June 28th Flu Update
China claims it is strenthening its surveillance of bird flu outbreaks.ProMed reports that the outbreak in Siberia is intensifying.International experts cite Indonesia's failure in fighting bird flu. Note the reuse of protective gowns.Key among those, they said, was a shortage of protective equipment that might have led to the infection in hospital of the last family member to die and the unchecked movement in and out of hospital of patients.
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Jakarta has asked for $900m (£494m) in grants over three years to finance a plan it submitted to an international donors conference in Beijing. But international experts argue $200m a year is far more realistic. More-over, many of the things Jakarta is asking for are things it should be prepared to pay for itself, they add.
“It’s a little bit absurd. I don’t know why people don’t call them on this,” said one expert. “What is this money going to be used for? It’s going to be used to build government institutions that should be there in the first place. It’s not [bird flu] specific. It’s things . . . any civilised country should have.”
Romania says it has lowered the number of flu outbreaks to 21.Switzerland is ordering 8 million "pre pandemic" doses of flu vaccine, which will be mis matched, but may slow down a pandemic. The question is, when do yu give it?China says it is also investigating the 2003 bird flu case. (CIDRAP reports).An Australian vaccine is moving forward in testing.Reuters has this interesting story on the economic impact of a pandemic. In many ways, it will boil down to how people reaction--rationally, or in a panic mode. Also, the article points out that you have to look beyond the initial reaction--which is bound to be strong, and focus on the recovery. "The (economic) effects tend to be lower than you'd expect because people are good at adjusting," said Donald Marron, acting director of the U.S. Congressional Budget Office, citing the U.S. economy's resiliency after the Sept. 11, 2001, attacks and last year's Hurricane Katrina. "A lot depends on the public reaction, which is difficult to predict," Marron added.
A US official says closing borders is low on the priority list.Utah did a tabletop drill to prepare for the bird flu.North Bay Parry Sound (Ontario) released its pandemic plan.Here's an op-ed from the Canadian minister of health on what Canada is doing to prepare for a pandemic.Now here's the REAL question...will bird flu kill the Internet. Notably, could the bandwidth handle the massive telecommuting?
You know you've heard this...isn't bird flu another "false alarm" like Y2K, West Nile, SARS, etc. Effect Measure looks through each of these, with an eye toward two things. First, some of these things did happen. And two, when you are preventing something, you never know for sure if you really prevented it or if it would never have happened on its own accord.Effect Measure also has this, when follows right along. The first six months of this year were the worst for the bird flu. This virus is less a false alarm than it was last year.Conditions for a possible pandemic continue to ripen. The virus is geographically distributed in ever new and different environmental niches, has produced the largest cluster of human cases to date, with solid evidence of human to human to human transmission, and has infected other mammalian species in which to experiment with new lifestyles and genetic endowments. This is the first time in history the world has been able to watch what might be an evolving influenza pandemic, so we don't know what we are looking at. So far what we see is both frightening and fascinating -- the horrible fascination of watching a trainwreck in slow motion.
June 23 Flu Update
In the big flu news for the day, WHO has announced that the virus did mutate in the family cluster in Indonesia. There are strong statements that the mutation DID NOT make it more able to pass from human to human (what would you expect?) Still, its the first evidence we have seen of a mutation of that kind...and, (my view), no one really knows what the virus needs to do to flip the switch. Here, we link to Helen Branswell. "As far as we know they don't correlate with any particular functional changes about the virus," Dr. Keiji Fukuda, co-ordinator of the WHO's global influenza program, said in an interview from Jakarta. "It doesn't confer any greater transmissibility or any greater pathogenicity."
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Tracking single cases or small clusters is like watching sparks. Each one might trigger a fire - but to date WHO sees no signals that's happening, Fukuda said.
Here's a wire story on the same topic. US experts say that it is "noteworthy" but not enough to change the pandemic phase. Note also, the wonder at being able to do this kind of detection in a remote Indonesian village...(my note) can we really not say that technology and connectivity is giving us a significant advantage over past pandemics?Promed on the cluster story. Note mod comment (CP) that says asks, first, what initiated the cluster, and second, what made this family so susceptible?
Finally, CIDRAP covers this story.The other big news from yesterday was the Chinese scientists writing a letter to NEJM that said China had H5N1 two years earlier than they had ever admitted. Then, the scientists (or some) tried to withdraw the letter. Branswell again.
