Tuesday, February 28, 2006

February 28 Flu Update

Just today. Germany. Sweden. Iraq. Ethiopia. Russia. 35 countries in total now.

Bird flu, welcome to a European mammal. Cat in Germany has H5N1.

Health officials urged cat owners to keep pets indoors after the dead cat was discovered over the weekend on the Baltic Sea island of Ruegen, where most of the more than 100 wild birds infected by the H5N1 strain have been found.

As Recombinomics notes, this isn't a surprise, yet it will still focus people's attention.

Meanwhile, bird flu was found in two ducks in Sweden. H5N1 is being confirmed.

CIDRAP on Sweden and Germany.

The US has banned chickens from a part of France from import.

After what has been reported as H5 in Pakistani chickens, the country says it has ratcheted up the bird flu fight.

66 areas are still under quarantine in Turkey. Originally, 106 were quarantined.

Russia confirms another outbreak in Southern Russia, reported first yesterday.

A group of experts met in Paris, and they are citing the broad spread of the disease for raising concerns.

CNN also reports from Paris, where the situation in Nigeria is criticized, and H5 with a large bird die-off is noted.

Iraq is checking four potential new human cases. 3 cases are reported to be in Baghdad.

DEFRA, (UK ministry) reports on the state of bird flu.

Defra is asking all keepers of any types of birds to maintain a high level of biosecurity to reduce the risk of introducing the disease. Everyone who keeps poultry or other domestic birds should remain vigilant for signs of the disease.

Canadian Press with another story on what business should do to plan for the bird flu.

Skowronski said predicted infection rates in Canada are between 15 and 35 per cent. Influenza historically has a low death rate - the 1918 pandemic that killed at least 50 million people globally was an aberration - and most people will recover without any medical intervention and only a tiny fraction would need hospital care, she said.

At a similar meeting in Washington, Dr. Osterholm told business to think of bird flu as "a blizzard in Washington." Also: this is not a time to reward people for coming to work sick.

On the containment plan, is Britain developing a high-tech lollipop that will detect bird flu.

The Czech Republic is upping its Tamiflu stocks.

Effect Measure takes stock of what we know, Part II.

The debate that never ends--Promed on the migratory bird debate.

ProMed sums up some news from Europe--noting some things originally reported here yesterday.

Dr. Gleeson on the running tabulation of prediction on his website. They are not on the conservative side, nor are they outlandish.

Finally, the Economist weighs in on the bird flu, noting, accurately in my opinion, that the bird flu is a more serious threat in poor countries than in rich countries.

Monday, February 27, 2006

February 27 Flu Update

Having connectivity issues, this is all I could eke out.

WHO says there are now 173 cases, 93 fatal.

China reports two new cases, a 9F and a 26M. They are the 14th cases reported in that country.

CIDRAP follows this story as well, reporting they are in critical condition.

CIDRAP also reports on five new countries with bird flu confirmed or suspected.

One of them is Niger--Recombinomics has more.

The WHO Director-General issued a pretty basic bird flu statement....

The main health risk currently is to people who are in close contact with infected poultry, such as families with backyard flocks and poultry workers in wet markets or live animal markets.

Reuters give a good overview of the current state of play for the virus.

Of course, Effect Measure gives an even better on, with Part II to come.

The 21M in Romania from yesterday is said to be negative. As always, first diagnoses are often suspect.

WHO is praising India for its bird flu response--fast and efficient.

With bird flu in Switzerland, the obligatory "don't panic" responses are coming out.

Nigeria continues to reap the harvest of years of governmental abuse...farmers are too suspicious and are hiding their birds--mean the outbreak there is worse than people know.

More stories on the reeling poultry industry in India.

Odessa, Ukraine, has bird flu in a resort zoo, much like what happened in Jakarta.

Finland is testing 13 dead birds for H5N1.

Pakistan says it has found LPAI there. Again initial negative reports often change...

...as Recombinomics notes.

Alabama has a bird flu strategy published.

Britain updated its contingency plan as well.

Chiron is seeking approval for its bird flu vaccine.

On another front, Novartis And Alnylam are working on RNA interference programs.

APEC says bird flu continues to be a regional priority.

The point is made once again...poor countries need funds to fight the bird flu.

Candidly, I'm not sure how I feel about this, but Dr. Gleeson is inviting readers to predict the scope of the pandemic.

Here are his predictions:

1. I believe that the virus has a 30% chance in each of the next two years to become a global pandemic.

2. I believe that this virus will behave like a immunologically unrecognized influenza virus and infect 30% of the population.

3. I belive that 5% of those who are ill will die. Yes, this is higher than my initial guess a year ago, but this darned virus is not behaving according to the rules. And twice as many will die in developing countries as developed countries.

Busy day at ProMed...WHO updates on China and Indonesia.

The French have filed an OIE report, with birds outbreaks in the Southeastern part of the country.

And the ball goes back over the net, as the migratory bird debates continues, well, unabated.

ProMed reports on five different countries part I...

and Part II.

Feburary 26 Flu Update

Dead duck heralds bird flu in Switzerland.

ProMed says its is H5, but N1 not confirmed.

ProMed also had continuing news of new outbreaks, including Romania (birds), China and Croatia.

ProMed also covers the news from Asia. Note five people have been quarantined in Malaysia, and poultry sales are down 30%.

Romania is reporting a suspected human case, a 21M--no word on his connection to the birds.

A Montreal NGO issues report that says that the its not wild birds, and its not backyard bird farms (your previous two key suspects...) its the evil poultry industry. No doubt, BTW, that the virus does appear to spread quickly on a farm, but how does it get there. Clearly, political agendas are intruding on any serious efforts to answer this question.

More swans are dead in France.

The Indian bird flu is sending shock waves through the Indian poultry industry. Locals hope a chicken and egg festival will help revive the industry...

...as thousands of poultry workers have lost their jobs in the aftermath (of the flu, not the festival.)

A bird flu outbreak has been reported at a farm in Southern Russia.

The woman who died last Monday in Indonesia is now a confirmed bird flu death.

Germany also has three new wild birds with bird flu.

Additional news from the State of Washington on their flu plan.

Geoffrey Garrett, a British infectious disease expert, was intending to calm fears when he said that he didn't think that H5N1 was going to cause the next pandemic. He said:

"There are other influenza strains out there causing infection in birds that could start to spread from human to human."

