Tuesday, January 31, 2006

January 31 Flu Update

The Army says it will be watching--but little else--to see if troops are encountering bird flu in Iraq.

The EU is rushing one of its bird flu experts to Iraq.

There is a strong liklihood of a 3rd case in Iraq.

Iraq says it is treating 12 potential cases.

Recombinomics notes this cluster and writes on the potential H2H implications.

Dr. Gleeson has his response, which seems reasonable.

We can expect to see more isolated cases from Indonesia to China and, now, west to the Middle East simply because the virus has moved that far. These are not clusters. If we start to see a cluster of infected humans who do not live with chickens or infected health care workers, then we will have a different story. But for now, these cases are to be expected.
WHO on Iraq. Note that there is identified exposure to birds for the girl, but her uncle's exposure route is "under investigation."

Helen Branswell on the case in Iraq: "a most unwelcome twist."

Apparently, the Iraqi people, who have seen much misery, are not reacting strongly to the flu.

The Iraqi government says it has acquired 10,000 doses of "vaccine."

This report says the Iraqis have culled 500,,000 birds over the last two days to try and contain the outbreak.

Effect Measure on the bird flu in Iraq: "Nature's terrorist."

ProMed on Iraq. Those of you who have been critical of the mod are going to love this comment, though she does, IMO, raise one good question.

[It has been suggested that the disease situation in Iraq is exceptional in that suspected human cases have been reported in the absence of prior reports of disease in poultry. However, the evidence for this is contradictory. A previous article on the Iraq situation states both that: "There have been no confirmed cases of [bird flu] in Iraq," and then later that: "The girl had a history of exposure to diseased birds".

Elsewhere (in a Canadian Press article by Helen Brancewell, it is reported that: "The avian influenza-infected girl died after developing severe pneumonia in the Kurdistan village of Raniya, about100 kilometres south of the Turkish border and just 24 kilometres west of the border with Iran. She had an aortic aneurysm and a history of cardiac problems. The girl's mother rejected the bird flu diagnosis, but acknowledged that a number of her chickens hadmysteriously died before her daughter's death.

Further information is awaited. - Mod.CP]

(Yes, I know she spelled Branswell wrong)

ProMed on Cyprus and Iraq.

The world has seen its 160th known case of bird flu, with 85 deaths.

Greece says it is ready for the bird flu.

Britain says it will allow CO2 to be used in culling birds, if flu hits.

CDC gives a reality check on the situation in the US. Congress funded less than 50% of the President's request, the US is trying to triple its Tamiflu order, and the CDC director says we are years away from having enough medicine to fight a pandemic.

WebMd on the Pittsburgh activated flu virus, which provides protection even if there is a mutation.

As if on cue, in comes Dr. David Shay, who says the most likely first defense would not be medical--it would be social, ie, cancelling public gatherings.

Experts such as Shay are concerned that many people, including elected officials, still do not fully appreciate that there is no good medical defense against pandemic flu.

Marc Siegel is back, here in WaPo, with his virus-skeptic views. He also has a new book out.

Kirsty Duncan weighs in now, she of the highly dramatic hunt for the 1918 virus in the tundra. She's noting potential business losses, heavy on 1918 parallels.

The EU is the next to allow Tamiflu for children.

Dr. Gleeson also writes about travelling in foreign countries, especially one with endemic bird flu.

If you are in a country where the virus is endemic, have an exit strategy. If a cluster is reported in the country you are visiting, you may have only a very few hours to get out of the country. Face it, most countries will stop accepting flights from countries with an H2H cluster. By an exit strategy, I mean know the flight schedule of planes to anywhere safe and be psychologically prepared to go to the airport without packing.

Monday, January 30, 2006

January 30 Flu Update

Well, the news is in from Iraq. To no one's surprise, the 14F who died is now confirmed H5N1, and that makes it likely her uncle died from it, too.

Effect Measure has his take, calling it an "obvious" conclusion to the story.

So there you have it. The Fourth Horse of the Apolcalypse is cantering towards a war torn area with a destroyed civil infrastructure, overwhelmed medical facilities and 160,000 foreign occupiers poised to become global vectors.
CIDRAP also weighs in on this development. Here's the vital excerpt that says more is going on in Iraq than we may know.

A Reuters report from Geneva today said Iraq is investigating a possible third human case of H5N1 infection. That case involves a 54-year-old woman who was hospitalized on Jan 18 with respiratory symptoms and is still being treated, World Health Organization (WHO) officials told Reuters. She is from the same area in northern Iraq, near the city of Sulaimaniya, as the girl and her uncle.

In addition, the Times quoted health minister Dr. Abdul Mutaleb Mohamed Ali as saying that two other people in other parts of Iraq had been tested for H5N1 infection, but the story gave no results or details in those suspected cases.

Confirmation of the teen-aged girl's infection prior to discovery of poultry outbreaks in Iraq suggests that H5N1 may be spreading stealthily, under the radar of existing surveillance systems, the newspaper noted.

"We shouldn't be seeing human cases first, and this points to serious gaps in surveillance," WHO spokeswoman Maria Cheng said in that story. "But given the situation in Turkey, I don't think we'd be surprised to see isolated human cases in surrounding areas."

Recombinomics cites reports of a dozen people in isolation in Iraq.

Recombinomics on the Iraq situation. As always, he sees the tip of the iceberg everywhere he looks, and isn't always wrong.

Recombinomics also writes on the epidemic (as it were) of false negatives in the Middle East.

Algeria says a dead poultry breeder did not die of bird flu. We will have to wait for the real test results.

Partially driven by protecting tourism, Cyprus is mobilizing to head off the bird flu.

Question: has the virulence of the bird flu been overstated, based on experience in Turkey? Answer from Helen Branswell. Essentially, its too soon to tell. All 21 cases in Turkey are not lab confirmed yet. Even if all cases are correctly diagnosed in Turkey, you can't discount the virulence in Asia. I found the next part most interesting.

Even if the London lab confirms all 21, the evidence from the outbreaks in Southeast Asia and China paints a different picture: a high death rate and very little sign of the type of mild infections that might initially evade detection.