The story gets stranger. The researcher in whose name the retraction email was sent says he didn't send it...making you wonder who did?On Wednesday, the journal said it had received an e-mail signed with the researcher's name that requested the letter reporting the case be withdrawn from publication. Wu has since telephoned the journal's editors and sent a fax denying he had made any such request.
WHO has asked China to clarify the facts around this case.Effect Measure writes on the twists and turns in this story.Helen Branswell is back one more time, with a story on the Chinese flu vaccine which is showing some results.
A Chinese-made H5N1 flu vaccine has been shown to provoke good immune responses at significantly lower doses than those made by most western vaccine manufacturers - an early finding that could help other companies learn to stretch the limited global vaccine supply in the case of a flu pandemic. But the formula used by the Chinese company - vaccine made using whole viruses, rather than viruses broken into particles - is no longer commonly made by western flu vaccine manufacturers.
And they appear hesitant to shift gears on their year-to-year vaccine manufacturing processes to improve their output for a pandemic - an extraordinary event the timing and severity of which cannot be predicted.
"Companies that have been making split-virus vaccines are reluctant to test whole-virus vaccines because this would require them to get new regulatory approval for their process and this would cost them a great deal of money . . . for a specific product that they may never market," said Dr. David Fedson, a retired academic and flu vaccine industry expert who lives in France.
Bird flu panic has hit Zambia, and like everywhere else, chicken consumption is down.Indonesia is upgrading a bird flu lab to meet WHO standards.Burma is going to restock areas hit by bird flu culling.
The European Food Safety Authority has determined that there is no evidence of bird flu being transmitted through the normal consumption of chicken and eggs.More on wild bird surveillance in Oregon.CIDRAP has this report from a study that says that mass vaccination programs make it hard to detect human cases, and that when you have areas with low human cases and high vaccination, you should interpret results carefully. Report also notes that there have been strong warnings that bad vaccination programs are dangerous.Surveillance for H5N1 cases in humans," the authors write, "is becoming harder where poultry immunization is widely but imperfectly implemented, because the marker of local poultry deaths for human case detection is being lost. "Declines in the number of sporadic human cases in countries with poultry vaccination programs should therefore be interpreted cautiously."
Letter to editor in Chattanooga says that we should vaccinate for bird flu with what we have now--what could it hurt.Promed on OIE reports from Hungary--more bird outbreaks of H5.ProMed reports the June 2 Danish case was H5N2.Recent sequences released show evidence of recombination--from Recombinomics.
June 22 Flu Update
Back on board...
While I was out, the news broke that there may have been an H5N1 case in China two years before the previous earliest date in China. It was originally announced as SARS. News came out in a NEJM article from eight scientists, some of whom asked to be removed from the article just prior to publication.Here's the actual letter from NEJM.CIDRAP reports on this story, including a shocked WHO demanding some answers.Story cries out for Helen Branswell. And here she is. The eight wrote of the case of a 24-year-old man, apparently from Beijing, who had pneumonia and respiratory distress in November 2003. In that period, when the entire world was anxiously waiting to see if severe acute respiratory syndrome would re-emerge with the arrival of cold and flu season, doctors thought he was suffering from SARS.
The man tested negative for the SARS coronavirus. But H5N1 was found in tissue from his lungs. The letter does not state when the testing was done or how long it has been known that the man died from H5N1.
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Flu watchers aren't surprised that China had cases as early as 2003. In fact, outside China it has been widely assumed, given that three people from Hong Kong became infected with the virus during a visit to Fujian province in February 2003.
The retracton angle is interesting. You can guess it had something to do with internal political pressure, but we need to hear more to be sure.
Effect Measure comments, noting that Revere's IP is banned in China, but is critical of Chinese government.ProMed on China and Indonesia. (Note mod comment: news from China does not surprise any observer, or so it seems).The 98 contacts of the recent flu victim in China have been released after being under observation for one week. (ouch).WHO is conceeding H2H among the family cluster in Indonesia. CIDRAP reports.Biotech stock shares rose on this news.Zambia is testing dead birds for H5N1. WHO is appealing for calm.Malaysia says it is bird flu free, wants to export chickens again.All of Southern Africa is on a bird flu alert.GlaxoSmithKline is preparing to seek approval this year for its flu vaccine. On matching strains, it says: The vaccine should be able to protect people even if the H5N1 virus mixes with a strain of human flu, Stephenne said.
