December 27 Flu Update--Happy Birthday to the Coming Influenza Pandemic?
Photo Courtesy Cassidy Norvell on Flickr.It was two years ago today that I decided to blog the flu. Nearly every day since then I've posted the latest news on the avian flu. This is, in fact, my 693rd post, amazingly enough. Some days it takes a few minutes, and in busy seasons it can take hours. I've enjoyed it a lot, gotten nice feedback from people who read, and built a small following which is about 100 times more than I ever thought I would get.
The first post was on the discovery of AI in Japan.For what it is worth, when I started I believed a pandemic could hit any minute. It wasn't that close then, but its closer now than it was two years ago. The question is whether we have used our time to prepare ourselves for strategic, society-level solutions.
I did it because I was interested in keeping up on the topic, and as I begin the third year, I still am. So, thanks for reading. Thanks for commenting. I hope you find it useful.
A third member of an extended family in Egypt has died. He was in the hospital for 10 days, for those trying to calculate exposure sequences. Could he be the index case? (Ducks were being slaughtered for a wedding celebration).CIDRAP on the Egypt cases.Recombinomics also on the Egypt cases.Official WHO statement, strong on the exposure to sick poultry.Now that the flu is back, Vietnam is warning that it could be widespread in the country before it finally goes away.Effect Measure on the recent cases in Vietnam, the inevitable casting of blame, and the real story: the flu is entrenched and not going anywhere.For those who say the bird flu is going away...deaths this year outpaced the last year years combined.Flu reports in Asia has spawned a more watchful atmosphere at the airport in Manila.Stars and Stripes says that a recent bird flu outbreak in South Korea isn't a threat to military forces.Canadian Rx industry puts $1M into flu programs.Canadian scientists say they have identified a new fact about how flu replicates
The study revealed novel characteristics of a protein, called NS1, that activates a key pathway in the virus's reproduction. This information will help the researchers learn how to create harmless influenza viruses that can be used as live vaccines.
The pathway can be thought of as an assembly line with a switch to turn it on, says Zhou. "If the switch is turned on, the pathway enables efficient production of more viruses. But only the NS1 protein can turn on the switch."
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December 22 Flu Update--Christmas Edition
Readers, this will be the last update of this blog until December 26, the day before we will have a little second birthday party for the blog. In the meantime, we're going to have a Merry Christmas at our house, and I hope your house enjoys the season's blessings as well.
There is a new bird outbreak in Indonesia.The most serious bird flu problem today might be in Nigeria.More on the report that 62 million could die in a 1918 style pandemic.Helen Branswell (back on the flu beat) writes on this report.A U.S. infectious diseases expert challenged the paper’s suggestion that the developed world would get off relatively lightly from a 1918-like pandemic, saying the study and an accompanying editorial underestimate the effect of globalization on supply of essential goods and overestimate the capacity of developed world medical systems to cope with a crush of gravely ill people.
"The paper and the editorial have no sense at all of a modern global just-in-time economy, where the kind of drugs and medical services that they assume will be available in a modern world just won’t be there," said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
Effect Measure has its usual high quality thoughtful post on this report...essential to understanding this report in the context of December 2006. (Update: see Wulfgang's comments...I just read this article in depth, and it is fascinating and a must read.)This paper reinforces what we already "know" but often refuse to acknowledge. Whatever the analysis, the bottom line seems to be that the best way to protect ourselves is to have a robust and resilient society with an intact, effective and functioning public health and social services infrastructure. It is highly likely that the variable per capita income is a surrogate for the benefits those things bring to a community's health.
How many death's will it take before we know, that too many people have died?
CIDRAP (where Dr. Osterholm is Director) also has this story.South Korea has continued reports on culling.The bird flu is back in Vietnam, and the government says vaccination is the key to stamping it out.Wire story on how Asians are scrambling to stamp out this latest re-emergence of the flu.Effect Measure also looks around the world and notes that the virus does not care if we believe it is present or not.ProMed has an EU report on the state of the virus...heavy emphasis on the animal nature of the disease and improving veterinary services.Nice story from New Jersey that details how bird flu might hit a local community.Surveillance is ongoing for bird flu in South Carolina.CIDRAP on the battles on multiple continents as 2006 comes to an end.Cameroon has put money into the bird flu fight.A massive bird registry has been created in Britain.Experts on VOA say that the world made progress in 2006 on a number of diseases, including bird flu.
December 17 Flu Update...
is canceled. Will post tonight. Root canal...