"The evidence for widespread asymptomatic infections is just not there," says Michael Perdue, a scientist with the World Health Organization's global influenza program in Geneva.

Certainly the odd case here and there probably went unnoticed, the experts assume. Mild cases are more likely to fall through the surveillance net than severe ones.

But a number of studies have been done in Vietnam, Thailand and Indonesia looking for antibodies to the virus in the blood of people who were exposed but who didn't show signs of being ill, including chicken cullers, relatives of known cases and hospital staff who cared for H5N1 patients.

"And they essentially found zero. They haven't found any," says Dr. Scott Dowell, director of global disease detection and preparedness at the U.S. Centers for Disease Control in Atlanta.

Dr. Bob Gleeson does the Math on the fatality rates, and I think his point is key. So what if the virus is less virulent than in Asia. 1918 happened at 2.5%.

WHO update on Turkey.

From Davos, David Nabarro echoes something that Michael Osterholm has been saying for months...pandemic planning has to look beyond hospitals.

Keeping the taps flowing, the lights glowing, and food on the shelves may be a higher priority than caring for the ill during an influenza pandemic, the United Nations' coordinator for avian and pandemic flu has said.

"It may be more important to concentrate on the essentials of life for those who are living than it is to focus on the treatment of those who are sick," said David Nabarro, as quoted in a Jan 28 Reuters report following a pandemic simulation exercise.

ProMed runs the table on Eurasian news. Mod comment notes that you have a lot of political boundaries, including autonomous districts, and surveillance and reporting is tricky.

ProMed on Saudi Arabia confirming their Falcon has H5N1, the first case in that country. The bird doesn't migrate, and they speculate that perhaps an illegally imported bird might be at fault.

Reuters has polling that shows America is more worried about lots of things than the bird flu. This is not a surprise, and some are even rational judgments.

Turkey is getting an 8.5M Euro subsidy to fight the bird flu.

The Lancet will hold a flu forum in Singapore on indentifying gaps in pandemic planning.

Gilead profits up on Tamiflu sales.

Dr. Peter Gott answers reader's questions on Tamiflu.

ProMed with OIE report from Hong Kong.

In South Dakota, a City and the State are working together to prepare for the bird flu.

Via Crofsblog, a Canadian reporter wonders if he caught avian flu in Turkey.

Sunday, January 29, 2006

January 29 Flu Update

Effect Measure on the two cases in Iraq, and doubts about denials of H5N1.

Yesterday, we noted that Effect Measure had promised to read and comment on the Pittsburgh virus news, and this he did. Read for yourself. I've grabbed two key excerpts--bottom line is that the results are positive, though work is not done. Also note the cross-immunity this approach conferred.

All in all this is a promising proof of principle for a new approach to an H5N1 vaccine. It builds on other work and is parallel to several other efforts to do the same thing. Perhaps the most important signal here is that there is a great deal of interesting work being done on new vaccine technology. We note this work has been going on for some time and didn't need Bill Frist to hand Big Pharma the Christmas gift of liability immunity. But that's another subject.

Still, there is a long way to go. It has to be shown that such a vaccine is both safe and effective in humans. Protecting mice is relatively easy. Protecting humans is another matter. There may be a lot of natural immunity to adenovirus 5 that could interfere with the efficacy of the vaccine, which might require a move to another serotype or vector. Not an insurmountable problem but one that takes time. The safety issue isn't trivial when hundreds of millions or even billions might be vaccinated in a pandemic setting. A risk of death of only one in a million, while very favorable in the risk-risk trade-off calculus, might be a significant psychological barrier if in the first weeks of a mass immunization campaign the public sees several dozen deaths related to vaccination. Finally there is the problem of scaling up to produce adequate amounts of vaccine. This will be easier for this kind of vaccine than an inactivated whole virus one, but won't be trivial.

Japan is testing a bird flu vaccine.

The bird in Turkish Cyprus is H5N1, and there are more birds in Hong Kong with H5N1.

Reuters on Hong Kong's bird deaths.

ProMed on Cyprus and Hong Kong.

Recombinomics on Cyprus, and the lack of transparency he feels it exposes.

Pfizer says a bird flu vaccine is 2-3 years away.

The Lunar New Year holidays in Asia are not seeing lowered tourism.

Ukraine says bird flu is a threat, but one they are prepared for.

The Houston Chronicle on surveillance in Alaska for the bird flu.

The LA Daily News has a new humor columnist, and she wrote about the bird flu.

Crofsblog has found a journal article that details the results of quarantines in other countries and an extrapolation to the US. For my money, compliance with a quarantine for people who are not sick will be less than ideal.

Crofsblogs also pointed us to a new flu blog, from a Dr. Bob Gleason. He's an MD, and we'll be monitoring his posts for potential inclusion here.

Like this one...on where his warning light is as the Turkey situation subsides.

Saturday, January 28, 2006

January 28 Flu Update

As always, the first test of the Romanian woman who died of bird flu is negative. Time will tell.

Meanwhile, with the second death in Iraq tests are being conducted by WHO in Britain.

ProMed on Iraq and Romania.

Recombinomics with a strongly worded piece on the Iraq case, and the state of play throughout the Middle East.

Calling conditions "ideal" for a flu outbreaks, a coalition of groups is banding together to watch for the flu in Burma.

Another strongly worded flu warning from the Scotsman, perhaps the world's most jittery publication when it comes to the flu.

Flu prep is underway in Antigua.

In Davos, flu vaccine companies have promised to triple production capacity, in a few years.

Also in Davos, David Nabarro reminded the assembled that a lower virulence in Turkey was not a reason to let the world's collective guard down.

WHO was travelling in Jakarta, and advised the poultry markets be cleaned up.

Stanford is beginning to test for the bird flu.

Continuing story on the monitoring of migratory birds.

Volunteers are sought for US bird flu vaccine trials.

A Canadian website is selling Tamiflu without a script.

Effect Measure on the Pittsburgh vaccine. As usual, things may not be as big as media reports are. According to Revere, several similar efforts are underway, and mice are easy to protect. He pledges to read the paper and report soon.

In Saudia Arabia, Falcons with H5 are being culled.

