August 24 Flu Update
A 35 year old woman in Indonesia now has bird flu. ProMed reports. She is not from Garut, but health officials continue to go door to door in Garut, but without reported results. Indonesia is being criticized for cutting its bird flu spending. This is pretty hard to believe--that they did it, not that they are being criticized for it. 70 scientists wrote a letter to Nature asking for increased sharing of bird flu data. This is the single most important preventative step that could be taken for the bird flu, and it is amazing it has not happened. In its press release, Nature went further accusing some scientists and organizations of "hoarding" sequence data, often for years, so as to be the first to publish it in academic journals.
"We propose to expand and complement existing efforts with the creation of a global consortium -- the Global Initiative on Sharing Avian Influenza Data (GISAID) -- that would foster international sharing of avian influenza isolates and data," wrote the scientists, who include six Nobel laureates.
Effect Measure has high praise for this agreement.ProMed with more on the GISAID agreement.The CDC has (better late than never) announced this it is releasing its sequences. The mere fact that the US is only just doing this is only proof of how bad this has been.Vietnam is setting up bird flu task forces. Rewards are being offered for reporting an outbreak.Effect Measure with a must read on the (now) slow, less perceptible spread of bird flu in animal populations, proposing the idea that it is too late to eradicate it.
Recombinomics has translations of reports that say that there are three sick siblings which could be a potential cluster.The Netherlands is easing its bird flu restrictions.Hospitals in South Africa are planning for bird flu wards and infection control, even though their experts say it isn't necessary.
A Taiwanese bird flu shelter has been established. Interesting use of building design to seperate confirmed sick from suspected sick--and also ensure that staff do not move between the two groups, either.
CIDRAP has a story that has bounced around for some time--does use of Tamiflu mask bird flu? A study of Vietnamese H5N1 cases in a September 2005 issue of The New England Journal of Medicine found that genetic evidence of the H5N1 virus could not be detected in throat swab samples until between 2 and 15 days (median 5.5 days) after illness onset.
"If a patient is on oseltamivir for 3 days before the first swab is taken for diagnostic testing, it's possible the result will be negative, but the patient could be infected," he told Bloomberg News.
Link to New England Journal Medicine that CIDRAP is citing.Jackson Hole, Wyoming paper says that it is safe to hunt despite bird flu, though wearing gloves is always a good practice.Interesting. I had not seen this. India has a pretty broad poultry ban in place.The University of Iowa has $1.2M for bird flu research.The ever-hip Asheville NC is preparing for bird flu.
“This is not science fiction. It will happen again. There will be no existing vaccine to treat it,” Salyers warned an assembly of the WNC Communities meeting Thursday at Asheville-Buncombe Technical Community College’s Enka campus.
Yorkshire, England, reminds readers that bird flu is not gone.
August 18 Flu Update
Another woman has died in Indonesia, as cluster concerns continue to grow.Indonesia is continuing to investigate the cluster. My note: in this one, the people don't all live in the same house, so it if is a cluster, it would seem to indicate a higher level of contagiousness. As both men developed symptoms on the same day, epidemiologists assume that they acquired their infection from a shared environmental source, the WHO said.
``The currently recognized incubation period for H5N1 infection of 2 to 8 days makes human-human transmission between the two highly improbable,'' it said.
Effect Measure notes this, and how confusing it is to sort out the exact situation with media reports. Revere is waiting for the dust to settle.ProMed on the Indonesian cases. Note the mod comment:
The 2 young men could have acquired their infection from a shared environmental source. The currently recognized incubation period for H5N1 infection of 2 to 8 days made human-human transmission between the 2 highly improbable.
Recombinomics has a local translated report on another potential new case.A Thai scientist says that bird flu in that country is not closer to human transmission.The UN has warned that bird flu in endemic in Asia, and this compounds the problem with the disease in people.To wit: more outbreaks in birds in Cambodia.Some have said that vaccine makers are using too many old versions of the bird flu virus in developing their vaccines. There is evidence that the virus is diversifying in real time. WHO has now joined this chorus--of course, with a caveat not to be alarmed about the diversification, but plan for it when developing better vaccines.CIDRAP has this story as well, which may be the most significant of the day.
Michael T. Osterholm, PhD, MPH, a leading pandemic preparedness expert, said recognition of the three subclades demonstrates how diverse the virus is and how dynamically it is evolving. He said the WHO notice is more important for the questions it raises than for the vaccine guidance it contains. "Does that mean H5N1 is closer to becoming an agent that can readily transmit human-to-human? That's the billion dollar question," he told CIDRAP News. Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of the CIDRAP Web site. Many experts who follow the ongoing analysis of the H5N1 virus sequences are alarmed at how fast the virus is evolving into an increasingly more complex network of clades and subclades, Osterholm said. The evolving nature of the virus complicates vaccine planning. He said if an avian influenza pandemic emerges, a strain-specific vaccine will need to be developed to treat the disease.