A Ft. Myers FL paper ran this editorial--an actual checklist of things business and families could do to prepare for the bird flu. Very interesting, as they note that they expect to be accused of hyping the flu to sell papers. So, the checklist is discreetly placed in the opinion pages.

Senator Wayne Allard (Co) writes a coluumn on the US being ready for the bird flu.

Lansing, MI TV station on the popularity of Tamiflu.

Newsweek writes on new technologies being developed to help to combat the bird flu.

Of course, many promising treatments flame out once they move from animal tests to human trials—and it's still unclear whether avian flu will become readily transmissible among people. But if it does, products like these might one day be a real shot in the arm.
Effect Measure writes on the story we ran yesterday on the publicity the Flu wiki got.

In the midst of some highly technical genetic stuff, Recombinomics says that recent samples show this:

The acquisition of these human polymorphisms is cause for concern. These acquisitions create longer regions of identity with human influenza sequences, which increase the likelihood of additional recombinations. The acquisition of human polymorphisms in isolates from Vietnam and Thailand has been noted as have the acquisition of European swine sequences.
Finally, must read from Laurie Garrett, one of our favorites. She tells us bird flu might be in US by early Fall.

Sunday, February 26, 2006

February 25 Flu Update

China reports two new human cases, and fears a massive outbreak in the Spring.

Earlier on Saturday, Xinhua reported that two new human cases of bird flu had been diagnosed in the east of the country.

A Chinese girl in eastern Zhejiang province and a woman farmer in neighbouring Anhui province were currently in critical condition, Xinhua cited the Ministry of Health as saying.

Effect Measure uncovers an interesting story about a comment that says that the virus killing birds in Indonesia is different from the virus killing people. Obviously, the genetic makeup of the virus is the #1 item on the watchlist.

PETER CAVE: Are you seeing mutations in the virus in Indonesia?

ANDREW JEREMIJENKO: Yes, that's a good question. We are seeing mutations in the human virus. We are not seeing that same mutation in the bird virus. And that's of great concern.

Basically, when you do an investigation of a bird flu case, you should try to find the virus from the human and match it up with the virus from the bird and find the cause.

Now, in Indonesia, the investigations have been sub-optimal, and they have not been able to match the human virus to the poultry virus, so we really do not know where that virus is coming from in most of these human cases.

PETER CAVE: Does it suggest it's going through an intermediary before it's infecting humans?

PETER CAVE: It's a possibility that we can't rule out. I think they really need to do a lot more investigations. So far the closest match we have to the human virus is from a cat virus. So the cat could be an intermediate. We really don't know what's happening yet. They need to do more studies, they need to get better investigators on the ground to work out what is happening in Indonesia, and it needs to be done urgently.

PETER CAVE: Can Indonesia do this on its own?

ANDREW JEREMIJENKO: I think they need international assistance. So far the investigations have been unable to match the viruses. It is poor communication between the Department of Health and the Department of Agriculture. There are many reasons, but they don't seem to be able to match the viruses from the human case to the animal case, and that is putting the world at threat.

Here's the raw interview.

ProMed reports that the bird flu is back in Cambodia.

EU tries to avert flu-based trade war...one of the predictable human effects of the flu.

In India, a medical college official is strongly critical of the media for creating panic around bird flu.

Similar theme--two more sick birds, no need to panic.

(Question: when is panic ever needed?)

Wire story: health officials are alarmed at the fast spread and sweep of bird flu across Europe.

Dr. Scott Dowell of the U.S. Centers for Disease Control and Prevention said it's difficult to predict the spread of the disease in the next few months, because public health officials have little experience tracking a disease spread by migratory birds.

"I'm not an expert on migratory birds carrying human pathogens. I don't know who is. We're going beyond our experience," said Dowell who heads CDC's global disease detection program.

The closest analogy he could think of is West Nile virus, a bird-associated illness that began in Africa and landed on the East Coast of the United States in 1999. Within four years, it had spread to the West Coast.

As to where the virus has the best chance of morphing into a more serious human threat, Nigeria, where many people live close to their chickens, poses a particular threat. Its 800 federal veterinarians lack the support they need to combat the disease, said Dr. Peter Cowen, former director of a WHO coordinating center in veterinary public health.

Indonesia confirms 20th death.

More Indian "hype?"--can the country stand a second outbreak.

India says all its 95 human samples were negative.

Here's some dead birds reported to have died of something other than the flu.

Pakistan says it is still bird flu free--no mention of anything in Kashmir, where a case was earlier suspected.

Promed on South Korea and Malaysia.

New York State releases its pandemic plan.

Preparations in Washington (as in the state) are ongoing. Article includes collaboration with other states and British Columbia.

A Japanese companys says it can use a petrochemical product to replace the star anise chemical used in Tamiflu. This is not the first time that shikimic acid has been synthesized.

A conservative think tank says that the FDA is over-regulating vaccines and preventing production.

Dr. Gleeson points to what he thinks people should look at when planning for a H2H pandemic.

Recombinomics has some genetic data, with quick results from Italy.

Finally, here the fluwiki gets some news coverage, and some cautious praise from the "real" scientific community.

Saturday, February 25, 2006

February 24 Flu Update

The Wall Street Journal ran a very interesting story out of their Hong Kong Bureau (Nicholas Zamiska) yesterday on how the world has been hurt by an academic dispute about bird flu samples in China. A US group of scientists had written a paper based on some Chinese samples from Qinhai, and did so without crediting the Chinese scientists. (Link is subscription required).

"Since that meeting, China hasn't provided a single sample from its infected flocks, despite repeated requests by WHO amid roughly 30 outbreaks the country has reported in tthe past 12 months."

Effect Measure comments on this story and this topic as a whole. Certain behavior might be acceptable in ordinary times, but not in extraordinary times.

Viruses move across borders much more quickly than data, even though the latter are capable of moving with the speed of electrons. The speed bottle neck here is social and political. Neither the outmoded system of international relations nor the twentieth century mentality that governs senior academic researchers and journal editors works in this situation. In an emergency there must be some recognition that the usual criteria of personal and national credit are suspended. That might entail both a real and a perceived sacrifice in recognition, credit and perhaps economic benefit. Since that is a lot to ask of people and nations, we see the best antidote is worldwide censure of behavior that in other circumstances would be considered acceptable and usual but in this circumstance is reprehensible.

WHO is reporting that a third human case in Iraq is suspected, north of Baghdad. Also, story notes that Perdue of WHO says that the disease appears to be the isolate from Turkey.

WHO is warning Iraq to do more to control bird flu.

