals, any patient with flu symptoms who'd recently traveled to Asia and had contact with live poultry would be sent to an isolation room, said Dr. Stephen Weber, whose job is to control infection outbreaks.

The best outcome will be if this pandemic never materializes. This is possible, although seeming less likely by the day. The advantage of strengthening community relationships and structures that foster mutual aid in prepration is that it will not be wasted. We get better, stronger, more resilient communities for whatever happens.

There is still time to fill the sandbags and get our treasures up off the floor. We can help each other. Let's get busy.

posted by Orange @ 9:13 AM 2 comments

March 21 Flu Update

There so far was no indication of direct exposure to dead or diseased poultry in some of the cases. That has been the usual source of exposure for humans who caught bird flu, which remains a difficult disease for people to catch.

“It is not a deadly virus because only 83 people worldwide have died of it since its discovery,” he said, blaming the media for negatively highlighting bird flu by publishing sensational stories. “Neither have we prepared for the virus nor is there a need to do so,” he added.

The WHO's Regional Director for Africa, Luis Gomes Sambo, told the conference in Gabon's capital Libreville that countries found to have bird flu must implement a minimum level of control measures, including confining poultry, improving veterinary controls and ensuring those involved used protective clothing.

Such measures are far from straightforward in Africa, where many areas lack basic public health and veterinary services and what clinics there are often run short of essential supplies.

posted by Orange @ 10:26 PM 0 comments

March 20 Flu Update

Meanwhile, in an apparent effort to increase the amount of data available to scientists, the WHO will ask its 192 member states to adopt a resolution in May that includes a pledge to share virus data, Margaret Chan, the WHO's pandemic-flu chief, said yesterday

"We earned a lot of trust during SARS and we could blow it all on H5N1," he says of the WHO. "But I don't think that that's a big gamble as long as people understand exactly what we're saying. And it's not a bumper-sticker statement . . . we don't know what the next pandemic is going to look like."

One strain, or clade, made people sick in Vietnam, Cambodia and Thailand in 2003 and 2004 and a second, a cousin of the first, caused the disease in people in Indonesia in 2004.

The bird flu virus spreading around the world is mutating into more variations with genetic characteristics that increase the risk of infection in humans, according to a U.S. government study.

posted by Orange @ 11:14 PM 0 comments

March 19 Flu Update

Health secretary Prasanna Hota told FE that no fresh orders would be placed with the companies, as “indiscriminate use of Tamiflu could be a health hazard.” He, however, added that order for another 20,000 doses already given to Roche would not be retracted.

posted by Orange @ 11:11 PM 0 comments

March 18 Flu Update

posted by Orange @ 10:42 PM 0 comments

March 17th Flu Update

"There is no direct clinical trial evidence that shows that oseltamivir is effective in human H5N1 disease because such studies have not yet been conducted," the WHO said in a statement posted on its Web site www.who.int. "Because the optimal dosage has not been resolved by clinical trials, and because H5N1 infections continue to have a high mortality rate, prospective studies are needed urgently to determine optimal dosing and duration of treatment for H5N1."

"It is possible that severely ill patients might benefit from longer duration of therapy (for example 7-10 days) or perhaps higher doses (for example 300 mg/day), but prospective studies are required," it said. Children should be given the drug preventively for the same length of time in weight-adjusted doses. "For people with repeated or prolonged exposure such as healthcare workers or personnel involved in bird culls, pre-exposure courses, repeat post-exposure courses or continuous treatment may be necessary," it said.

Science has little to lose from this as sequences currently being kept secret are lost anyway. Science has a great deal to gain in terms of a head start on crucially important scientific information now being sequestered for private gain, reputation or credit by scientists who should behave better.

The Times has learnt that Britain successfully proposed easier movement of birds at a crunch European Commission committee meeting last month agreeing a common response to bird flu. Supporters of organic and sustainable farming yesterday accused ministers of a “daft” change designed to help trade which risked repeating the swift spread of foot-and-mouth throughout Britain.

posted by Orange @ 9:30 AM 0 comments

March 16 Flu Update

As reported in the March 17 issue of Science, the researchers used a technique called functional glycan microarray, which studies specific sugar molecules that allow the virus to attach itself to cells. There are a few known mutations that can convert other viruses with H2- and H3-type components from bird to human infections, but the new study showed that these mutations do not cause the H5 bird flu virus to switch to a preference for infecting human cells.

There was a slight change in the virus found in the Vietnamese boy. "This paper concludes that this change might be sufficient for the avian virus to get a foothold in the human population, but not sufficient for the virus to have full virulence in humans," Paulson said.

posted by Orange @ 3:50 PM 0 comments

March 15 Flu Update

Q What can county residents do to prepare?

A We want people to understand the common elements of infection control: covering your coughs, staying home when sick, not sending kids to school when they're sick, washing hands. We're recommending keeping a two-week supply of food, water and medications in the house, along with face masks, gloves and disinfectants.

posted by Orange @ 10:37 PM 3 comments

March 14 Flu Update

Last summer, researchers collected samples from about 6,000 birds that travel between Asia and Alaska to test for H5N1 infection. About 10 percent of the birds had a low-level strain of the virus that usually doesn't kill, but could mutate into the lethal version at any time.

Government and university scientists plan to check at least 75,000 more migrant birds this year. They also will do what they call "sentinel sampling" of Alaskan chickens, ducks and geese to see if they've been infected.

All the recent avian flu cases occurred along wild bird migratory routes.

"I can't think of any outbreak that was not on a migratory flyway," Ip said. "Birds have most of the globe covered. They don't leave any niches unexplored."

One of the major challenges facing immunization with many of the currently available vaccines is the need for refrigeration, often referred to as maintenance of the cold chain. This is a particularly difficult problem in developing countries with limited medical resources. One of the advantages of a vaccine utilizing peptides and DNA is that both of these components can be lyophilized, stored at ambient temperatures and reconstituted "on-site" with saline. "We have promising data in an animal model suggesting that we will be able to achieve levels of immunity consistent with protection from H5N1," said Dr. Powell. The company has recently completed a pre-IND meeting with the FDA and hopes to enter human clinical trials of its peptide vaccine against H5N1 later this year.

"Society just can't accept the idea that 50 percent of the population could die. And I think we have to face that possibility," Webster said. "I'm sorry if I'm making people a little frightened, but I feel it's my role."

posted by Orange @ 10:24 PM 2 comments