Friday, March 31, 2006

March 31 Flu Update

The Indonesian death (a one year old girl) is H5N1 confirmed.

CIDRAP on Indonesia, and other possible human cases--Azerbaijan, Afghanistan and Cambodia.

More on Afghanistan from Cambodia--they say three deaths in children may be H5N1.

ProMed continues to cover the world.

[1] Indonesia, Papua: suspicions denied
[2] Cambodia, south-west, ducks: new outbreaks
[3] Thailand, dogs: suspected
[4] Denmark, wild birds: update
[5] Cameroon, wild duck

Jordan has its first human case, but its an Egyptian who the government says contracted the disease at home.

ProMed on bird outbreaks in Russia, Israel and Denmark.

I guess he wasn't in the mood to be interview with David Nabarro.

Britain is purchasing Austria flu vaccine, targetted to the front line workers in the economy.

"We have animal studies which indicate it gives good protection."

It is made by injecting the wild H5N1 virus into animal cell cultures.

The vaccine is then fermented in large steel tanks before being purified.

Meanwhile, the BBC gets an inside look at human flu trials in Belgium.

Dr Ripley Ballou from GSK, said: "We believe that using an adjuvented vaccine strategy will allow us to prepare the immune system so that it will be able to respond and recognise a virus that may not be exactly the same as the virus in our vaccine.

Latin American and Caribbean countries are talking about a bird flu task force.

Tanzania has formed a bird flu task force.

More criticism of the British governments flu plans.

Recombinomics on the vaccine results from yesterday--glass is not even half full.

The Pan American Health Organization held a meeting and said that bird and human surveillance are key to fighting the bird flu.

Don't know what to make of says Israeli official is blaming journalists for spreading the bird flu.

On the heels of yesterday's news that the bird flu may hit California first, Secretary Leavitt takes the Flu Tour there.

Leavitt was also in Oregon...noting again that "Oregonians will have to help Oregonians."

More on yesterday's EU flu simulation, detailing (of course) the breakdowns. The Swiss tried to close their borders, and the surveillance system was overloaded.

The New York Times "Ask Science" column fields reader questions on the bird flu.

Ithaca NY paper blames flu "panic" on Donald Rumsfeld and his pharmacy stock portfolio.

Effect Measure on a unique flu issue, as a town in Northern UK changes a plan on a public sculpture because it might attract birds....and the flu.

Flu Pandemic Countdown Konfabulator Widget

Thursday, March 30, 2006

March 30 Flu Update

It is now believed that when the bird flu comes to the US, it will be in California.

"The unique feature of this model is that it challenges conventional wisdom, which says that flu is spread by children bringing it back to the household," Miller said. "That may be true at the household level, but regionally it is spread by adults."
Cameroon has a second case of bird flu, in a bird.

ProMed takes in the world....

[1] Israel, poultry: 8th outbreak
[2] Pakistan (Bamyan): wild birds and poultry, suspected
[3] Czech Republic, swan: H5N1 confirmed
[4] Denmark, wild birds: H5N1 confirmed
[5] India (Madhya Pradesh)

ProMed on the second confirmed death in Egypt, and a new case in Indonesia (child fatality)

There's a new human case in Egypt. An 18F with reported contact with dead birds.

I think this is an untold story. For all the "nature is in control" talk, how do you account for Vietnam's apparent success with the bird flu?

Cambodia launches bird flu education program.

Yesterday's news was about the problems with the vaccine. Its all over the news today, which we aren't going to repeat....except for Helen Branswell.

"Having a vaccine that would require 90 micrograms times two (doses) in and of itself would not and cannot be the answer to where we want to be," Fauci, whose institute funded this research, said in a teleconference for journalists.

"It's a step towards that but it is a small step."

Our other exception is for Revere...

and OK, CIDRAP, too.
Here's the NEJM editorial on the article, calling for adjuvant use.