Breaking News--suspected bird flu death in Iraq

At this hour, Iraq is reporting an a suspected new bird flu death. Here's the rub. It is a 40M, who is the uncle of the young girl who died there earlier, but whose tests were deemed negative. Of course, we have often seen false negatives, especially on the first case in a country. This seems to me to make this more likely to be a false negative.

January 27 Flu Update

CIDRAP on WHO releasing its latest version of the "containment" plan. Must read.

Indeed, many disease experts are skeptical that stopping an emerging pandemic is possible, given the weak public health and disease surveillance systems in many of the countries hardest hit by H5N1 avian flu, where a pandemic is considered most likely to start. Skeptics also cite the lack of a vaccine and scant supplies of antiviral drugs.

But the WHO document says the attempt should be made, because it could save millions of lives and prevent economic and social disruption.

"Even if containment efforts ultimately fail to stop the emergence of a fully fit pandemic virus, these efforts could slow the initial spread of the pandemic and give countries time to increase preparedness," the draft states.

"Each day gained following the emergence of a pandemic virus—if rapidly detected—allows the production of around 5 million doses of a pandemic vaccine. Each added day gives countries more time to adapt routine health services to an emergency situation."

Here's the link to the .pdf of the actual plan.

New York State is making its bird flu plans.

CIDRAP on the deaths reported yesterday.

Public health or protectionism...US Sen Tom Harkin calls for meat not to be imported from China due to bird flu.

David Nabarro notes that the flu in Turkey is less lethal than in Asia...(my note: I don't think you can draw that conclusion. What if there are more known cases in the denominator?)

WHO says Indonesia is vulnerable to the bird flu.

In the least shcoking news of the day, N. Korea denies bird flu report from there.

In Hong Kong, 13 people are under surveillance when there was a dead bird in their village suspected of H5.

Russia is preparing a "resolution" on the bird flu--says it has been well received in the EU.

Synbiotics says its test has received USDA approval.

Japanese paper says Tamiflu has a death rate of 24.

More on 2 major human vaccine trials beginning.

Effect Measure on the evidence of the flu spreading, including yesterday's Turkish Cyprus report, and a new report from Azerbaijan.

Recombinomics on Cyprus.

ProMed with a multi-country update.

ProMed with the latest about wild birds--and what can you do about poultry?

Crofsblogs on Davos, where apparently the media was blamed for inciting panic. Surprised bloggers didn't get the blame.

Crofsblogs on the first bird case in Georgia.

Thursday, January 26, 2006

January 26 Flu Update

National Geographic reports on the first large-scale genomic analysis of the flu virus, which has doubled genetic information available.

"We've observed that avian viruses have a molecular characteristic that human viruses do not," Naeve said.

"That allows them to interact with human cells and potentially shut down pathways in human cells. That finding gives us a whole new means by which viruses interact with cells that we didn't understand before," he said.

"We believe this may be important in [determining] virulence—in combination with other genes."

Reuters on the study listed above.

But Naeve's team may have identified a protein to watch. It is called NS, for non-structural protein, and is only made once the virus has infected a cell.

The avian versions seem to allow the virus to do much more damage to a cell than the human versions of NS, Naeve said.

"We were surprised to see a lot of variation in this NS protein. That was the clue. We felt it must be playing an important biological role," he said.

It is possible that a mutation that would allow a flu virus to more easily infect people will weaken the NS protein, Naeve said. But no one knows.

Branswell on the mutation story.

From Indonesia, a reported 15th death in a 22M chicken peddler.

At the US Conference of Mayors meeting, Mayors were asked to put bird flu right up there with crime and unemployment.

WHO is supporting strict rules on the early reporting of bird flu.

Perhaps alarmed by Turkey's feelings of superiority upon seeing the flu subside, the EU has urged them not to drop their guard.

Richard Branson of Virgin says that a pandemic could ground 70% of airline flights.

Romanian poultry farmers are hurting due to bird flu, and what a new tax on imported birds to compensate them.

Traditional Lunar New Year chicken meals are apparently still popular.

They have a bird flu plan in New Brunswick, which is in Canada. (Just kidding). And its based on Worst Case Scenarios.

On the vaccine front, University of Pittsburgh scientists say they have engineered a flu virus that is 100% effective in chicken and mice.

The Health Director in Springfield, Missouri says the best way to fight the bird flu is to "stay vigilant." (I'm not kidding. I think she mixed it up with terror).

The UK has lifted antitrust laws to promote vaccine production during a pandemic.

Effect Measure with Part LV of the "China won't share story."

ProMed on North Korea and Indonesia.

H5 confirmed in Cypriate Turkey, Recombiomics reports.

Wednesday, January 25, 2006

January 25 Flu Update

There was another flu death in China. This is a case we have been talking about for some time, not a new case. People close to the women have been observed, but not gotten sick.

Meanwhile, another patient is out of quarantine in China.

Reuters on China--as well as a new case in Indonesia.

WHO on China.

ProMed spans the globe, so you don't have to. Note two children released from hospital in Turkey.

ProMed has latest from the bird front, too, including the latest on the migratory bird debate.

In Algeria, an old refrain. A poultry farmer died with flu symptoms. Initial tests are negative, but....

Experts are working to allay fears of bird flu.

Yet another meeting in Asia to discuss bird flu.

There's a suspected dead bird in Georgia---they suspect the flu.

This had to be a sight. In Egypt, a farmer decided his chicken chicks had bird flu. So, he dumped them all at the side of the road, to the astonishment of motorists. He has the chicks back...no charges are pending.

Here are the latest WHO case count figures.

A Japanese man says that North Korea had a human bird flu case in December. Certainly no surprise, if true.

As usual, Recombinomics has underground reports showing a more serious situation.

CIDRAP says the Tamiflu gates are open again...and any restrictions imposed last Fall are off.

The USGS is sponsoring a Congressional briefing on bird flu preperation measures.

Japan says it will get to its Tamiflu target next year.

An excellent primer from San Diego on the state of play of the flu virus. Realistic and accurate. Note Niman at the end.

Henry Niman, a veteran flu researcher who once worked at Scripps Research Institute and founded a biotech company that became Ligand Pharmaceuticals in San Diego, believes conversion is inevitable, that H5N1 will become an established human flu virus within the next year or two.

