Saturday, December 23, 2006

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.


At 11:01 AM, Blogger Wulfgang said...


Good for you and Merry Christmas back at you, you deserve a break. I too shall lay low and enjoy my Christmas respite with my parrot, Barnabas.

Like many of your readers, I have been anxiously waiting for the Revere’s to remark on the Harvard study, published in the Lancet. I found the Effective Measure commentary (Bird flu: how many deaths will it take ‘fore we know?) about the study, well, pretty insightful and fascinating, and probably one of the best ones they have done this year. True, some of the actual report findings are not new or surprising, for example – an extremely wide variability in excess mortality across different countries and regions, and the basic fact that the bulk of pandemic’s fatalities will be seen in the developing (i.e. underdeveloped) world countries. This kind’a figures to be correct logic in my mind, after all, poor people get sick and die more frequently than wealthy people. Revere suggests more correlation is required in the latitude and income variables, and this is true – this is an indirect way of identifying countries most likely impacted. I also noted Revere’s observation that, “future mortality could be larger if the 1918/20 pattern of low older adult mortality were in fact due to some acquire immunity from the pandemic of the mid-19th century”- very interesting comment. I might actually be immune to the effects of H5N1 since I got the flu in 1957 and 1968, this is very good news for me.. Revere’s conclusion about not being lulled into complacency and self-confidence because one lives in a developed country, because these countries also contain pockets of endemic poverty, is an excellent one – an avian influenza pandemic would know no boundaries.

Now, this has all caused ‘Ol Wulfgang’s upper and lower hemispheres of his brain to engage, and caused some thought process on the complex subject of pandemic transmissibility, models and fatality expectations. Estimated influenza death rates are not simply related to and a correlation of latitude and low income variables. Influenza related deaths reflect the combination of two epidemiological parameters: the attack rate, which is a measure of a pathogen’s transmissibility, and the case-fatality-rate (CFR), which is a measure of a pathogen’s virulence.

Here’s some facts that most people don’t know: there have been in fact, four epidemics/pandemics in the last century; 1918 (H1N1), 1951 (A/H1N1, also), 1957 (H2N2), and 1968 (H3N2). In actuality, the 1951 influenza epidemic caused an unusually high death rate in England, in particular, the weekly death rates in Liverpool even surpassed those of the 1918 great influenza pandemic. Also a fact is that in Liverpool, where the 1951 epidemic was said to originate, it was "the cause of the highest weekly death toll, apart from aerial bombardment during WWII, in the city's vital statistics records, since the great cholera epidemic of 1849". I direct everyone’s attention to the following CDC Emerging Infectious Disease report for some fascinating details of a comparison of the 1918, 1951, 1957, and 1968 epidemics, if you think I’m fibbing:

This all goes to say, in Wulfgang’s old mind, all this talk about viruses, antigenic drift and shift, estimation of fatalities due to an influenza pandemic, and models – is terribly complex, interconnected, and unpredictable. There is more that we don’t know, than we do know. Which brings me back to the same conclusion as Revere: “the best way to protect ourselves is to have a robust and resilient society with an intact, effective and functioning public health and social infrastructure”. For lack of societie's proper attention to this dilemma, I am continuing to stock up on massive quantities of twinkies and Clorox.

Happy holdays to all...



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