The World Bank approved $50M to help Nigeria fight the bird flu.

The European Commission did a pandemic simulation report. The simulation was better than an earlier one, and still week on the business side.

Here's the official EU release.

Belfast's plan, obtained by a paper, says that essential services would be difficult to maintain during a pandemic.

Pakistani official continues to say no human cases there.

Apparently, there was a report that South Africas was at greater risk for bird flu than its neighors. South Africa disputes that.

A physician in the south of England says Britain's bird flu plans are too optimstic.

AviBiopharma says it is applying to begin clincial trials for a new flu therapy.

The company said it will base the application on lab studies showing that Neugene antisense drugs are effective in stopping the replication of influenza viruses, including the bird flu virus strain H5N1. Antisense drugs interfere with genetic processes to stop the manufacture of harmful proteins.
GlaxoSmithKline is also beginning a clinical trial using an adjuvant.

From British Columbia, a doctor talks about the unique strand of genetic material that is the flu virus. "Sloppy, capricious and promiscous" is the description, which makes the flu virus much like my college roommate.

The same BC paper asks if they are ready for the flu. First a unique Rx, then a common concern.

He noted that infectious diseases are caused by biological agents in the environment. Blatherwick said people can reduce the risk of infection by frequently washing their hands. “You are the one who decides if you are going to get infected,” he told the audience. “One of the things is that happy people don’t get sick. So be happy. That’s one of the solutions. Besides washing your hands, get happy.”


McNeil also reported that in a pandemic, there wouldn’t be nearly enough potentially life-saving hospital ventilators, which pump oxygen into the lungs. U.S. health-care providers would choose whose life would be extended with a ventilator and who would be denied access and, inevitably, die.

“To some experts,” McNeil wrote, “the ventilator shortage is the most glaring example of the country’s lack of readiness for a pandemic.”

The Governor of Oregon released that state's pandemic plan.

Apparently, the south gum tree of Alabama contains shikimic acid, used in Tamiflu.

Recombinomics with more proof that the random mutation theory is "fatally flawed" in his view.

Recombinomics also continues to see a familial cluster in Azerbaijan.

Finally, the fireworks continued on the comment thread on Effect Measure, with Marc Siegel firing back at least a couple more times, and Michael Osterholm joining in as well. If you like this sort of thing, here it is.

Finally, Revere has another comment on his view of blogosphere debates....(go to the bottom of the post).

Wednesday, March 29, 2006

March 29 Flu Update

The New England Journal of Medicine drops today's bombshell. There's certainly limited optimism in the blogosphere for the flu vaccine, but this data (covered in NYT) suggests the situation is worse than feared.

A dose 12 times the amount used in a standard flu shot protected just 54 percent of the people in a study being described Thursday in The New England Journal of Medicine.

That level of effectiveness is "poor to moderate at best," in the opinion of Dr. Gregory A. Poland of the Mayo Clinic, who wrote an editorial accompanying the report.

Our other bombshell--or bombshells--are coming from the pens of Revere and Marc Siegel. An alert reader pointed me to their rather bombastic fight. You are aware, no doubt, that Marc Siegel is someone who thinks too much is being made of the bird flu, and you are probably aware that Revere doesn't think much of Siegel's views. Finally, Siegel is on a book tour, and his links have been on our site the last couple of days. Suffice it to say he's toeing the same line he always has.

So, Revere blogged. Here is but a sample.

I suggest he read the Nature paper before commenting on it (or he can read the Effect Measure post on it if reading the paper itself is too arduous). I would love it if he would explain the meaning of a "large mutation" and a "small mutation" and where in the article it says that we are two of each away from the next pandemic virus. I have just re-read it and it says no such thing. I would love it if he would explain where it says the virus attaches deep in the lungs of birds, since only human tissues were used in the study. I would love it if he would tell me where the paper says we can't transmit the virus to each other.
Siegel reacted rather strongly, via comments on the Effect Measure site...also emailing the comments to Revere with the subject line "coward." Here's a taste.

i dare you to allow me to answer your posts in print or to engage me in an open debate. your distortions of what i write are childish and extremely unprofessional.
you are discrediting yourself as a physician and as a public health expert.
FYI - i have received many congratulatory letters on my latest articles from scientists all over the country.