"What that will mean in terms of a pandemic depends on exactly what version of the virus gains human status," he said. "Some versions of H5N1 are milder than others. If one of them prevails, any resulting pandemic might be more like 1957 or 1968. If a more deadly version prevails, it might be 1918 all over."

Carolina story on actual people participating in clinical vaccine trials.

More on vaccines--Glaxo says vaccine on board by the end of 2006.

However, Garnier said it was difficult to say how effective the new vaccine would be given that it was as yet unclear how the H5N1 virus would develop.

"It's all a question of mutation," Garnier said.

"If the mutation is a slight variation on H5N1 the vaccine is likely to be effective ... But if it's a wide mutation, where the new virus is systematically different from H5N1 then ... the vaccine is not going to be effective," Garnier was quoted as saying.

Yesterday, we noted that WHO was calling for earlier reporting in Asia, based on the containment strategy. Effect Measure asks if that's not just a false hope, and if WHO knows it.

Via Crofsblogs, Killer Flu from CNN.

Tuesday, January 24, 2006

January 24 Flu Update

Turkey says everyone with bird flu is getting better and being discharged, and is looking to declare the crisis over.

Austria is suggesting that the EU maintain a centralized crisis stash of Tamiflu to help stamp out any outbreaks.

Voice of America on a US computer database at Los Alamos that is being used to fight bird flu.

Citing the containment plan, a WHO official says that Asian countries need to be more prompt reporting bird flu cases.

Russian story on possible spread of flu there from China and Turkey. Of course, its already there....

UN FAO warns that Afghanistan says that country is at high risk for bird flu.

On a similar note, Nepal is preparing for protecting its poultry.

Dutch farmers are considering not vaccinating their birds if it will keep them from being exported...something which could become a common problem in the near future.

The League of Arab States is going to have a bird flu meeting.

Taiwan is apparently afraid that its diplomatic isolation would hurt it during a flu pandemic, but the US assured Taiwan they would be right behind them if it happened.

An even more cruel sign of what a pandemic could do...a medical journal contains guidelines for prioritizing access to mechanical ventilators.

Bronx Zoo vet talks about his trip to Russia to study bird flu outbreaks.

To get ready, Portugal is building a flu vaccine production facility. When the vaccine is ready, they'll start cranking it out.

Study in Vietnam says 80% of birds vaccinated developed some immunity to bird flu.

WaTimes carries a column with the party line of the BioTech industry.

Roche says that it is shipping Tamiflu all over the world.

I told you a couple days ago the WHO Fact Sheet was important reading. CIDRAP has an analysis of it.

Effect Measure summarizes--and copiously links--a debate from other blogs on whether bird flu is crying wolf.

Monday, January 23, 2006

January 23 Flu Update

Program note: tune in to Oprah tomorrow.

A note from CIDRAP: Our center's director, Michael T. Osterholm, PhD, MPH, will be the featured guest on the Oprah television show tomorrow (Tuesday, January 24), which is devoted to the topic of avian/pandemic flu. Originally the topic was to be covered in a segment of a program that also included other topics of import. However, during the taping last week, Ms. Winfrey decided it demanded the entire hour. See http://www2.oprah.com/ for more information.

Ironic: WHO is being forced to defend their assessment of the flu pandemic---as being an over-exaggeration. They've certainly heard differently on the flu blogs over time.

Meanwhile, in China, the 10th reported case was announced today. The victim is a 29F. Here's her story.

The woman, surnamed Cao, ran a dry goods shop in a farm goods market in Jinhua Town in Sichuan Province, a notice on the ministry's web site said.
CIDRAP on the 10th case in China.

Mod comments totals it all up in China.

Recombinomics says the family cluster in Turkey is growing.

Turkey notes that in general the health of the patients in Turkey is getting better.

The cull count in Turkey is at 1.28M.

The IMF says bird flu has not hit the Turkish economy...noting the relatively small number of cases.

A US delegation in Turkey praised flu control efforts there.

Sf Chronicle looks at the scare in Europe with the feared French case.

The Russsians say that there are new flu cases among people returning from Mecca.

Furthermore, they say they have no cases in the country at all.

Reuters writes that the flu in Turkey preyed on a town heavy with poverty.

Report from the WHO Executive Board meeting, which included discussion of pandemics.

WHO situation update confirms two deaths in Indonesia, noting large poultry outbreak in the family's neighborhood.

Iraq is preparing a bird flu prevention program.

In Vietnam, reports are very positive on the bird vaccination program.

ProMed has this report on the Crimea, where a new outbreak shows circumstantial evidence of migratory birds spreading the flu (based on mod comment).

Two suspected, but unconfirmed cases of flu in Cyprus. ProMed reports.

ProMed surveys the news in Turkey.

Sunday, January 22, 2006

January 22nd Flu Update

An apparent scare came and went today. A French woman returned ill from a trip to Turkey. Later, it was determined she did not have H5N1 (I don't think one of these traveller scares has turned out positive yet.

The cull count is well over 1 million in Turkey.

Algeria is preparing to spend $111M to protect itself against bird flu.

In Turkey, companies are moving to novel marketing techniques to get people to eat chicken--like giving it away for free.

Reports say that bird flu fears are not reducing travel around the Asian Holidays, including the upcoming Chinese New Year.

An Australian professor is criticizing New Zealand for over-reacting to the bird flu. (I have to admit that the Kiwis have taken pandemic planning farther than most others. Their remote island quarantine plan had a reality show feel to it. Still, they might be the ones laughing in the end).

Another Kiwi expert says the preperation "makes sense."

Newsweek writes on what the spread of flu to Turkey means...noting its "too soon" to say that H5N1 was a false alarm.

The Royal College of Surgeons (UK) hosted a flu summit to try and "shock" British business into preparing for a pandemic.

Meanwhile, in Canada, companies seem to be doing better.

Dr. Seth Berkley writes in Newsweek that the fight for the flu vaccine is similar to the fight for an AIDS vaccine--in which he is involved. Among his recommendations is limited liabitity protection. Note article title: "we're running out of time."

