The Coming Influenza Pandemic?

May 22 Flu Update--Today, there is a large amount of breaking news.

Helen Branswell from late last night (via Crofsblogs) on WHO edging closer to an H2H diagnosis in Indonesia. A father may have caught bird flu from his son. (Note, too, that the man picked up his Tamiflu and ran away from health authorities.)

“There's no supporting evidence to suggest that this is a continuing environmental source that we've uncovered yet in the investigation,” said WHO spokesperson Dick Thompson.

“The investigation is still ongoing. We wouldn't discount the possibility that it is human-to-human transmission.”

Recombinomics says this is evidence of Phase 4.

Two siblings in Iran have been confirmed H5N1 deaths. Three of their relatives are in the hospital after they all took a trip together. (Family cluster?).

ProMed on Iran.

Malaysia looks back across the Straits of Malacca at cases in Indoensia and has concerns.

ProMed on the shuttlecock maker in Indonesia, and on two more deaths in that country.

Birds have died in three districts in Siberia.

The bird flu continues to spread in Burkina Faso.

Comprehensive summary of Romanian situation in ProMed.

CIDRAP summarizes: three new cases in Indonesia, and two in Iran.

Scientists are still concerned about limited H2H in Indonesia.

``An extremely high priority should be to determine whether the virus has undergone any significant genetic changes,'' Jennifer McKimm-Breschkin, a virologist at Australia's Commonwealth Science and Industrial Research Organization (CSIRO) in Melbourne, said in a phone interview today.

Indonesia says it is not H2H, but the statement below is not reassuring--nor do they have much credibility.

``The virus is still the H5N1 strain based on the sequencing DNA examination but we need to confirm'' with the World Health Organization's lab in Hong Kong, Indonesian Health Minister Siti Fadilah Supari told reporters in Jakarta today. ``But I think it will not be much different.''

Thanks to the alert reader who got me on this. The Washington Post says the US is sending Tamiflu to Asia. Apparently, the country where it is headed is a secret. And Secretary Leavitt says that its a US stockpile and under US "control." There are two ways of looking at this.

1) We're overcautious.
2) There's something going on in Asia (ie an outbreak) they want to keep quiet--AND they are preparing to launch their "containment plan, (via crofsblogs).

Recombinomics is more on the 2 side, saying that with our supplies already short, we wouldn't send more there unless a situation was underway.

Yesterday, we noted the quarantine in effect in Bucharest. Effect Measure thinks this is a vigorous response for another bird outbreak.

Excellent, must read Effect Measure. WHO continues to say all cases are from "close contact" with sick birds. Revere persuasively disputes the certainty of that claim, and then notes the following.

Given the evidence, we should keep our minds open to other possibilities, namely, contaminated food or water, an as yet unidentified animal reservoir or vector, and of course person to person transmission. At this point I believe WHO is probably right in substance: most cases probably are of proximate bird origin. But they don't have the evidence that they claim and I find that bothersome.

Finally, Effect Measure writes that even people in the scientific community are feeling the bird flu threat has receded...yet, as evident from this update, the virus continues to march on.

The OIE representative from Southern Africa says there are few signs of migratory birds carrying the flu. Rather, trade appears to be the culprit.

The World Health Assembly is ongoing in Geneva. Sadly, the Secretary-General of the organization died just before the assembly began.

CIDRAP on the tragic death of the Secretary-General.

We cannot have missed the message of the Federal government since last Fall: "Local governments should not look to us for help." Yesterday, the National Association of City and County Health Departments did just that--namely with equipment and help distributing vaccine and antivirals. This is interesting, too.

The officials also briefed staffers on some of the innovative approaches that communities have undertaken to prepare for a pandemic. For instance, Marty Fenstersheib, the health officer for the Santa Clara, Calif., County Department of Public Health, said his community is developing a three-step triage system.

The county's 2,300 hospital beds would be filled in about three weeks during a serious pandemic, so most patients would be treated in their homes, Fenstersheib said. Sicker patients would be sent to "influenza care centers" in places such as hotel ballrooms. Only the sickest of the sick would get care at the hospital.

"Hospitals have told us to keep people away from our rooms, keep them away from our facilities as best you can," he said.

Fenstersheib said the California hospitals believe they can use cafeterias, hallways and other space to increase their bed capacity by 10 or 12 percent. They also would send home people scheduled for elective surgery.

There is news of a breakthrough on a poultry vaccine.

Another story on the Alaska surveillance, and the lab in Madison, Wisconsin where the work will be done.

In the UK, the Medical Research Council has grants for bird flu research.

Lee County, Florida, will hold a public forum on the bird flu.

The US has provided some avian flu equipment to Pakistan.

The same thing will happen in Tippecanoe County, Indiana.

CIDRAP on WHO's two anti-viral recommendation.

Nick Zamiska and the Wall Street Journal on the WHO's two anti-viral plan.

More ProMed on the migratory bird debate, which continues to rage. Here is the mod comment:

I don't think that anyone can deny that there are crossing wild bird cycles of pathogenic AI infection and infection cycles and transmission in commercial and backyard poultry. The bigger questions are where in the avian ecology will the changes occur that will facilitate the H5N1 virus (and other AI viruses) becoming demonstrably pathogenic for humans, if it persists and why, and the economic impacts of the industrial and domestic costs of AI. Neither are simple. One might argue that any AI virus that had successfully mutated to chronic infectivity in birds and suddenly acquired the ability to infect significant numbers of humans, might find the latter of negative advantage if there were no humans to infect. Put another way, if a mutation does not provide a competitive advantage or benefit, the new organism disappears.

posted by Orange @ 6:13 AM