Later, Revere responded again. No excerpt here, but suffice it to say that "pipsqueak" was used.

There's a second death in Egypt, and three more confirmed cases. WHO reports.

Article acknowledges that bird flu would be a disaster in the Congo, yet there are clear and present problems which must be addressed more urgently now.

Indian vets say that bad blood samples are hampering the nation's ability to fight bird flu in poultry.

Dr. Fauci with a dose of reality....bird flu is likely to arrive in US on an airplane.

In Alaska, they will test pond and river water for traces of bird flu (does this mean they are testing wild water?)

Vietnam has vaccinated 6 million fowl against the bird flu...the national poultry population is 220 million.

The EU will fund 50% of any aid given to the poultry sector to compensate for reduced demand during pandemics and their scares.

Toronto says SARS helped them prepare. Here's something I haven't seen before.

Ontario’s influenza plan aims to free up overwhelmed hospitals by providing telephone and Internet home care to less vulnerable patients.
Official with the Chinese Medical Association says country needs better education on the bird flu. Last two people who died waited too long for treatment.

The Leavitt Flu Tour was in Utah.

An AI task force member from the Asian Development Bank is lauding Indian response to the bird flu.
Morgantown, WV, is making its bird flu plans.

HealthCanada warns Canadians against fradulent claims.

Roche has licensed another Chinese company to make Tamiflu.

CIDRAP on a dead Egyptian human and a sick Swedish mink.

FDA approves Relenza to prevent (not treat) flu...

A scientific meeting in Geneva will cover Tamiflu and Relenza, and include a careful analysis of the date to make sure we are going in the right direction. Revere notes here that some people think Relenza may have been overlooked.

CIDRAP gives us the staight scoop....

Four large, placebo-controlled studies have shown the effectiveness of Relenza for preventing flu, the FDA reported. In two trials, the incidence of flu in households whose members received the drug was 4.1%, versus 19.0% in households where people received a placebo.

ProMed on Cambodia and Egypt. The Cambodian story says that a young girl who died was from a village where no birds with flu can be found.

Tuesday, March 28, 2006

March 28 Flu Update

Bird flu hits Madhya Pradesh, India. Culling to begin immediately.

Six more areas in Jalgaon (India) are hit as well.

3 new cases of H5 found in Afghanistan.

ProMed on hundreds of dead birds in Pakistan, as well as news from Sweden, the Czech Republic, and positive cases in Papua.

Russia says it has contained an outbreak to a local area in southern Russia.

Australia offered Indonesia bird flu assistance. Indonesia said no because Australia was granting temporary visas to visitors from Papua.

PETA says to be safe from bird flu, be a vegetarian.

Helen Branswell on the Chinese "vaccine." Not much hope here.

“This is horse serum (blood),” Dr. David Fedson, a retired vaccine industry executive and virologist, said from his home in France.

“You couldn't get any regulator authority, certainly in a developed country, to allow any horse serum preparation to be used for anything. It would be with great reluctance that they would do that.”

The crisis has eased in Azerbaijan, and the experts are going home.

Same story in Iraq.

In Zambia, a health official reminds the people that poultry trade can also help to spread the disease, not just migratory birds.

Indian physician writes on the 1918 flu.

No bird flu in Pakistan, yet poultry sales are down 80%.

ProMed OIE reports from Jordan (first cases), Afghanistan, and Myanmar.

Effect Measure points out that the "cooked chicken is safe" argument is OK, except for people who have to handle the raw chicken.

Effect Measure has further analysis, as nature takes control, human control measures fail, and we lack the infrastructure to administer a vaccine, which we don't have.

