Wednesday, May 31, 2006

May 31 Flu Update

We're back. We were back Monday, meant to update yesterday, but blogger was down. So, we're here today...

In Indonesia, a 15 year old boy is dead from H5N1. The story goes on to detail an awful month in Indonesia, and how that country is on pace to pass Vietnam as hardest hit flu nation.

CIDRAP on Indonesia. A few key points.

  1. There is no one else infected around the cluster in Indonesia--leading one to believe that the family cluster was just that.
  2. The newer family cluster has a number of people quarantined. However, none seem to be sick. Seems to me this one is clear H2H.

On April 29, according to today's update, nine family members spent the night in the same small room as the index patient when she was severely ill and coughing heavily. Five to 6 days later, three family members experienced symptoms. These were her two teenaged sons and the surviving brother, who was from a village 6 miles away.

The sister of the initial patient developed symptoms at the same time, as did the sister's 18-month-old daughter. The sister, who lived in an adjacent house, cared for the index patient, accompanied by her young daughter.

WHO report that sparked this, via Promed. Note that the 54 quarantined people are receiving Tamiflu--a shot an containment itself.

Absolute must read from Declan Butler of Nature....on why containment didn't work in Indonesia, and on data sharing.

Effect Measure writes along the same lines--containment simply is unlikely to work.

Recombinomics with commentary based on the Nature story--is there a combination of factors leading to H2H?

Thus, the combination of a wild type HA cleavage site, amantadine resistance, and PB2 E627K would be a combination of changes that would be cause for concern.

This is also big news from CIDRAP. Azerbaijanis who died from bird flu earlier probably caught the disease from dead swans--the first infection of humans from wild birds.

While affirming that the Daikyand victims probably caught the virus by handling wild swans, the report says that limited human-to-human transmission can't be ruled out, given the incomplete information available.

In other observations, the report says the Azeri cases point up the importance of oxygen therapy in H5N1 infections.

"Severe hypoxia, caused by the prolonged course of viral pneumonia, appeared to be underrecognised and treated late in children," the report sates. "The early establishment of oxygen saturation monitoring and provision of continuous oxygen therapy is therefore crucial to prevent decompensation and multi-organ failure already observed" in H5N1 cases elsewhere.

Flu experts warn that there are several countries under-reporting bird flu cases--due, it says, to overwhelmed public health systems.

The EU sent out a warning: accelerate your pandemic prep, because its closer to midnight than it was before. Or, maybe not so clearly. Check this language out.

“The likelihood that [the H5N1 virus] might achieve any inherent potential in the near future may have risen.”

Governor Corzine, NJ, says that 2.6M people in his state could be sickened by the bird flu.

Flu experts are using Google Earth in their fight against the bird flu. (Google Earth is an awesome tool).

To see for yourself, check out the Google Earth Maps Declan Buter of Nature does.

EU says 741 wild birds with bird flu in 13 countries.

ProMed with report on this story.

In the state of Washington, they are monitoring snow geese for bird flu.

HHS officials joined the Governor of Kansas on the flu road show.

Teaching hospitals in Toronto are preparing for a pandemic.

Stockpiling anti-virals to protect all hospital staff from getting sick in the first place so that hospitals can keep running;
Canceling or scaling-back some programs and services (ex. elective surgeries) to create additional capacity in hospitals;
Redeployment of staff to other roles in the hospital to maintain adequate staffing levels;
Educating staff about the pandemic and the organization's response;
Using an ethical framework to guide decision-making.

Two Aussies write that despite the rush of cases in nearby Indonesia, its still mostly a game of wait and see.

A conference was held in Melbourne to highlight business planning for the flu.

More from Australia. Effect Measure notes how Australia once thought it had enough Tamiflu for 1 million people--but now, knows it does not. What happened?

Thailand had planned to participate in a vaccine program with Japan, but when Japan wanted all of the limited production, Thailand scuttled the plans.

The Michigan Department of Public Health did a bird flu briefing in Sturgis, MI.

Cruzell of Holland is doing clinical trials on its bird flu vaccine.


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