``If you compare H5N1 isolate to the flu virus that created the flu pandemic in 1918, we know it's only a little difference,'' he said. ``This little difference will not change the quality of the vaccine."
During the three-day bird flu meeting in Indonesia, that country finally admitted that it has a severely limited ability to respond.Bird flu prep kits are being given to schools in Contra Costa, CA.Manitoba, Canada, has assessed that its poultry and swine are at low risk for bird flu.Manitoba's pandemic preparedness plan.Bird flu scare caused a huge glut in the poultry and egg markets in Europe, and the EU is rushing in to help support prices.More on bird flu pledges falling short. US had pledged $1.9B, has forked over only $300M to date.These stories come out every once in a while. Grassroots Balinese are not worried about the bird flu...nor are they very knowledgable about it. I think that some people have such difficult lives its hard to have the luxury to worry about non-immediate threats.Dr. Mary Emmerichs, a professor at UW-Sheboygan, thinks people don't learn the lessons of history. Specifically, about the bird flu. She is giving a talk in Fond du Lac, WI, on a local perspective on the 1918 pandemic, as part of a local effort to educate on H5N1. In my opinion, this is an excellent approach. The 1918 story creates context and limits what is otherwise an abstract threat.A public meeting on the flu in Indiana revealed...the need to have another meeting.Local planning is also ongoing in Santa Rosa County, FL.Stanford is looking for volunteers to participate in trials to test a vaccine produced in Australia.India is still banning retail Tamiflu sales.
Storm Break
Heavy storms have hit the area, and its effecting connectivity and electrical power. Next update tomorrow.
June 16 Flu Update
WHO confirms the recent Chinese case has H5, and a June 14th death in Indonesia is reported. CIDRAP reports.Canada has reported a case of H5 on Prince Edward Island....N1 confirmation still coming.This release details the initial government response.A Canadian agency says it is unlikely it is H5N1, via ProMed.While Recombinomics says there is evidence of H5N1.Helen Branswell on volunteers in US taking a new internasal H5N1 vaccine.But the flip side of the impressive list of potential positives is one big potential negative: scientists aren't sure it will induce enough of a protective response in humans to be worthwhile -- although they think so.
Its not just the Chinese....apparenntly, Denmark waited two weeks to notify WHO about an outbreak.ProMed has a complete report on the situation in Denmark, past and present.Must read editorial from the Bangkok Post, with an interesting perspective. Is too much attention being given to H5N1?
Serious thought should be given to a plea issued on Wednesday by scientists around the world calling on the G8 leaders not to get so caught up in the potential threat of bird flu that they divert their attention from the real global killers: TB, HIV/Aids and malaria. They issued the appeal ahead of the G8 summit in St Petersburg next month, which will have a bearing on the allocation of funds.
USA Today with a high profile story on the surveillance going on in Alaska.
Via Crofsblogs, a report has been received that the young girl who died in West Sumatra may have had two sisters who died of bird flu as well.
Apparently, culled birds in Maharashtra were not disposed of properly, and there are fears the bird flu could come back after the Monsoon season.Russia has a bird flu program to propose at the G8 summit.The Red Cross says donors are not responding to its call for support for a possible pandemic, and it could effect response. Forbes has this on how to align your portfolio for the pandemic....the moment the WHO shifts the alert level to Phase 4, expect a literal overnight collapse of the Asian markets similar to the currency crisis of 1997. That crisis started in July 1997 in Thailand, but it caused a global financial domino effect. That is what we are looking at with a Phase 4 warning.
Maine is testing its birds...on the Alaska plan.Reporters are told how to reduce their chances of getting the bird flu.A group of veterinary virologists are working together with a pledge to release bird flu sequences.
Effect Measure writes on this story as well...noting that while it is an important step forward, none of the signees are from China. Further....It is time for US government policy to require all NIH and NSF grantees to deposit avian influenza sequences into GenBank immediately as they are obtained and certainly for CDC to do likewise.
There are a bunch of local stories today (or, Friday is a tough day to find local news stories :-):
Knox County, TN, is preparing for the bird flu.A health district in Alberta is doing some public education.Public meetings have been held in Greene County, IN.Roanoke,VA Red Cross also has someone working on the case.They are also planning in Memphis, TN.The local health director is commenting in Albany, GA.