In Egypt, the poorest farmers are refusing to participate in the culling.

ProMed with more on the disease in wildlife around the world.

Recombinomics reminds us that the Swedish mink expands the host range.

From the NY Times, via Gadsen AL, DENISE GRADY and GINA KOLATA attempt to determine the actual risk of bird flu going H2H.

Marc Siegel is back...fear of bird flu is the "sickest" thing.

So why did the ``flu hunter,'' world-renowned Tennessee virologist Robert Webster, say of bird flu on ABC that there are ``about even odds at this time for the virus to learn how to transmit human to human,'' and that ``society just can't accept the idea that 50 percent of the population could die . . . I'm sorry if I'm making people a little frightened, but I feel it's my role.''

I'm sorry, Dr. Webster, but your role is to track influenza in the test tube, not to enter into broad speculation on national television. By your way of thinking, we should all be either building an escape rocket ship or killing every bird we see before it can kill us.

Monday, March 27, 2006

March 27 Flu Update--"Nature is in control"

A second human death has been reported in Egypt...

and a fifth human case.

A dead swan 100m south of Prague is the first reported case in the Czech Republic.

In Sweden, a mammal (a mink) is infected with H5, and the nature of the disease leads to the conclusion it is probably N1.

Cambodia says three additional suspected human cases were negative.

Here's ProMed from when the cases were just suspected. I include this story because of the number of false negatives we've seen, just as reference. They could easily be H5N1.

1,500 chickens were found dead in Bhojpur, India, on Sunday, and a panic has ensued.

ProMed on case in rooster in Serbia, and other mid east cases.

CIDRAP on the continued disease spread.

WHO's David Nabarro continues his blunt and strong talk on the bird flu.

On avian flu, he notes, he predicted a range of 5 million to 150 million deaths - the same range the World Bank was using - but headline writers quoted only the higher figure. And how many does Nabarro now say could die? "I don't know," he said. "Nobody knows."
But he repeatedly said that he is more scared than he was when he took the job in September.

CIDRAP on the lack of unreported mild cases in Cambodia...a very important finding, in my view.

Effect Measure notes Indonesia's mixed (charitably) record on bird flu....and now the nation turned down money from Australia.

Must read Seattle Times, including Nabarro and Dr. Webster, with the quote of the day.

"We cannot contain this thing anymore," said Dr. Robert Webster, a virologist at St. Jude Children's Research Hospital in Memphis, Tenn., who has been studying the virus since it emerged in 1997. "Nature is in control."

ProMed on the reports from Egypt.

8 French-speaking African nations held an emergency meeting on bird flu.

The cull has begun in Palestine.

Bulgaria has decided no more Israeli chickens.

Zambia is monitoring wild birds.

A Doctor in Vietnam says that people are overreacting to bird flu fears.

"The ratio of meetings to patients is probably 10 to 1: Hawaii tomorrow. Geneva and Singapore next week," said Farrar, in jeans and carrying a red backpack, on a break from a conference where he was - naturally - speaking on the topic.
Wondering how a pandemic would hit the insurance industry?

A bird flu pandemic could cost European life insurers as much as 20 billion pounds ($34.92 billion) in extra claims and U.S. insurers about $18 billion, a report said on Monday.

These payouts would likely be tolerable for the life insurance industry; and as long as an outbreak were temporary, the companies' credit quality would not likely change, but profitability could be hurt, the report from Fitch Ratings said.

HHS has developed a pandemic planning checklist for schools.

In Ireland, bird flu plans are said to be overdue.

Canada has established a website to inform its citizens about the bird flu. Press release here....

GlaxoSmithKline will produce Tamiflu in Taiwan.

Sunday, March 26, 2006

March 26 Flu Update

There's a suspected new human case in Egypt--18F with reported bird contact.

The Falcon in Hong Kong from last week is H5N1 positive.