December 14 Flu Update
The New England Journal of Medicine is prepared to report that vaccines for bird flu do not need to be a perfect match in order to be effective.Suzanne Ohmit of the University of Michigan School of Public Health and her colleagues found that in the fall of 2004, Sanofi-Pasteur's FluZone vaccine was 77 percent effective and MedImmune Inc.'s Flumist worked in 57 percent of the cases even though the flu strain making the rounds that year was not selected for the vaccine.
Experts speaking in Indonesia urged the world to "beef up" its bird flu protection systems. The quote listed below gets to the nitty gritty of planning that people usually miss...
Drugmakers told the conference they were trying to get around simple but daunting logistical problems in developing H5N1 vaccines for humans. "Syringes and needles will be in short supply in the event of a pandemic," said James Young, president of research and development at MedImmune Inc, which markets a nasal spray vaccine that fights the common flu. "We are looking at changeable tips -- after spraying into the nose of one person, you can change the tip and go to the next person," he said.
Here Reuters recounts the ravages of past epidemics as a sidebar to the story above.CIDRAP with an interesting story...the Institute of Medicine studied whether community interventions (covering your mouth, quarantine, etc) would help in a pandemic. The answer: maybe a little.North Korea claims to have a vaccine for birds.Myanmar continues to monitor bird flu.The US has issued a warning that the bird flu could still mutate and cause a human pandemic.The stories are trickling in from the Truth for America's Health Report on state preparedness. Here is Florida's.Effect Measure on the report on the nation's preparedness.Recombinomics notes that the Qinghai sequence has been found in the South Korean birds. He asserts that this demonstrates that the disease is being spread by wild birds.An avian influenza committee ("The Akwa Ibom public enlightenment committee for mass awareness on Avian Influenza") is "taking off"In China, the Vice Premier has urged the state to increase its efforts in bird flu prevention.Korea Air reports people still selecting chicken for their inflight meal.
Harvard held a discussion group on the overall public health system, following along a common theme from Effect Measure.... The global response to bioterrorism and AIDS is increasing health system capacity in a way also useful if avian flu strikes, according to experts attending an interdisciplinary conference on Asian flus.
The bad news, however, is that vast disparities in health care systems still persist and, despite the expanding capacity in recent years, bird flu could still have a devastating impact.
For the fluwonks, I suppose this document might be interesting reading...an Illinois Schools guide to what to do during a pandemic.Here's the actual document.
December 1 Flu Update
In Thailand, officials are considering whether to take the controversial step of vaccinating poultry against the flu.Canada has issued a warning about Tamiflu, blogged here by Revere. Note MSM screwing up vaccine/anti-viral distinction in headlines, and Revere's own practice on Tamiflu (which matches mine).The EU has extended its ban on importing birds for 3 additional months.South Korea says it dealt well with bird flu...but North Korea would be another story.ProMed on WHO guidelines for diagnosing bird flu. Mod comment says that the guidelines are in response to concerns raised in those NEJM articles on missed cases.Excellent article on vaccine labs gearing up to fight the bird flu.The animal husbandry industry lost $2B due to bird flu, according to a report.CIDRAP on the Canadian triage plan to allocate ventilators. The inclusion criteria identify patients who may benefit from critical care treatment, focusing on respiratory failure.
Exclusion criteria place patients in three different categories: those who have a poor prognosis despite critical care, those whose care demands resources that can't be provided during a pandemic, and those who have underlying advanced medical conditions such as malignant cancer or end-stage organ failure that complicates their critical influenza status.
The authors write that they struggled with the decision to put an age cutoff in the plan's exclusion criteria. They did not include one in their original protocol draft because they claim age may not strongly predict critical care outcomes. "However, we received strong and consistent feedback from both expert and stakeholder consultations that an age criterion should be included," they wrote. Age above 85 is listed among the exclusion criteria, but the authors suggest that the topic of age cutoff requires more research and community input.
The "minimum qualifications for survival" component attempts to place a limit on the resources used for any one patient. "This is a concept foreign to many medical systems in developed countries but one that has been used in war zones and refugee camps," the authors write. In the triage protocol, patients are reassessed at 48 and 120 hours to identify early those who are improving and those likely to have a poor outcome.
Lame Duck Governor (flu humor) Bob Taft held a pandemic exercise in Ohio.Stars and Stripes says to be aware, not worried.
Nice story from the Central Michigan student paper--A professor and student are studying water, sediment and feces in migratory pathways for bird flu.There is now a website that has information on wild bird surveillance.Officials in North Dakota are conducting bird flu surveillance. The American Public Health Association has a seasonal flu blog...and in this post they answer the question of whether the flu shot will protect against bird flu.A UN map on the bird flu.