Op-Ed piece from two state health directors gives recommendations for public health preparation.
June 15 Flu Update
China says it tested 98 contacts of the newest flu victim, and they were all negative.
The 7 year old girl who died in Indonesia June 1 is a confirmed positive H5N1 death. Here's a comment in the WHO update:"The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviours that should be avoided."
Skeptical of actually getting compensation, people in Indonesia are not cooperating with the government's flu containment program. The esteemed Helen Branswell has this on Canadian flu preparations. Conference Board vice-president Prem Benimadhu suggested the findings were "a bit surprising," especially given only 28 per cent of the businesses asked to respond to the survey even bothered to answer.
"The surprise is the gap between concern and execution," he said.
Macao is on bird flu alert.A Doc and health board member in Lincoln (MA) had this to write about the bird flu for local readers.Canada says it will limit its Tamiflu stockpiles to a relatively low population ratio, saying a vaccine is key.
Revere writes on the difficulty of local news reports (oh, so available with the Internet) to get reliable info, as he has human translations of two different stories on a sick reporter who might have been H5N1. Of course, a sick reporter would be H5N1 fear, but is that what it is?Here's Recombinomics on the same reporter (heavy user of machine translations).We've written here about Secretary Leavitt and the Magical Mystery Flu Tour. Apparently, WaPo is criticizing him for too much use of the plane. Revere comes to his defense.Finally, Effect Measure notes the case in China, saying that it appears to be another sporadic infection--and its a mystery on who gets sick and who doesn't.Recombinomimcs notes neurological involvement in a case from the Sumatra cluster, which leads to some genetic inferences.China is trying to evaluate whether past bird immunization efforts have been effective.Polk County (IA) is holding its final bird flu forum.Cuba says it is ready to detect and fight bird flu anywhere in the country.
New Zealand apparently has some live H5N1 for case detection purposes, and its being kept under heavy, heavy biosecurity.
We reported a couple days ago on the story about protecting pets from bird flu. Here's an interesting an acerbic mod comment on ProMed.
It is clear that the UC Davis faculty found a ready listener in Ms Tansey and it is now summertime. If this risk were real, we would have had reports (plural) from Europe of infected domestic cats.
June 4 Flu Update
Today's leading flu news comes from the New York Times, which writes that H2H may exceed official estimates. What's fascinating about the story is that it features Dr. Niman of Recombinomics, and gives him some credit for a recent WHO change. Note this: While Dr. Niman is an irritant to public health officials, his digging sometimes pushes them to change conclusions, as it did in the recent Indonesia case. The W.H.O. at first said an undercooked pig might have infected the whole family, but Dr. Niman discovered that the hostess of the barbecue was sick two days before the barbecue and the last relative was infected two weeks after it.
His prodding, picked up by journalists, eventually led the W.H.O. to concede that no pig was to blame and that the virus probably had jumped from human to human to human.
The Indonesian nurse who fell ill after treating two boys suspected of having H5N1 is said to be H5N1 negative, based on local tests.Afghanistan says it needs $1M to fight the bird flu.Meanwhile, donors have pledged $60M to help fight the flu in Vietnam.Finally, the World Bank says pledges are way behind in the fight against bird flu.Here's a Wendy Orent article that made its appearence while I was on vacation. I note that Revere gave it mostly good reviews.In a casino, the house usually wins, but occasionally someone hits the jackpot. It's the law of large numbers -- given enough time and enough opportunity, viral mutation will toss up a deadly combination. No one wants to win the bird flu slot-machine game. If the genes happen to line up and a vulnerable human happens to be the host in the right place, the disease takes off and a pandemic explodes. Given how mutable the H5N1 virus is, the thinking goes, at some point this is inevitable.
But as Brown knows, evolution doesn't work this way. Gene mutation isn't in the driver's seat. Rather, it's Darwin's charioteer -- natural selection -- that drives evolution. Mutations are the raw material of evolutionary change. They don't determine which direction the chariot will go.
Vietnam notes no new outbreaks in six months.Riverside, CA, will be having a bird flu summit this week.ProMed with an OIE report from Djibouti.Recombinomics says that statements by David Nabarro essentially phase out two pandemic phases.