Israel says it has eradicated all bird flu...this phrase has come back to haunt more than one minister.

Jordan says it is free of human infection.

In India, the secondary toll is hitting. Three poultry farmers have committed suicide recently.

Effect Measure does a "no frills" update on where the virus stands.

If it doesn't happen, that will be great. Anyone who says it couldn't happen or that we needn't be concerned about it yet because it has only killed birds and a handful of people is unbelievably irresponsible. I will name names: Marc Siegel and Peter Doshi.

Greece held a "chicken fest" to prop up sales of poultry there.

Some Tamiflu has arrived in New Zealand.

In Virgina, officials are warning about the bird flu.

An opinion piece from the Times Leader of Central Pennsylvania says history should teach us that we are better prepared for a pandemic than we were in 1918. (Note: not an unusual perspective. No soldiers coming home, better surveillance and better science).

Crofsblog points to a Globe and Mail story on why we can't figure the bird flu out. Note Rever is quoted. This is must read content.

Another issue, Prof. Levin said, is persuading policy-makers to act on academic results. "Getting recommendations across is difficult," he said. "Policy-makers are conservative because there are so many lives at stake."

On a slow days for breaking news, some interesting stories on local preparation for the bird flu.

Luke Shockman, of The (Toledo) Blade, an excellent healthcare reporter, had this extensive and interesting story of how the Toledo area is getting ready for the bird flu.

A dean of a Prep school in Maryland writes in the Wall Street journal about how they are preparing for the bird flu.

And perhaps most importantly, the school is wrestling with several difficult questions before they are on our doorstep in an emergency: How would we enforce a policy of "social distancing" should a pandemic influenza break out? At what point would the school close its doors? How would students access curriculum through computers or other forms of distance learning?
In Broward County (Miami, FL), the schools are preparing there as well.

Leah Kelly, the district's executive director for student support services and exceptional student education, said alcohol-based soaps and hand wipes -- which schools don't typically use -- are best when dealing with avian flu, so officials are looking to stock up on those.
The University of Iowa has appointed one of it Public Health professors to implement a pandemic flu plan for UI.

March 25 Flu Update

A one year old girl has died of bird flu in Indonesia, based on local reports. The reports say she had been in contact with sick birds.

ProMed on Indonesia.

WaPo on yesterday's Chinese death, and on Indonesia.

In Malaysia, two people are being tested, and are suspected to have bird flu. (Note: results will be interesting. These two were uncovered during a door-to-door search.

Denmark has its 12th bird case.

Slovenia says tests there have cleared their poultry.

Israel says its culling is nearly done.

The World Bank is giving the Palenstinians $2M to help fight the bird flu.

Secretary Leavitt is in Colorado on his flu tour...

and he was in Indiana as well.

Recombinomics on the release of the next US vaccine sequence, from the Indonesia stain.

Crofsblog found this...excellent stuff. It uses Google Earth to show flu outbreaks around the globe. Developed by Declan Butler of Nature, this site will be updated weekly. Google Earth is an awesome program, and this is just one of a million different ways it can be used to powerfully illustrate information.

Saturday, March 25, 2006

March 24 Flu Update

Two more deaths in Asia. The Shanghai death we reported earlier has been confirmed, as has one in Cambodia, the first there in nearly one year.

In response, Shanghai is ratcheting up its alert level.

WHO reports on Shanghai. She was a migrant worker, but there are no reported bird cases in Shanghai.

CIDRAP on China--42 people are under observation.

WHO on Cambodia, a 3 year old girl who is said to have played with chickens.

ProMed on Cambodia and China.

Poland confirms H5N1 in another bird (a hawk).

This report says the bird flu has been found in Jordan, but no human cases.

The Palestinian Authority will begin culling chickens in Gaza.

Has bird flu reached Gaililee, nothern Israel?

CIDRAP on the middle east cases.

ProMed on the Middle East, and on a UN report that says bird flu might present a threat to endandgerd mammals.