Effect Measure weighs in on this, as well.Effect Measure says we need to understand the full range of animals who can get and transmit bird flu. He wonders what effect dogs, cats, rats, etc, might play in the transmission of the disease.Of course H5N1 could be infecting many other animal species (cats, rats, etc.) but they still might not be important sources of human infection if the virus is not easily transmitted from them to humans. But some of them might be important, depending on the various modes and pathways of infection. Moreover, a virus which currently is not easily transmitted from some non-poultry source could become so as it adapts to its new biological and ecological environment. More information on viral survival in the environment, transmissibility by other routes than inhalation, and a broader consideration of affected species is urgently needed. Efforts might usefully be concentrated on animal species commensal with humans, such as companion animals and domesticated livestock and small rodents that live in human settlements.
Interesting: Thailand has noted that screening a healthcare facilities is not effective, because some working class people go straight to the pharmacy. So, pharmacies are being enlisted to screen for bird flu and other infectious diseases.An article in Nature says that if you are going to vaccinate a flock, you should at least vaccinate 95% of them to be effective.
An article by two Chinese scientists in the British Medical Journal attempts to draw lessons from SARS and apply them to bird flu.Zimbabwe has banned poultry imports from outside the Southern Africa Development Community.The Chairman of the Gordon County Board of Health (GA) has warned local people that bird flu would be a big problem in US.Lee County FL is preparing its bird flu plan."I still believe in a place called Hope" Arkansas is doing bird flu planning.Training is underway in Piggot, AR, too.Vietnam is tightening its bird flu quarantines as it desperately tries to remain bird flu free.IBM and South Florida are looking for $18M to develop a supercomputer to help fight the bird flu.
The supercomputer would be used to study bird flu and other infectious diseases. Eventually, it could help to transform the city into a research mecca with a university-affiliated Center for Emerging Infectious Diseases at its hub, attracting scientific and technological talent and businesses who want access to the King Kong computer.
Vietnam is banning the internal transport of poultry on public vehicles.
August 16 Flu Update
A new weakness of the bird flu virus has been found. British researchers are reporting that there is a second set of neuriminidase that has four instead of five. This opens up a new playing field in the development of anti-virals."Those drugs were designed using the structure from one group of neuraminidases and, it turns out, genetically, there's another group," said John Skehel, senior author of the study and director of the National Institute of Medical Research in London. "The first group contains five neuraminidases, and the second group contains four."
"What we've done is determine the structure of three of those four, which hadn't been done before and, it turns out, they show some structural differences from the group that was used to develop Tamiflu and Relenza," he continued. "The major difference is the presence of a cavity next to the active site of the enzyme. In this group, the cavity is a constant feature."
This suggests that it may be possible to design or identify other compounds that would block neuraminidase activity.
"Relenza and Tamiflu work, so the idea is that this difference in structure might be used to develop new drugs which would block the neuraminidase just in this group," Skehel explained. "It may also well be that they block activity in both groups."
A 9-year old girl has been confirmed dead in Indonesia of bird flu. She lives in the village where there are some cluster suspicions.Skagit Valley, WA, is doing wild bird surveillance for bird flu.Matsu, a remote island in Taiwan, is completing a bird flu exercise today.
The Health Director in DeSoto County, FL, went to the paper to make sure people did not panic over the bird flu situation in Michigan.Jasonville, IN, will hold its final informational meeting for the public.Knox County IL held a tabletop influenza simulation.Four countries in Southern Africa are preparing to keep the bird flu from entering the region.York and Adams Counties, in Pennsylvania, and conducting joint pandemic planning.Missouri is preparing for Tamiflu purchases for the state.Effect Measure looks at a paper on a cytokine storm in another disease, and what lessons it could provide for H5N1. (Cytokine Storm is a disregulation of the immune system that is part of the lethal force of bird flu.)Recombinomics says that town in Indonesia with three cases may have a fourth.The Snomish County Health District is preparing to stockpile Tamiflu, for its employees and families.
August 14 Flu Update
News reverberating on the Michigan front. Lots of media attention. Unique takes only are included.
CIDRAP on the Michigan situation. Important note: birds are healthy, and found as part of routine surveillance. It seems sure it is LPAI. An analysis of genetic sequences at the NVSL has already suggested that the avian influenza virus in the swans is similar to the low-pathogenic avian flu virus identified previously in North America. Routine sampling in wild ducks in the United States showed evidence of low-pathogenic H5N1 in 1975 and 1986. The virus has also been detected in Canada as recently as 2005.