South Korea is talking about four confirmed human infections. I think this is important. They were exposed in late 2004 to early 2004, and showed symptoms, yet have the antibodies today.

ProMed on this and others news. Mod comment on what this could mean.

India is awaiting one last lab result, but expects it to be negative as well.

However, not everyone is accepting what is coming out of India's news machine. Effect Measure translates a classically oblique and diplomatic that could signal real concerns about what has been learned there.

Here's the WHO report.

Recombinomics on what could be a human death in India.

ProMed with the straight news from India.

CIDRAP reports bird flu is in Georgia--the former Soviet state.

ProMed worldwide survey. Note especially the late reference to many dead birds in Pakistani Kashmir.

ProMed worldwide survey II.

Chiron says it will produce 70% of its US vaccine order before turning its attention to the next round of seasonal viruses.

Indonesia has the most cases, and this Australian says that the country has too little money and expertise to fight the bird flu.

ABC News (US) has this on a pandemic drill help in Lyon--a low-profile kind of effort from which things could still be learned.

This is something we would expect to see more of as things get worse--the Japanese have banned French poultry.

Here's another: poultry farmers in Nigeria are highly suspicious of the government's bird flu plans--a polisci point: mistrust in government, growing everywhere, will be making fighting a bird flu harder.

In Europe, airlines are looking for SARS on clues to fighting the bird flu.

European airlines have drawn up contingency plans to ground thousands of flights and installed disease protection supplies on planes in the event of an outbreak of the bird flu virus in Europe. There have been no changes so far to passenger's travel patterns following positive tests for the H5N1 strain of bird flu in poultry in Europe, but airlines said on Friday they were leaving nothing to chance. Adopting lessons from the deadly SARS epidemic in Asia two years ago, some airlines have installed masks, goggles and gloves on planes while training staff how to respond to an epidemic.
We ran the picture earlier this week, but here's the National Geographic story--the ravens of the Tower of London have been brought in.

Controversey in Australia over speculation bird flu is already there.

Sensibly, the Red Cross says that the key to fighting bird flu is to empower local communities with information and resources--just what Secretary Leavitt says, though doesn't necessarily do.

Tamiflu has been good for business at Roche.

Indonesia is buying 12 million capsules of Tamiflu--5 million from Roche and 7 million from local sources.

Roche is trying to help India with its prevention need--more delivery statistics.

With all the Tamiflu talk, its important to keep in mind that there are still open questions as to its overall effectivenss. Enter Forbes with this article on concerns about drug resistance. Though this is for seasonal flu, it provides a cautionary tale.

A lecture was given at Purdue University on the bird flu. Here's the key quote:

George Avery, assistant professor of health and kinesiology, believes the issue is a serious problem, but not as big as many believe.

"We have the ability to develop these medicines and human-to-human transmission has not yet been proven," he said.

"Our current state of sciences are so advanced, we would be able to deal with (an outbreak)."

Local TV reports on how to find Tamiflu in the Tennessee Valley.

Effect Measure on the way chickens are raised in Arkansas. We often say that bird flu risk is less here because of how we raise chickens--read this for a different perspective.

Thursday, February 23, 2006

February 23 Flu Update

Welcome Daily Source Code Listeners! Thanks for checking in, and I hope you come back soon! Thanks for the mention, Adam!

The Daily Source Code interviewed two venture capitalists from Kleiner Perkins Caufield and Byers. One of them was an MD. Very interesting. They are funding companies with new vaccine technologies, new anti-viral technologies, and an instant flu test--critical to the "containment plan." They view these to be "platform" technologies of use even if there's no pandemic. Their firm is putting in $200M, and expect that to attract an additional $800M. Give a listen.

Here's a release on the formation of the fund.

USA Today says 60% of Americans worried about the bird flu. The most useful way to look at this poll--what would people do right away if the bird flu hit?

About 46% of respondents who eat chicken said they would stop eating it if bird flu hits the U.S. poultry industry.

If human outbreaks occurred, 75% said they would reduce or avoid travel, 71% said they would skip public events and 68% said they would stay home and keep their children at home while the outbreak lasted.

Behavior might change back once people get used to it.

Today's big news is that 11 of the 12 people in India in quarantine are said to be cleared of bird flu.

CIDRAP on India's negative human cases, and the arrival of bird flu in birds in Slovakia. Other nations are also covered.

ProMed also on India...

and ProMed on the rest of the world. Note brief mention of Palestinian National Authority outbreak.

And it looks like the bird flu has hit domestic turkey farm, the first time it has spread beyond wild birds in Western Europe. Case counts continued to rise across Europe.

On France, Recombinomics says that the outbreak is of concern, especially is swine are around.

News is almost too plentiful coming from India. The BBC as a nice, clear story on what the state of play, as we know it today is.

Meanwhile, in Malaysia two people have been admitted to the hospital for influenza tests. This is in addition to four people already being tested.

The British government awarded 33M pounds in contracts for human vaccine.

A British critic savages government bird flu plan..."disarray."

New Zealand's parliament has issued a similar report, citing "gaps" in planning.

The UN is calling for an intense international effort, including bird vaccination, in Nigeria to try and contain the virus in what could be a serious trouble spot.

Indian experts are saying "simple precautions" will protect citizens from bird flu.

The Mayor of London is afraid that racing pigeons might spread the flu, but pigeonbasics.com says that is wrong.

The Health Protection Agency (UK) notes that it is valued for its expertise around the world.

Secretary Leavitt's Magical Mystery Flu Tour stopped in Nebraska, which touted its preperation programs....

tour coverage also includes Alabama.

A scientists in Australia says he believes H5N1 is already there, and a regional government releases its bird flu pandemic plan, a typical mix of closed schools and makeshift morgues.

Here is Dr. Anthony Fauci on how a "robust" flu demand for seasonal vaccine would help us prepare for a pandemic.

Deloitte's lead pandemic guy was in Australia talking risk management.

There's patent fighting in India over Tamiflu.

The Isle of Man had its first bird flu scare, with seven dead swans which are said to have tested negative.

Effect Measure on "the luck of the Irish."

Another enlightening post from Dr. Bob Gleeson. He now views H2H as unstoppable, though current situation is a steady yellow.

Pretend we identify an H2H cluster in rural Indonesia, a cluster that can not be stopped. Ten to twenty days of rumors and confusion. This cluster will enlarge and spread (how well and how fast depends totally on the how easily the virus transmits from person A to person B and C). Suddenly, there are sick people in Jakarta. Ten more days of confusion and rumor. And, all of a sudden, more cases and then, bam, the travel restrictions go up. If you are in Jakarta, go to a nice hotel, you might be there for several weeks.