Greyhound Canada is going to stop transporting birds.

China is employing RFID to fight the bird flu.

Azerbaijan warns that spring will bring fresh outbreaks.

Bird flu spectre haunts the poultry industry in Pakistan.

Argentina has purchased 5 million courses of Tamiflu.

For those scoring at home, this one scores against the migratory bird theory. Or, at least, the migratory bird ONLY theory. An outbreak on a French turkey farm is said to be not explainable by migratory birds.

ProMed on this report as well. Note mod comment. If you're looking for a simple answer, its probably not there.

Escondido, California will hold public bird flu forums.

Vietnam says it has synthesized the main ingredient in Tamiflu.

An Insurance Industry trade paper looks at Tamiflu risk adjustment in Alaska.

Effect Measure jumps in on the "deep lung" issue, with a kind word for the article we unearthed when the story came out. (As always, thanks for reading). Here's his conclusion, which follows must read scientific analysis.

At this point we don't know. The investigators speculate (in the news stories more than the papers themselves) that the reason bird flu is not as "catchable" as ordinary flu is that its residence deep in the lungs makes its transmission more difficult. There is no mucus in the gas exchange units so coughing and sneezing is less likely to create a virus-containing aerosol. Or so it would seem. In truth, however, we don't know the main routes of transmission. Gas from the alveoli (the deep air sacs) is certainly expelled on exhalation, likely contains virus, and once outside the humidified environs of the respiratory tract would rapidly dessicate (dry up) and could form droplet micronuclei. The assumption that virus deep in the lungs is less transmissible might be correct but it has not been shown. Other factors might be involved. Neither paper tested the transmissibility question, which remains pure speculation (although not implausible). The Japanese paper also points out that if the virus were to develop the ability to dock with α-2, 6 cells, either in addition to or instead of α-2, 3, we could have a nasty actor on our hands. One isolate from Hong Kong in 2003 seems to have this ambidextrous character, although most H5N1s do not.

Today, we link to this article from Recombinomics. He looks at the Shanghai case, and calls again for more open disclosure of data.

It was important to link to him today, because he also received a moment in the sun, as Dr. Niman was profiled in the Wall Street Journal courtesy of Nick Zamiska. He's much maligned and often criticized (even in comments posted to this blog), and occasionally out front of things, but he is also educated and informed with a valid perspective. Further, when this blog started in December 2004, he was often the only source reporting flu news anywhere. Cheers, Dr. Niman.

Thursday, March 23, 2006

March 23 Flu Update

A woman in Shanghai died of suspicious symptoms.

ProMed on the WHO containment plan (today's key phrase is "3 week window") and on the death in Shanghai.

ProMed with more outbreak news, including Kazhakstan.

Internet hoax about bird flu across US border in Mexico sends futures falling, is eventually denied.

The Swiss are pointing out that a pandemic risk still exists, even though we now "know" why it doesn't pass from person to person.

Maine is picking up the pace on bird flu, including monitoring modelled on what has gone on in Alaska.

Activists are complaining that measures to protect against bird flu are forcing increased industrialization of the industry, which will cause other disease problems.

Albania and Greece are going to cooperate to fight bird flu.

China had an educational meeting for Red Cross workers to educate on the bird flu.

Banal VOA boilerplate on US preperation for bird flu.

Sweden reports more bird flu in Stockholm (in birds).

The poultry industry commends the US government for its bird flu planning.

Israel, Sweden and France have announced revised bird flu measures.

From Alberta, an article on tough decisions to be made during a flu pandemic.

If 60% of those infected with influenza are expected to die, health-care officials should withhold treatment from those who aren't likely to survive, says Francescutti.

"Don't try and do anything heroic," he says. "Those people should be isolated and made comfortable but let them die because they're going to die."

Hawaii is also preparing for the bird flu.

CIDRAP on yesterday's "deep lung" news.