In Alaska, they are testing wild birds for the bird flu. (This is the kind of thing that makes complete sense to me).

In Danbury, CT, the hospital is prepared if the bird flu hits.

New Zealand article containing Q&A on a pandemic. This is the first time I have seen this question---can you drink water of rainwater tanks during a pandemic?

Recombinomics exhaustively details the timeline around the family clusters in Turkey. Naturally, this is seen as evidence of H2H. Judge for yourself.

Crofsblogs on an article about Romania tightening border patrols.

Finally, tonight, I'm relinking to the WHO Fact Sheet that came out Friday. I read it all last night, and its a must read for anyone looking for an update on the current situation. Pneumonia is virtually always present.

One feature seen in many patients is the development of manifestations in the lower respiratory tract early in the illness. Many patients have symptoms in the lower respiratory tract when they first seek treatment. On present evidence, difficulty in breathing develops around 5 days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody. Most recently, blood-tinted respiratory secretions have been observed in Turkey. Almost all patients develop pneumonia. During the Hong Kong outbreak, all severely ill patients had primary viral pneumonia, which did not respond to antibiotics. Limited data on patients in the current outbreak indicate the presence of a primary viral pneumonia in H5N1, usually without microbiological evidence of bacterial supra-infection at presentation. Turkish clinicians have also reported pneumonia as a consistent feature in severe cases; as elsewhere, these patients did not respond to treatment with antibiotics.

Saturday, January 21, 2006

January 21 Flu Update

Two siblings died a short while ago in Indonesia. These are now confirmed H5N1, making the total there 14 deaths. Once again, there are assurances of contacts with dead chickens. Their father and sister are also hospitalized.

ProMed on this case.

The eighth reported human case in China is reported to be recovering.

From Turkey, here's a bizarre one. Its only three paragraphs long, so I'm going to put the whole article below. Talk about family clusters.

Six members of the Ozcan family living in the Dogubayazit district of the far eastern Turkish province of Agri on the Iranian border were transferred on Friday to Igdir State Hospital with suspected bird flu.

Six members of the Ozcan family, related to Fatma Ozcan who died of bird flu last Sunday, applied to hospital complaining of sickness.

Father Mehmet Ozcan said that they had paid a condolence visit to Fatma's family. Two days ago he and his children ate chicken which his wife had killed and put into the deep freezer a month ago.

Recombinomics tries to piece this one together--noting fears of H2H transmission.

This is a little choppy, too, but I think it says that a child died on the way to the hospital, and was feared to have bird flu, but later authorities said the child did not have respiratory symptoms.

Hong Kong says its monitoring is sufficient....

though not everyone agrees.

Pakistan says it is fully bird flu free in poultry.

Greece places funds behind bird flu fight.

The Chinese say that their bird flu work is going well.

Here's a story on a Canadian company turning Christmas tree needles into shikimic acid for Tamiflu.

Iran is increasing its bird flu measures.

ProMed on Syria and Iran.

Here's a Mobile, AL review of the John Barry flu book.

500 public health officials in Kentucky met to work on their pandemic plan, which was developed in 2003.

WHO has published a new bird flu fact sheet. Very informative. Says the virus can survive in bird droppings for a month...a week even in hot weather. On the migratory bird debate:

Direct or indirect contact of domestic flocks with wild migratory waterfowl has been implicated as a frequent cause of epidemics. Live bird markets have also played an important role in the spread of epidemics.
Recombinomics on the Iraqi case, lab negative so far...notes how many times this exact pattern has been seen on clinically presented first case.

January 20 Flu Update

Turkey called out its neighboring countries for "hushing" the bird flu--seemingly referring to Iran and Syria. Its unclear if he is referring to the disease in birds or humans. Either would be a big deal, but if there were human cases in Syria and Iran, we'd look at the current situation a lot differently.
"It is unofficially known that this illness exists in our neighbouring countries which are ruled by closed regimes, but these countries do not declare this because of their systems," Agriculture Minister Mehdi Eker told a news conference.

Effect Measure commments on this issue, concluding that he agrees with Turkey--he's suspicious.

Crofsblogs found this--Syria has asked for help in detecting the bird flu.

Also from Crofsblogs, Armenia is asking for the same.

Turkey will be holding an influenza summit in Turkey, with reps from each of the 81 provinces.

ProMed on this conference, and on International cooperation as a whole. Note the mod comment that recently humans were a "sentinel" for animals, and not the other way around.

Thailand contributed 100M baht to the International Flu Fund.

VP Dick Cheney says that the bird flu could cause economic problems for the US.

Now that Hong Kong has confirmed animal cases of bird flu, it is scouring its bird markets for evidence of disease.

There was a brief bird flu scare when a man on an airplance had a fever (?), but it was ruled out (New Zealand).

Roche has responded to studies that say that Tamiflu is of uncertain effectiveness against bird flu by saying it is effective, though the proper human dose has not been determined yet.

Roche also says that its production of pledged Tamiflu (for WHO) is on track.

Portland Biopharm AVI saw its stocks rise based on some positive results on a universal flu vaccine.

Paper in New Zealand notes that in a real pandemic, counting flu cases would be next to impossible.

The Mercy Corps has formed a Avian Influenza Task Force.

The Financial Times (UK) says that smaller businesses are at higher risk for bird flu. Hadn't thought of this, but its exactly true.

India says its has a test that can detect bird flu in 45 minutes.

Article from a Jordanian newspaper which explains the bird flu to people there.

Part IV (and the final part) of Effect Measure's excellent piece explaining the biology of cells, viruses, influenza, and why the mutations in Turkey are worrisome.

ProMed on the Nature stories referenced in the Effect Measure story. Mod says "Interesting data, but no more than the beginning of what may be a long and complex story."

ProMed has this on a Russian scientist, warning people in that country that the bird flu will be back, and identifying that the Southern regions will be hit first, based on migratory patterns.

ProMed on the Iraqi negative determination, with appropriate skepticism.

ProMed confirms previously reported 35F case in China.

Crofsblog on Christian Science preperation for the bird flu.

Recombinomics says that WHO is covering up evidence of larger family clusters in Turkey--"scandalous."