Wednesday, February 22, 2006

February 22 Flu Update

There's a report of another death in Indonesia. Tests are being confirmed, but contact with chickens is reported.

Navapur is the region where bird flu has hit India hardest. All the chickens there were culled.

ProMed on birds in Malaysia reported as negative, and says India has confirmed human cases.

Recombinomics says Navapur has a cluster, and its getting bigger.

12 patients in India are isolated and treated with Tamiflu. No reported cases of bird flu.

Here it says five cases are being tested and results will be known Thursday night.

Here is says rumors of cases are unproven.

ProMed on bird cases in Austria, cases now on mainland Germany, and suspected bird outbreaks in Slovakia and other news from around the world. Here's the list of countries with bird outbreaks.

Austria, Azerbaijan, Bosnia Herzegovina *, Bulgaria, Cambodia, China (People's Rep. of), Croatia, Egypt, France *, Germany, Greece, Hong Kong (SARPRC), Hungary, India, Indonesia, Iraq*, Iran, Italy, Japan, Kazachstan, Korea, Laos, Malaysia, Mongolia, Nigeria, Romania, Russia, Slovakia *, Slovenia, Thailand, Turkey, Ukraine, Vietnam.
The Times of London surveys what is going on in Europe, including Britain ordering 2m doses of bird vaccine.

An Indian writer notes that bird flu is manna from heaven for people who run Internet scams.

FAO says that Afghanistan is woefully underprepared for flu, and since it is surrounded, its only a matter of time.

Krishanagiri is an Indian state with many migratory routes over it, and at higher risk of bird flu. They are taking steps, but they seem like baby steps.

Pakistan says there's no bird flu there, but they are preparing as well.

Ireland says proper defenses are in place there for bird flu.

Nigeria destroyed 100,000 chickens.

Vietnam set up a steering committee on preventing bird flu passing to humans.

The EC approved vaccination of poultry in France and the Netherlands.

WHO updates Nigeria. Four people with potential flu, one dead. The outbreak is now known to have begun on January 10.

Recombinomics notes this, and adds reports of dead dogs and cats.

The State of Delaware had a bird flu summit.

Venezuela is acquiring Tamiflu.

Effect Measure notes that seasonal flu is shutting down hospitals in OK, and the question of what would happen during a pandemic is not lost on the people there.

CIDRAP on the spread of bird flu, based on WHO reports. Here's an interesting take on the migratory bird debate...could it be trains.

The WHO stopped well short of assigning to migratory birds the major blame for the virus's recent spread, a notion that has been controversial. David Halvorson, DVM, a veterinarian in avian health at the University of Minnesota in S. Paul, said today that H5N1 is probably being spread both by the movement of poultry and by the movement of wild birds, but no one is absolutely certain.

"The fact is we don't really know why it's being found in so many places so suddenly," he told CIDRAP News.

Halvorson suggested that trains may play a role in the spread of H5N1, as they have in past outbreaks. In the United States in 1925, "People were shipping poultry to New York live bird markets. Then dirty, contaminated crates were being shipped back." This contributed to the spread of a highly pathogenic avian influenza (HPAI) outbreak.

"I think that the trans-Asian railway system fits the temporal and spatial pattern of virus distribution starting in July of last summer," Halvorson commented. "For us in the Western Hemisphere, it would be extremely unusual for water birds to be migrating thousands of miles in July and August, a time when they are ordinarily taking care of their young."


It is considered unusual for an avian influenza virus causing outbreaks in birds to remain this genetically stable over so many months," the statement continues. "This finding raises the possibility that the virus – in its highly pathogenic form – has now adapted to at least some species of migratory waterfowl and is co-existing with these birds in evolutionary equilibrium, causing no apparent harm, and travelling with these birds along their migratory routes.

"If further research verifies this hypothesis, re-introduction of the virus or spread to new geographical areas can be anticipated when migratory birds begin returning to their breeding areas."

The ever-present migratory bird debate is attacked again via Promed. Here, the author tries to get after the conservation lobby's attempt to have it both ways.

A similar argument was used when the virus appeared in Nigeria. That country is a winter destination for birds that summer in Siberia. There were Siberian outbreaks in summer 2005, and then recently in Nigeria, but not, it appeared, in Egypt, where most migrants from Siberia to Nigeria must pass. "How did it skip the whole Nile delta and get to Nigeria?" asked William Karesh of the US's Wildlife Conservation Society last week in the Washington Post newspaper. Now it appears that H5N1 did not skip Egypt. "The cases in Egypt make it even harder to say it wasn't spread by wild birds," says wildlife virologist Bjorn Olsen of Umea University in Sweden. It is possible, e adds, that the virus was not detected in India and Egypt until now, because it entered the country in very few birds, but has steadily multiplied, as infections multiply among birds in crowded wintering colonies.

Breaking Podcast News

The bird flu and the Kleiner Perkins VC firm creating a pandemic investment plan is the focus of today's Daily Source Code with Adam Curry....that's a podcast, and one of the most listened to anywhere. Check it out.

Tuesday, February 21, 2006

February 21 Flu Update

Quoth the Raven...


WHO update on the "rapid geographic spread" of bird flu.

For human health, experience elsewhere over the past two years has shown that the greatest risk of cases arises when the virus becomes established in small backyard flocks, which allow continuing opportunities for close human contact, exposures, and infections to occur.

All available evidence indicates that the virus does not spread easily from poultry to humans. To date, very few cases have been detected in poultry workers, cullers, or veterinarians. Almost all cases have been linked to close contact to diseased household flocks, often during slaughtering, defeathering, butchering, and preparation of poultry for consumption.

No cases have been linked to the consumption of properly cooked poultry meat or eggs, even in households where disease was known to be present in flocks.

France and the Netherlands are both calling for poultry vaccination in Europe.

Hungary confirms bird flu in birds--seventh EU Nation.

Helen Branswell on efforts to quell fears of bird flu.

John Wood, a leading influenza virologist, doesn't believe the recent developments have changed the nature of the pandemic threat posed by this virus.

"I think the risk is still the same as it was a few months ago, before the virus started moving all over Europe and into India and Nigeria," Wood, who's with Britain's National Institute for Biological Standards and Control, said yesterday.