"These results are not unexpected in a given surveillance activity," DeHaven said at the media briefing.
Recombinomics is calling for the sequences to be made public from Michigan, to check on the Qinghai isolates.13 dead birds were also found in Essex, UK, but botulism is to blameThe July 12th death in China is now confirmed H5N1. CIDRAP on that case, and the 17 year old from Indonesia.ProMed on the Indonesian case, noting the prevalence of sick birds in most bird flu cases.Revere writes on India's claim to be bird flu free, and the limited WHO definition that lets a claim like that be technically true.Thailand wiill continue bird flu measures until the end of 2006.The Health Department in Des Moines, Iowa is buying up Tamiflu. A lecturer in India notes the potential harm of avian flu on the financial system there.A Czech scientist says that he has discovered a "compound" that is effective against the bird flu.But Havlas said work is needed on a 'transport' mechanism. 'It must be chemically modified to get it into target cells and the viruses' which is 'very hard work,' he said.
Gilead is now responsible for taking the research to the next level, although Havlas said the work could take 'several years.'
Vacation Hiatus
We'll be in the North Woods of Michigan from August 4 until the 14th. Looking forward to the break and the respite. The next update of the Coming Influenza Pandemic? will be the 15th or 16th.
Thanks for reading and keeping in touch.
July 31 Flu Update
The bombshell news today is a scientific study that attempted to replicate the mutations it would take for bird flu to become transmissible between people. The results (on ferrets) show that simple genetic changes are not enough. Good news. Of course, it could still happen, it's just not a simple process. And, replicating nature is always tricky. Still, this is important knowledge, because it means we may have more time than we suspected.But at a telephone news conference on Friday, an author of the study, Dr. Jacqueline M. Katz, said the scientists had tested only a few of the many hybrids that could be created. Further studies will examine more.
Helen Branswell is on the story (yeah!). Here article gives strong voice to those who are talking about the study's limitations. To test what might happen in nature, scientists would have to conduct what are called classical reassortment studies, where H5N1 and human flu viruses are allowed to co-mingle in a lab dish, producing naturally occurring offspring viruses. CDC is currently conducting such work with more current H5N1 viruses, Katz said.
The results could be different, said Dr. Frederick Hayden of the World Health Organization's global influenza program.
"We may see surprises and different gene reassortant patterns there. But until you actually do the experiments, that would just be a matter of speculation," said Hayden, who echoed Gerberding in saying this study doesn't offer any insight about how likely or unlikely H5N1 is to cause a pandemic.
CIDRAP also has this report. The CDC officials were asked whether reassortment "dumbs down" or weakens the virus. Katz replied that the hybrids were less virulent than H5N1, but cautioned that the results apply only to the 1997 strain.
Gerberding commented, "The pandemics of 1957 and 1968 were caused by reassortant viruses. Those were not dumb viruses."
In answering other questions, Katz said some scientists believe the 1918 pandemic virus, unlike the 1957 and 1968 viruses, arose through slowly accumulating mutations in an avian virus rather than through a reassortment event. "We're looking at the approach of the 1957 and 1968 pandemics where there was a more sudden change," she said.
The most important lesson of the research so far, according to Katz, is "the knowledge that this process isn't simple, the procedure for the virus to acquire the properties of transmissibility."
Effect Measure weighs in. He hasn't read the paper yet, but notes that the headlines are racing ahead of the actual science, and that we still don't know much more than we did.
This virus is capable of amazing parlor tricks and parlor tricks often look impossible until you see how they are done. Then they look simple.
Recombinomics says that there were no results because it isn't reassortment that causes mutations anyway--its recombination.There are now 131 cases "under suspicion" in Thailand.Thailand (which has often boasted of its bird flu prowess) is blaming Laos for this outbreak.Thai editorial reminds readers that even with past success, flu requires constant vigilance.ProMed on Thailand's accusations (and an offer to "help" Laos), and Bulgaria's fear that it will get bird flu from Romania.CIDRAP on Thailand.Thai OIE report on bird outbreaks.Novarax also has successful bird flu news.UN FAO official says that fighting bird flu in Asia is hampered by a lack of aid.A second roundtable was held in Rochester NY to prepare for the bird flu.There is still one region in Russia which has active bird flu.A Winipeg lab has been named a WHO reference lab.Iowa is stocking up on Tamiflu.Dr. Gerberding will give the Oppenhemier lecture at Los Alamos.Effect Measure uses cuts in substance abuse funding to illustrate his point that fighting flu is all about an overall commitment to a public health infrastrcture.Bird flu is effecting the quality of shuttlecocks.