Thursday, January 19, 2006

January 19 Flu Update

Effect Measure notes that all the experts are saying that the Iraqi case is not H5N1. Heavy false negative alert, as always.

Meanwhile, Indonesia also confirms that a 14-year old girl died of a bird flu.

An Indonesian toddler who died of bird flu earlier in the week is said to be confirmed H5N1.

Meanwhile, H5N1 has been found in a dead bird in Hong Kong, seven miles from the Chinese border.

Yesterday, we noted that Lancet had written about Tamiflu being of unknown effectiveness against bird flu. Helen Branswell is on board with significant criticism of this report.

The lead author, meanwhile, argued Wednesday that the work is a solid piece of analysis aimed not at the public but at the scientific community. And Dr. Tom Jefferson said anyone taking from the review the message that neuraminidase inhibitors -- the better known of which is oseltamivir or Tamiflu -- do not work against H5N1 avian influenza would be misreading the article.

"That's not what the review says. That is wrong,'' Jefferson said from Rome, where he works with the Cochrane Vaccines Field, a division of the Cochrane Collaboration, an international not-for-profit network aimed at promoting evidence-based health care.
Belgium says it will have enough drug stocks in hand by the end of this year.

California has announced its bird flu plan.

WHO says that it expects the flu infection rate in Turkey to slow.

Latest WHO update on the China case (35F) we reported yesterday. Note her family members are under observation.

CIDRAP on the second mutation in the Turkey virus, also covered yesterday. Note that the mutation is bringing the disease closer to human infection.

Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of this Web site, said the findings point up how little is known about exactly what changes would be sufficient to produce a pandemic strain of virus.

"We know what changes occurred in the 1918 virus, but is that the example or is that the model?" he said. "In other words, does it have to be exactly like that, or can it be a series of changes somewhat like that? We don't know if some changes are more important than others or if some changes have to happen together."

While virologists have learned a lot, "there's more that we don't know than we do know," Osterholm added. "The thing I think is concerning about the situation in Turkey is we continue to see the potential for mutations to occur, which in turn leads us to the possibility that all the wrong mutations might occur and result in a 1918-like experience."

Finland says it is ready for the bird flu.

The first of the ordered Tamiflu has arrived in Malta.

Detroit Free Press on the five things you should know about the bird flu.

Military officials met in Stuttgart to discuss the Army's plans if a bird flu hits Europe.

Effect Measure has the third installment on Virus 101.

ProMed with a multi-country review of the flu around the globe. Note continued bird outbreaks in the Ukraine.

Recombinomics on the science behind the flu mutations in Turkey.

With the bird flu safely overseas, Americans continue to voraciously devour chicken.

The Daily Mail (UK) says that elderberries may fight the bird flu. So does sauerkraut, which could make for a medically strong casserole, if highly distasteful.

Wednesday, January 18, 2006

January 18 Flu Update--Has the Flu Hit Kurdish Iraq?

As we reported earlier, officials are investigating a case of possible bird flu in Kurdish Iraq. There's a dead 15 year old girl. Apparently, birds that eventually end up in Turkey will stop in this area.

ProMed on this situation.

Recombinomics on Iraq.

Me on Iraq: quick note, just to say that for those readers for whom history--and 1918--are the main points of interest, the introduction of the flu into a war zone is almost scary.

There is apparently a fifth flu death in Turkey. It was an 11 year old girl who died on the way to the hospital.

ProMed on Turkey.

Declan Butler of Nature is one of the leading science journalists writing on the flu, and he's tied into social networking on Connotea, too. Via Crofsblogs, here is a troubling story on the "alarms over bird flu mutations." Entire article is a must read.

Scientists studying virus samples from the human outbreak of avian flu in Turkey have identified three mutations in the virus's sequence. They say that at least two of these look likely to make the virus better adapted to humans.

The Turkey outbreak is unusual, because of the large family clusters of cases; the fact that many of those infected have only mild symptoms; and the speed with which infections have arisen — twenty cases, including four deaths, in less than two weeks. So scientists are urgently trying to establish whether the virus is behaving differently in this outbreak from previous ones in Asia. In particular, international teams are investigating the possibility that the virus is moving between people.

Recombinomics, citing an OIE report, says that there has been an "explosion" of bird flu in poultry in Turkey, and feels human cases will soon follow.

Recombinomics also looks at the clusters in Turkey, and says the virus is becoming better at transmission.

There's a six death in China, as well. She was a 35F poultry butcher.

ProMed on this case--noting that if confirmed it would be the first case in Sichuan.

ProMed writes that the case fatality rate in Turkey is much lower than that in Asia--but I ask if that's because of more comprehensive case reporting.

World leaders have coughed up (sorry) the $1.9B that it was said was needed to fight the bird flu.

CBC on the bird flu conference.

A good Reuters story on the striking real impact of bird flu on those for whom poultry are a way of life.

The UN's FAO has this warning for Europe--there's plenty of ways for the bird flu to spread around.

"FAO - says FAO Director General David Harcharik - is concerned that new areas may be contaminated as a result of traffic involving goods, people and animals, as well as through bird migrations".

Malaysia says it needs $213M to fight the bird flu.

The UN says every country is needed to fight the bird flu.

An official with the Ministry of Health in Singapore has a good observation. Asia will see more flu cases, because the fundamental conditions--people living in close proximity of birds--haven't changed.
The Taiwanese talk about what they learned at a bird flu conference sponsored by WHO in Taipei.

From the Sydney Morning Herald, a contrarian view from a writer who says the only pandemic is panic.

Malta says a pandemic is unlikely this winter.

The British Medical Journal Lancet will hold an Avian Flu conference in Singapore.

Lancet also warned strongly that too much up reliance is being placed on Tamiflu to prevent a pandemic. Note these strong words for a medical journal.

In a paper published online by the British journal The Lancet, the experts say they see no evidence that the top-selling drug worked against H5N1 avian influenza and fear the treatment could be of limited use if the H5N1 virus ever mutates into a feared pandemic form.

Asia wants more Tamiflu.

How to distribute Tamiflu is an ethical question for companies.

Singapore is hedging its best, and adding Relenza to its stockpile.

In Turkey, a doctor has said that with enough funding the country could have a human vaccine in 2-3 months.