The story goes on to quote the experts as saying they worry more when disease is in domestic birds, as opposed to wild birds. They then note that Nigeria and some other countries have had recent poultry outbreaks.

Effect Measure has a different WHO report that talks about mutations of the virus. Despite Dr. Nabarro saying that the virus was two mutations closer to H2H, this WHO statement says that its really very difficult to know that for sure. (I'm paraphrasing, you should read the whole thing yourself.) Revere is disappointed, though, when WHO concludes a nuanced statement with paradoxical confidence that human transmissibility isn't imminent.

Here's the link to the WHO report.

In India, the soybean industry says it won't be hit by the flu there, even if it loses chicken feed as a market.

As reported yesterday, Flu is back in Malaysia with 40 reported dead birds.

I think its a fair observation that there seem to be strong reactions in India to the flu being found there-but maybe its only because there's more English-language media there. There are apparently 8 new potential human cases in that country. Note this:

At a meeting of the CCEA, Prime Minister Manmohan Singh and his senior colleagues decided to get the railways and Indian Airlines lift the ban on serving chicken and eggs. The decision came as different wings of the government appeared to be pulling in different directions.

Let's assume the use of "wing" is an unintentional pun.

Animal vaccine makers in India are gearing up a response.

WHO experts continue to express concern.

``It's absolutely unprecedented,'' WHO spokeswoman Maria Cheng told The Associated Press. ``We've never seen so many outbreaks of the same virus in so many different regions, and our concern obviously is that humans could potentially come into contact with birds infected with H5N1, which would mean populations worldwide are potentially at risk.''

FAO says bird flu continues to spread among birds in Nigeria, but with no reported human cases.

The Indian Ag Minister has asked the media to stop inciting panic.

Officials in a part of India are reporting that they delayed reporting the bird flu, though only for a few days.

Bulgaria says no human cases in that country. (We doubted this one before).

Pigeonbasics.com is defending pigeon racing from bird flu panic.

Birds are dying in Niger, and the flu is feared.

Slovakia also reports bird flu in two wild birds.

Contrary to a report yesterday, the Palestinian MOH says no bird flu there.

The Daily Telegraph brings back stories from the 1918 flu, and reminds everyone that we are "overdue" for a pandemic.

Two large Swiss Pharma firms are combining forces to develop a RNAi based vaccine for bird flu.

"An RNAi therapeutic could be an innovative modality, crippling the virus through incapacitating several genes. In addition, such drugs might be adapted to new strains as they emerge. Of course, the technology is young and is just now being tested in early clinical trials, but our hope is that it will open new therapeutic frontiers," he added.

RNA interference, or RNAi, is a naturally occurring mechanism within cells for selectively silencing and regulating specific genes.

Since many diseases are caused by the inappropriate activity of specific genes, the ability to silence genes selectively through RNAi could provide a new way to treat a wide range of human diseases.

Fake Tamiflu continues to be available on the Internet.

Indonesia will deliver Tamiflu through community health centers. (Each center gets enough pills for 10 patients).

ProMed...travel warnings issued for Egypt, and surveillance ongoing in India. Mod CP says...

No new human case has been reported from any country. Also there has been no confirmation of direct transmission of H5N1 avian influenza virus from wild birds to humans anywhere in the outbreak areas or beyond. The screening [in Imdia] appears to be based to a large extent on symptomatology and may be intended to reassure the population rather than to locate human cases. -Mod.CP
Promed with various surveys of the news around the world. Note that poultry sales are plummeting.

Monday, February 20, 2006

February 20 Flu Update

Reuters says six are in quarantine in India, and officials are going door-to-door to find the bird flu.

Door-to-door surveying has three babies in quarantine.

(Is it just me, or could this door-to-door searching be counter-productive?)

No flu in Shimoga, India.

Here's the fall out from flu on the Indian stock exchange.

Indian drug companies are gearing up to provide Tamiflu if there is a human outbreak.

Apparently, there was doubt about flu tests initially in India when bird flu was announced. The government has now put that to rest.

India's neighbors are closing out poultry from India.

Outside India, the flu continues to spread in Nigeria.

Here's another article from Nigeria which attempts to educate citizens there.

Most health experts researching and fighting the incidence of human bird flu do not have an optimistic outlook. They point out that the pathogen has not appeared to evolve such that human-to-human contact is contagious, yet it remains that people working with fowl, swimming in infected rivers, playing in an area where carcasses were buried, or breathing air near a poultry processing plant, can lead to infection.

In South Africa, efforts to educate poultry trades are proving difficult.

Bulgaria suspects its first human case. I'm not sure why--the article says he doesn't have the symptoms--but we can keep an eye on this one.

South Africa is planning for the arrival of the flu with the idea it has six months to prepare.

In the meantime, South Africa has Tamiflu listed as one of its precautions to the bird flu.

Its not just in the US--Australia is now talking about providing indemnity to vaccine makers in return for speeding up production.

Arizona has revised its original pandemic plan from 2000.

Here's an excellent article from the BBC. The Tamiflu Containment Plan requires the drug to be administered in 48 hours--yet current testing methodology takes longer than that.

CIDRAP on the spread of the bird disease...

and the high number of suspected cases in humans.

Effect Measure writes that the WHO officials in Indonesia continue to take the most optimistic viewpoint--even when they don't know. This despite increasing clusters and faster mortality. When will WHO worry, Revere wonders?

ProMed with official confirmation of Indonesia death reported yesterday.

ProMed with a variety of news from around the world. Note that flu may have reached the Gaza Strip.

OIE report from India and Indonesia.

OIE from elsewhere in Europe and Asia.

Dr. Gleeson has this actuarial study on health care needs during a pandemic.

Recombinomics notes that mother and brother of a potential flu death are also sick--can you say cluster?

Recombinomics also says bird flu has been confirmed in Bosnia.

Crofsblog has this---11 "states" in Egypt have bird flu, and dead birds are, to say the least, a common sight.

Crofsblog also has this from Malaysia, which had its first H5N1 case since November 2004.

Sunday, February 19, 2006

February 19 Flu Update

Today's lead story--ProMed (ProMed!) is reporting 25 suspected human cases in Iraq.

This report says that a 27M died of bird flu in India. He is reported to be a poultry farmer. A mother and son are also reported to be sick and in the hospital.

Later, the Indians said it wasn't bird flu. I don't believe either one, yet.

I think Effect Measure is doubtful of the government.

The Egg Industry in India is shooting back. There is no bird flu there--it is an invention of multi national corporations.

An initial report in India says that bird flu is not initially effecting poultry sales.

India says that the national cooking style will kill flu virus.

Editorial in Financial Times (Bombay) says that the only thing surprising about the bird flu discovery is that it took this long.

(Note. I was reading an article from late last year from Dr. Webster, and he had a line in it that read something like this: watch out if bird flu becomes pervasive in India.)

There are literally dozens of stories on India today. I've tried to pick good ones, feel free to search for a comprehensive list if you like.

New reports on increasing human clusters in Indonesia.

Deja vu all over again....dead birds inside the Cairo zoo and the zoo is closed.

Recombinomics has reports that the bird flu is spreading in Egypt.

France is responding strongly to bird flu....on "war footing" says BBC. ,,

and Germany has sent the army to the island where bird flu was found.

Eygpt also denies a human case that was reported.

Niger continues a desperate struggle against the bird flu.

Crosblogs has this on continued spread in Austria.

Thailand says its controlling bird flu, and ready to talk to exporters about sending flu to other countries.

Winipeg is looking at the potential business effects, including interruptions to key supply lines in medical services.

ProMed on a world survey.

Recombinomics extrapolates some flu news to wonder if bird flu isn't already in North America, via Siberia.

Here's a pandemic preparation survey from Marsh, via crofsblogs.

February 18 Flu Update

Another country heard from...India has the bird flu (Western part of the country). 500,000 bird cull is on the way. They are checking eight people for bird flu, though this is often precautionary.

Recombinomics has this on an unconfirmed, but suspected human death in India (this originally sources to a Reuters report.)

The Indian media is responding. Here is a do and don't. (IE, do eat cooked food, don't touch the droppings).

Local story from Indian media...

The PM is getting involved...local media says the eight are "hospitalized"

Story on their local action plan being activated....

After much hype, its now coming into play---the Indians have use for their generic Tamiflu.

Here a story from India on the deadliness bird flu....

Meanwhile, a 19th death was confirmed in Indonesia, the most flu stricken nation on earth. He died on Feb. 10.

More on yesterday's report of Egypt. The government is culling 10,000 birds, and talking about how large scale poultry farms are safer ways to raise chickens, not on "rooftops." Seven people were tested and reported negative.

In Britain, they ask if bird flu is on the doorstep. Channel 4 reports...

The Turkish Press (of Detroit MI) has a flu timetable.

More on Secretary Leavitt in Nevada for flu summit. This is an interesting story.

What happens when children can't go to school, the faithful can't attend Sunday service and people can't fill their prescriptions?

South African story on the "encouraging" flu vaccine.

The Republic of Indonesia is upping its Tamiflu stocks in the face of rising case counts.

A Philadelphia company says its anti-immune drugs can boost the effectiveness of Tamiflu.

Effect Measure on the "breakthrough du jour." I think his basic message--and one we hear all the time from people who are not in the cheerleading business (Pharma and MSM), is that there are no miracle plays here. Lots of time and work left to do.

Another high quality Effect Measure entry. Everyone wonders about H5N1 hitting the Americas, and notes uncertainty about the relative roles played by migratory birds and poultry trade in spreading the disease. Finally, a note--if human cases emerge in Europe, the theory that you need to have an intimate living relationship with poultry will be discredited.

Revere also comments on the Sandman post from yesterday. Don't be afraid to use fear....

Recombinomics notes H7N7 in Germany, and the ever present chance for Recombinomics.

Promed has the latest missive from BirdLife International attempting to debunk the migratory bird theory--and then a rebuttal which claims the avian welfare activists are using the flu to come after factory farms. Finally, the mod weighs in with an interesting insight.

Given limited facilities and time, he told us that you should ignore the body of an epidemic and investigate the outliers because how these occurred would provide the most insight. Later this was defined by David Roger's 'Two Models' Rule: A mathematical model to describe the core area of an epidemic will need some 20 parameters but for the margin you will only need 3 parameters. This is logical because at the margins the disease is either present or it isn't; in the centre the incidence is going up and down all over the place. This is what we are seeing with H5N1 avian influenza; what is or is not happening in central China may only be confusing the interpretation of long-distance spread.

ProMed on the reported disease in Indonesia, and a man in quarantine in Bulgaria.

ProMed with a worldwide survey.

Saturday, February 18, 2006

February 17 Flu Update

Bird flu...welcome to France...

and Egypt.

Official WHO report on the second confirmed death in Iraq.

Here's an interesting story. Klaus Stohr of WHO says the world has spent too much time looking at anti virals and not enough on vaccines. There has been a lot invested in antivirals. This is a must read.

Governments have spent at least an estimated $3 billion stockpiling doses of Roche's Tamiflu, according to Stohr. But currently available doses of the anti-viral would cover only two percent of global population.

The Tamiflu tab dwarfs the estimated $20 million that companies are spending on clinical trials to develop a pandemic vaccine, he said. Governments including the United States are investing to expand manufacturing plants, but there are no global figures.

"A vaccine could bring protection to many more people -- you get more bang for the buck," Stohr said.


"These preliminary results hold a lot of promise, but it takes three to five years before you know what contribution a vaccine can make to pandemic preparedness," Stohr said.

In all, eight clinical trials have been completed, with six ongoing. At least another 14 are planned for this year, making a total of 28 trials, including one at GlaxoSmithKline Plc, Europe's biggest drug maker.

"There are still too small a number of companies that are currently ready and have finished clinical trials," Stohr said.

Vietnam says it has a bird flu vaccine that is ready for testing.

Here's another story on the day in the flu, with a little mention of Romania. Its interesting. The conventional wisdom seems to be that Asia and Africa is where the flu will come, because of the living conditions between people and birds. Read on.

"The situation is critical. So far we can say we have been lucky that we had no cases of bird flu in humans," said Adrian Streinu-Cercel, head of Romania's main virus laboratory. "It's not enough to force people to wash their hands, you have to give them the means to do it," he added. "The likelihood that some kids in Romania come in contact and play with sick or dead birds is not zero," said WHO expert Guenael Rodier.

A member of the South African National Assembly has a (literal) recipe for fighting the bird flu.

A member of Parliament in Ireland has these honest words for people there...pandemic planning can only mitigate the effects of a pandemic.

There was something from this story in my comments yesterday, but officials in Indonesia say they are worried about limited H2H.