At St. Louis University, they are studying flu vaccines for children--timely given the proportion of infected children.

Vietnam is working on a vaccine, as well.

Effect Measure has a story that I first saw on a great comment from yesterday's update--the H5N1 may cause systemic infections in cats. Among other interesting points, this could explain the spread of virus from farm to farm.

(From the BBC) Writing in Science, the researchers say: "The implications are that, during H5N1 virus outbreaks, domestic cats are at risk of disease or death from H5N1 virus infection, either due to feeding on infected poultry or wild birds, or due to contact with infected cats.

"Second, the role of cats in the spread of H5N1 virus between poultry farms, and from poultry to humans needs to be re-assessed.

"Third, cats may form an opportunity for this avian virus to adapt to mammals, thereby increasing the risk of a human influenza pandemic."

Professor John Oxford, an expert in virology at Queen Mary College, London, told BBC News Online the study was "very significant and slightly alarming".

He said there was little evidence at present that cats could be infected with other forms of human flu virus, and so the possibility that H5N1 could mix with a human virus inside a cat and produce a deadly new strain was probably slim.

However, he agreed that it was possible that cats could be responsible for avian flu spreading from farm to farm - a phenomenon which has baffled scientists.

Professor Oxford said there was also work to suggest that pigs could be infected with H5N1, and, unlike cats, they could also harbour human versions of the virus.

"H5N1 is getting more and more worrisome," he said.

"If any virus is going to cause a great human pandemic in the near future, then it is likely to be H5N1."

Part II of Effect Measure's fascinating story of what a cell is, and how it is infected, and how it mutates.

Breaking News

A 14 year old girl in Kurdistan, Iraq, has died of bird flu symptoms. Obviously, this is unconfirmed until lab results are in, but this is sending shock waves through the community.

Tuesday, January 17, 2006

January 17 Flu Update

Four dead, 21 sick in total, one of which is getting sicker. The toll continues in Turkey.

Reuters on Turkey.

In Indonesia, a three year old boy died of flu, shortly after his sister died in a lab confirmed case.

This story is inevitable...why the children? Is it contact with the birds, or something else? Buried in the story, note this:

With Turks complaining of symptoms still checking into hospitals, there were concerns the virus might still be spreading to people despite the precautionary slaughter of nearly 1 million domestic fowl.

There's also a new case in East China, a 35M.

From the International Donors Conference, the EU and Roche have increased their pledged committment.

The Russians have announced a $40M plan to fight bird flu.

I don't understand why news like this doesn't prompt investment in stopping the flu in Asia, but US insurers today said they could lose $133B in a pandemic.

In New Zealand, 1.4m people will get a letter on preparing for the bird flu in their mail box.

Cyprus seeks more drugs and to calm fears down, at the same time.

World Bank President speaks on bird flu.

Company advertises information on pandemic survival for business, from a risk management perspective.

In New Zealand, the central bank received backpacks with flu supplies.'

Bloomberg has this story, that says the drive for better flu vaccines might improve seasonal flu vaccines, too, which have not been much of a priority to date.

The Times (UK) asks if a pandemic is the circumstance that warrants breaking a flu drug patent.

How the flu scare is effect poultry shops in New Jersey...good local story.

Effect Measure has a very educational first start on explaining how a flu virus works. Dense, but if I can read it, so can you.

Monday, January 16, 2006

January 16 Flu Update

We're back. Was able to check in on the news a little bit over our vacation. Back to the daily routine!

New deaths are reported in Turkey and Indonesia today. For those family cluster junkies out there, two siblings of the dead child in Indonesia are also ill.

Nothwithstanding this, WHO says the threat of bird flu is diminishing in Turkey..

"We do expect to see some (more) cases because it takes time before the virus in birds has completely disappeared," Dr. Guenael Rodier, who heads the WHO mission to Turkey and is an expert in communicable diseases, told Reuters in an interview.

"We know that the risk remains with close interaction between people and birds but we believe it is going down daily."

Aiding in this, Turkey has culled near one million birds.

WHO update on pandemic situation--dateline Turkey.

Ducks began dying in the family’s household flock on 1 January. On that day, the girl, assisted by her brother, slaughtered a duck for food.

On this same point, Effect Measure writes on the seminal question--is it going H2H yet? Of course, as he notes, its almost inescapable that if it can, it will, so the question is prepare now or later.

ProMed on Turkey. A few interesting points.

  • 16 of 20 cases not serious.
  • Case was originally a false negative.
  • Because isolates are similar to those in China, mod theorizes that its social and environmental causes--and not the virus--that explains the differences in Turkey.
OIE report in Turkey.

WHO's David Nabarro is pushing large nations to put money into flu fight.

Take a deep breath...Jerusalem bird flu fear unfounded. (and say that three times fast).

The EC is pushing for European countries to step up flu flight checks of people and baggage.

"It's very easy to blame bird migration, because then no one's responsible," said Juan Lubroth, a senior United Nations scientist who has spent the last week in Turkey investigating the outbreaks. "Migrating birds may introduce the virus into an area, but it is human activity that spreads it."
Iran is preparing for the bird flu to cross the border from Turkey.

Delegates from France are in Vietnam learning how to fight the bird flu (historic irony warning)

Bulgaria got 500 packs of Tamiflu donated.

The Fort Wayne Journal Gazette notes that the flu pandemic would strain drug supplies--which it would.

The WHO Lab in London is a central point of the flu drama, based on this story.

ProMed on Indonesia, detailing cases and clusters.

Recombinomics notes that (unconfirmed) reports from November showed that 77 cullers had died in China--and then notes additional evidence--that of massive drug shipments to the region. Obviously, any unknown outbreak of this size would be signficant. Oddly, if we knew the virus in Turkey was similar to that in China, and that outbreaks had occurred in both places, then it might actually reduce some worry about the virus getting worse.

Recombinomics notes this indication of cluster to cluster (C2C??) transmission in Turkey.

Thursday, January 12, 2006

January 11 Flu Update

We are going on a little trip for the holiday weekend, so the next update of this blog will probably be the evening of January 16.

The deaths keep coming. There were two more deaths in China.