"We can't guess when the spread of the virus among humans will occur because it will need a thorough examination of the source of the virus from each patient in a cluster," the spokesman and head of the bird flu surveillance unit at Jakarta's Sulianti Saroso Hospital, Ilham Patu, was quoted by The Jakarta Post as saying.

"But the fact that we have more and more cases of bird flu clusters shows that we are very close to having one."

Another article seeks to introduce avian flu to African readers.

ProMed on the Iraq case, with a comment on the question of genetic susceptibility.

ProMed World Survey. A couple nuggets. First, a mod notes that while wild birds have had infection in Europe, no poultry has been hit yet, a situation he calls "inconceivable." And, the first case is suspected in Mauritania.

WaPo on the continuing efforts of wildlife experts to make the case that migrating birds do not spread avian influenza.

The BBC on Business Organizations in that country preparing their members. They are finding unprecedented demand for their seminars.

A British government critic is saying that the nation is too reliant on Tamiflu, which could be resisted, and a vaccine that won't be there in time. (Note: I can't recall if I have seen if the virus spreading today is Tamiflu resistant. Somehow, I think I heard it wasn't).

As well as focusing on bird flu vaccine production, he said the Government should advise people to stockpile food, medicines, water and other supplies. Although the Government's primary ex-penditure has been on Tamiflu, Prof Dunnill said "there is now a good deal of doubt about how valuable this drug will be". He said it was "very worrying" that resistance had already been noted.

Dead swans test negative in Finland--we'll watch for possible follow up tests.

Delta--a state in Nigeria--is taking steps on the bird flu.

A meeting was held to discuss preventing bird flu in the "American Region."

HHS Secretary Leavitt is touring the country with this cheery message--refreshing, if only for its candor. Notice the introduction of the phrase "pandemic pandemonium."

'Any community that fails to prepare with the premise that the federal government will rescue them will be tragically wrong,'' Leavitt said during the pandemic flu summit with Gov. Jeb Bush and other officials.

Florida's plan, said Bonita Sorensen, deputy state health director, is an ''all-hazards approach.''

''It is just another event for which we are preparing,'' she said, and includes public campaigns urging residents to create family plans and to stockpile food and water.

Among the disaster drills Florida will soon conduct, she said, ''is the pandemic pandemonium,'' an exercise in the chaos and panic that potentially would travel alongside avian flu.

Roughly the same event happened in Nevada.

The Business Planning Summit continued in Minneapolis. Employers zeroed in on how to protect their key asset--their employees.

Best-practice examples from different business sectors were summarized. For healthcare, one of the key strategies noted was to keep workers working and to continue to provide routine care along with the special care needed in a pandemic. The need to develop a comprehensive supply plan specific to healthcare, including routine medical supplies and personal protectie equipment, was emphasized.

Also at the Summit, risk communication guru Peter Sandman talked about the virtues of scaring people.

"There's no way to get people to take precautions without frightening them," Sandman said.

Effect Measure on the Lowy Institute report we linked here a couple days ago.

Finally, Crofsblog correctly labelled this story a must read. He's right. Its a "Bad Science" column in the Guardian.

Thursday, February 16, 2006

February 16 Flu Update

An Australian company says it has an effective vaccine at 15mg, using an adjuvant. That's about half the previous lowest total. Obviously, progress on the vaccine front is the best news at all.

Meanwhile, in the US, there is testing for a bird flu vaccine in children, which, given mortality rates, is important.

Another company is using a booster to increase the effectivness of Tamiflu.

John Barry, author of the most influential flu book ever written, which can be purchased in a link to the right, has an excellent historic reminder. In 1918, the first wave of flu wasn't the killer, it was the second wave. If that happens again, we may have more valuable time to prepare.

The President of Albania says that his government's anti-flu measures are working, despite being surrounded by bird flu nations. (Time will tell.)

The EU is launching more measures to fight the bird flu.

The representatives, who met in Brussels for a two-day meeting after the outbreak of deadly H5N1 bird flu in some EU member states, agreed to set up a 3km protection zone and a 10km surveillance zone around the outbreak spot.

"Within both zones, all poultry and captive birds must be kept indoors, on-farm biosecurity measures must be applied, the movement of poultry and other captive birds both within and from the zones should be restricted, and wild bird hunting and the assembly of birds must be forbidden," said the European Commission.

This appears to be an offical Q&A document on why the EU is implementing its measures.

News article on restrictions within Germany.

In Europe, Slovenia now has the bird flu. Its swans (again), and the fifth EU nation this week alone.

CIDRAP summarizes the European emergent cases.

A former health minister in Italy says the PM is irresponsible raising the bird flu alarm--his current health minister disagrees.

Its confirmed--the Uncle in Iraq died of bird flu.

ProMed has this from WaPo--is their a genetic factor in bird flu mortality--in the host?

With 4 cases confirmed or suspected, her family represents one of the largest clusters of bird flu among humans in the world. It is also notable in sharing a characteristic with nearly all the other family clusters: Those infected by the virus were related to each other by blood and not by marriage. This raises the possibility that genetics play a role in determining who among those exposed contracts the often-lethal disease.

"It's intriguing," said Sonja J. Olsen of the Centers for Disease Control and Prevention in Bangkok, who has studied family clusters of avian influenza. If a biological explanation were ultimately proved, she added, "perhaps we could identify people at genetic risk."
ProMed surveys the scene from Europe to Africa.

More from Niger, where dead birds are raising the fear of the bird flu.

Multinational Corporations say they are doing their part to prepare for bird flu.

J.W. Marriott Jr., who heads global lodging group Marriott International Inc. (MAR.N: Quote, Profile, Research), said his properties were outfitted with masks, rubber gloves and special detergent to clean surfaces.


"The difficulty here is that nobody really knows what could happen. Nobody really knows what the treatment is, or what good prevention is. So we're left with trying to do our best with making our employees aware, providing flu shots, providing sanitation products, handwashes and so on.

A Dutch company is going to supply 30 million doses of avian vaccine for use in birds.

A flu update by Bhutan.

Florida held a bird flu conference, with the idea 20,000 people in the state could die in a pandemic.

This is fascinating. A VC firm is putting $200M in companies that develop technologies that fight infectious disease. A harbinger...or a bubble.

Here's a press release on a comapny with cell based vaccine technology that can be produced in weeks.

Tamiflu has arrived in Jakarta...

Speaking of Indonesia, Effect Measure isn't guessing where a pandemic might not start, but if he was, Indonesia might be on the top of the list.

A health official on Prince Edward Island says that society would be in chaos, and 200 people there would die in a pandemic.

Speaking of all these "projections," Effect Measure reminds us that no one really knows (even David Nabarro), just as no one really knows how many more mutations are needed (even David Nabarro). Revere teases us that he has an idea what the virus has to do to move on to humans, but isn't saying yet.

Recombinomics shows a report from Germany that infected swans were non-migratory, the avian flu may have been there for months.

Recombinomics also notes that its more birds than we think, and not just swans, which are big and easy to find.

Recombinomics with a technical article on...what else...recombination.

A loyal and alert leader sent me this--Korea is selling an air conditioner which has a filler coated in kimchi extract to kill the bird flu...I wonder how it smells.

Wednesday, February 15, 2006

February 15 Flu Update

"Something is very wrong." (Dr. Bob Gleeson)

The news just keeps expanding, it seems. Flu cases cropping up all around the world, big news from CIDRAP. Hopefully, I've been able to order this in a way that makes sense, but its increasingly hard.

WaPo on yesterday's flu news, including Iran and Italy.

The bird flu has entered Hungary--swans, again.

ProMed report says that the swans are H5 only, but it wouldn't surprise anyone if H5N1 was confirmed once it gets back from the all night lab in England.

Two birds died in Niger, which borders on Nigeria. Given the track record, virtually certain H5N1 diagnosis. Mod says it sounds like poultry, not wild birds.

There is well justified concern in Indonesia, where the human infection rate is picking up. The country is pledging to more carefully monitor even areas with no record of infection.

Note this on clusters:
The country's suspected sixth cluster of human infections, in two adults and their two-year-old daughter, has heightened concerns.

CP, the highly skeptical ProMed mod says that the clusters are not necessarily going to lead to H2H any sooner.

The Swiss have elevated their bird flu threat level. Poultry are not to be kept outdoors.

New York Times also writes on what is being done in Europe to protect poultry.

The Lowry Institute of Australia has issued a new report which attempts to project the "worst case" of the flu. How about 142M deaths, and a $4.4 trillion economic impact--equal to the entire Japanese economy.

Here's a link to the full report.

Key FAO official calls for better coordination, and better compensation for culled birds.

There's an official bird flu alert in Southern Iraq.

There's a massive new outbreak among birds in southern Russia.

Nigeria says its testing poultry farm workers for flu...my note--do these tests ever turn up asymptomatic cases?

ProMed on suspected bird outbreak in Denmark (a virual certainty), panic bird selling in Nigeria making the situation at work, Greek update and more on a massive Russian outbreak.

Recombinomics notes that Poland may have an outbreak, too.

Here's something that could become far too prevalent--major slaughter conducted in Zambia based on a false alarm.

In Nothern Thailand, another set of cases is said to be negative.

The EC is preparing to introduce protective measures in Germany, where an H5N1 bird was reported yesterday.

Here is an EU press release on the co-funding of surveillance plans and on a ban on certain types of poultry.

Reuters is at the CIDRAP Business Pandemic conference, and their writer seems to have the idea down. Here's the lead today. Peter Sandman makes an appearence, too

When burying a body in the backyard, don't put it too close to the septic system. That was one piece of advice offered on Wednesday to a business conference on preparing for a potentially lethal bird flu andemic.

Preparations for a global flu pandemic, which many experts believe is overdue, have begun but the grisly details are horrific and the number of sick could quickly overwhelm the health care system.

Here's CIDRAP's write up on its event. I suspect every syllable of the CIDRAP stuff in must read, though I have only skimmed. Will print out for some bedtime reading tonight.

Osterholm sought to background the audience on the science of pandemics in an hour-long talk he called "Influenza 101." A major theme was that recent research has uncovered chilling similarities between the H5N1 avian influenza virus now circulating in Asia and the H1N1 flu virus that took the world by storm in 1918.

Researchers recently have concluded that the 1918 virus jumped directly from birds to humans, which bears comparison with the way the H5N1 avian virus is infecting some humans, though it has not spread from person to person. Further, certain mutations seen in the 1918 virus have also been found in H5N1 viruses, Osterholm said.

"I can't come to any other conclusion than that H5N1 and the 1918 H1N1 [viruses] are kissing cousins of the highest order," he said.

He warned that modern medicine won't offer a great deal of protection in the first several months of a pandemic flu, if ever. Given the time it takes to develop and produce a vaccine for a new flu strain, "Don't count on a vaccine to get us out of this, at least in the first stage," he said.

The flu drug oseltamivir (Tamiflu) also has its limitations, he said. "The way we use Tamiflu now may not work for H5N1—it's likely to be needed at a much higher dosage for a much longer time period."

CIDRAP also polled their attendees, and found only 18% had a pandemic plan.

Helen Branswell was in Minneapolis for the CIDRAP conference (where else?) As usual, she finds unique insights. Such as...in a pandemic, the easy answer is to telecommute, isn't it? Are the servers ready for that? What if power loses take ATMs down? Cash Panic? More...

"There's lots of movement in the highest levels of corporate America," Falvey said. "They're taking it very seriously."

For her part, Cooper wasn't convinced much of the business sector has recognized that mass human illness would have unanticipated consequences outside of the health-care sector.

"I do not believe that businesses are prepared. I certainly don't believe the infrastructure is prepared," she said, referring to the vast network of services -- garbage removal, electricity, water systems -- that keep society functioning.

CIDRAP also did a section on the impact on infrastructure...

and on routine health services.

They held a similar seminar in Thailand.

Ghana is about an hour from Nigeria, and today their media took a shot at explaining the bird flu to the country.

A Canadian company has developed generic Tamiflu, and is preparing to ask the Canadian government for permission to export it to developing countries.

Interesting article from Hong Kong, noting that the flu causes lots of problems, including counterfeit drugs.

Bulgaria tells its citizens that it has five different tests for bird flu--as well as enough medicine in case things get bad. Of course, on these questions, time will tell.

Effect Measure on the migratory bird debate. Apparently, reports today in Nature and Science say the question is still open. Revere asks why it can't be both.

Crofsblog has this from Nigeria, as WHO officals were discouraged from travelling to flu sites.

Dr. Gleeson says he is getting increasingly nervous, "for a normally calm guy." Don't look to Europe where people don't live with their chickens--look to Africa, Asia and the Middle East.

Something is very wrong. The next move is up to H5N1--whether it wants to stay B2B with rare B2H or go H2H, now is the time. The next few weeks will be crucial.