There was also a bird flu death in Indonesia.

There is actually some consolation in Turkey, as signs of recovery are comforting.

Helen Branswell on increasing scientific work that indicates bird to human in Turkey--though still preliminary, that's where the signs are posting.

Recombinomics cites reports that say there are some changes in the virus.

Meanwhile, the UN says its needs $1.5B for the bird flu fund.

Meanwhile, a potentially important scientific find has occurred in Turkey. They are found two brothers who are asymptomatic with bird flu.

CIDRAP has a report on this, as well.

ProMed on the asymptomatic cases in Turkey. Mod comment is excellent, noting that some have been calling for seroprevalence studies among people living around birds for some time.

Recombinomics comments as well.

The UN says the virus "may be spreading despite the control efforts."

Remember all those Europeans countries ending their flu programs because the migration season had passed? Those plans are now being extended.

This New Scientist article (abstract) says that stamping the flu out in birds is possible, but would require rich countries to spend money in other countries.

Bloomberg reports the global total has passed 150 (ed note: known) infections around the world. The UN is saying we have warning this time, but need to know what is happening. An Asian meeting is upcoming to discuss monitoring.

Very intersting social flu effect. New Zealand says in 1918 funerals were part of spreading the flu, and that there will be no funerals during a pandemic.

In Pittsburgh, a doctor talks critically about the public health, and says the society cannot conceputalize what would happen in a pandemic.

New Zealand is running a national marketing program to help prepare for the bird flu.

The Journal of Molecular Biology has this report: a new test, called a glycan array, can be used to determine if the bird flu is mutating.

The test, called a glycan array, shows it would take very little change for the H5N1 avian influenza virus to cause a human pandemic, said Ian Wilson of the Scripps Research Institute in La Jolla, California.

"It would appear that two mutations could change the specificity dramatically going from avian to human," Wilson said in a statement on Tuesday.

WaPO editorial on Turkey, and what should happen next.

There are reports of counterfeit Tamiflu.

In UK, during urgent situations, drug import won't be an issue.

Effect Measure comments on an article calling for a "Manhattan Project" against infectious disease.

ProMed on Romania (more bird cases), China and Turkey.

Another ProMed survey of news.

Via Crofsblogs, a survey says US emergency rooms are not ready for the bird flu.

Tuesday, January 10, 2006

January 10 Flu Update

There's a new reported case of bird flu in Turkey.

Turkish PM says flu "under control" there.

More...cases are not critical.

OIE says bad weather is making the flu fight harder.

WHO Update on Turkey. Says 100,00 courses of Tamiflu have arrived--we'll see about the resistance issues now.

In Britain, a lab is ready to crack the code of the flu in Turkey, and reveal all its secrets.

Researchers at the National Institute of Medical Research can use the code to determine whether the virus is resistant to Tamiflu, the drug being stockpiled to deal with a potential pandemic, the London Telegraph reported.
"It is incredible. This will tell us where the virus came from. It will tell us whether there have been mutations," he said.

Effect Measure on this, and the Turks who are flooding hospitals and clinics...and how, in his view, the claims of "no evidence" that virus has changed being increasingly "hollow"

Excellent comments on Effect Measure as well, including some from Revere and Recombinomics.

ProMed on the WHO report from Turkey...note the following.

So far, children have predominated among fatal cases of the disease, and there has been no apparent transmission of virus between family members, although siblings have been infected. Healthcare and agricultural workers have not featured as victims of infection. These features suggest that the transmissibility of the H5N1 avian influenza virus remains unchanged.

Effect Measure lays out the spectrum of potential answers for the riddle about why people seem to be getting infected in Turkey more than elsewhere. Note that he echoes my comment from yesterday that flu doesn't need a high fatality rate to be catastrophic.

Helen Branswell is back. She writes that the first impression--and only that--is that the disease is no different than in Asia.

"I don't think there is something strange going on. That's not my impression," Rodier said from Ankara, Turkey, during a WHO briefing for reporters.

"But we're talking about impressions here, not about fact. And fact has to be established by data collection and data analysis, and that takes time."

ProMed on the study about the higher incidence and lower fatality. Mod comment below is valuable, as always.

In the absence of supporting serological data, it is premature to conclude that all or any of the symptomatic flu-like illnesses recorded are associated with H5N1 avian influenza virus. There are a diverse range of human respiratory viruses that could account for these findings.

CIDRAP on the news cases in China and Turkey.

Recombinomics has data that says 139 suspected and confirmed cases are in Turkey. Heavy on the suspected.

In Russia, Vladimir Putin is pushing for Russia to protect its southern border against bird flu.

Serbia is increasing border patrols as well.

ProMed on border controls in Bulgaria.

The Salt Lake City Tribune reminds everyone that when it comes to the bird flu, don't forget the pigs.

US Labor Unions are looking for protection for front-line workers in the event of a pandemic.

Alabama says chickens there are "really safe."

How will zoo animals in San Francicso be protected. Articles says they will go off display as soon as the flu is near.

Not suprisingly, this report says that Roche has reserved enough Tamiflu for each of its 65,000 employees and their families.

Vietnam says it has extracted shikimic acid from star anise.

Given that the flu may develop resistance quickly to Tamiflu, the Vietnamese are adopting their strategy for fighting the flu.

In Japan, H5N2 may have its first human cases.

Radio Open Source at NPR is planning a story on "The virus hunters." They are beginning to work on the show, and contacted me this week about who they might talk to about the bird flu. They also asked me to encourage you to go to their website, and submit the questions you would like to ask to the top scientists and authorities in the flu field.

The link is here.

I also was contacted by CBC, and had the opportunity tonight to preview a rough cut of a docudrama they are airing on January 11 at 9 PM--Eastern, I assume. It is excellent, and if you're reading with CBC access, you should tune in. It focuses on a family with a nurse/mother, and her dilemma...as well as showing people heading for the hills--only to be not welcome. Interspersed are experts like Dr. Webster, and other Canadian public health experts. Schools are closed, Vatican City closes St. Peter's Square, etc...and yet, each public health expert says that those measures don't really help. This is the full dramatization of Dr. Osterholm's (who is featured) "We're Screwed" scenario.