Ireland says it will have plenty of bird flu vaccine....

and Finland is going to buy vaccine in Holland.

The UN and 46 African countries have signed a pledge to coordinate bird flu efforts.

Earlier this week we ran a story from the Christian Science Monitor that had a contrarian article on the bird flu. Effect Measure says debate is a good thing, and joins right in. Most of all, note that the weight of knowledge now appears to be against the idea there are large amounts of undetected disease, and therefore for the idea that the virus is very virulent.

We also had a story on the lack of effectiveness of closing schools during a pandemic if the kids just turn around and go to the movies. Effect Measure says this makes sense, and says PTO groups should starting planning now.

Wednesday, March 22, 2006

March 22 Flu Update

The big news today is a study that purports to explain why flu isn't easily transmissible between people.

Scientists say they've found a reason bird flu isn't spreading easily from person to person: The virus concentrates itself too deep in the respiratory tract to be spewed out by coughing and sneezing.

I thought that all this sounded kind of familiar. So, check my archives, I saw that Helen Branswell wrote on this back on June 19, 2005, based on an autopsy of a flu victim.

Slated for publication in the July issue of Emerging Infectious Diseases, their findings of an atypical pattern of infection - deep in the lungs, away from the tracheal lining where virus could easily be coughed out at others - may help explain why H5N1 influenza doesn't yet spread easily among people.
So did Gina Kolata, based on an interview with Jeffrey Tauenberger.

The bird flu viruses now prevalent share some of the crucial genetic changes that occurred in the 1918 flu, scientists said, but not all. The scientists suspect that with the 1918 flu, changes in just 25 to 30 out of about 4,400 amino acids in the viral proteins turned the virus into a killer. The new work also reveals that 1918 virus acts much differently from ordinary human flu viruses. It infects cells deep in the lungs of mice and infects lung cells, like the cells lining air sacs, that would normally be impervious to flu. And while other human flu viruses do not kill mice, this one, like today's bird flus, does.
So why is this news?

ProMed on these reports, note the mod comment from CP.

Recombinomics notes that some genetic data suggests the version which has been deadly (and maybe more H2H) in Turkey and Azerbaijan may bind better to upper respiratory cells.

Bird flu in Gaza (in birds).

Britain confirms bird flu in Pakistan, and chicken sales go straight down.

China has decided to turn over its flu samples to WHO, in a concession to public pressure.

Any work done with China's viruses will have to credit the lab that supplied samples, and WHO has promised to help China negotiate terms of any commercial gain from them, she said.

"We hope that this is now the start ... of regular sharing that doesn't involve the degree of negotiations that we've had," she said.

Nick Zamiska from the WSJ is back...from tomorrow's paper. WHO has said it can't open its database because some countries would object. Yet, those countries have told the Journal they don't object. What's the real hold up here?

CIDRAP says WHO has published a revised pandemic containment plan. Its still basically the same containment plan.

Michael T. Osterholm, PhD, MPH, a leading pandemic preparedness advocate and a skeptic on the possibility of containment, said the revised WHO plan represents "a more realistic approach" to containment than the previous version. "However, the activity of the last 2 months in countries throughout Asia, Europe, and Africa only further supports the fact that early recognition and documentation of an emerging pandemic is going to be difficult if not impossible," he added.

Link to the WHO plan.

ProMed on Gaza and Israel, but also on a "worsening" situation in Russia and on OIE reports of a substandard flu vaccine for birds being used in China (remember when they were going to vaccinate every bird in the country?)

MSNBC on what schools will need to do during a pandemic, as one of the world's most effective incubators.

This report says the outbreak in Azerbaijan that has killed 5 "appears to have been contained."

The virus may be contained, but fear is running rampant. People are afraid to attend funerals, even with assurances of no H2h.

Egypt reports its fourth human case.

ProMed on Egypt, but also on an interesting report from Cambodia that says asymptomatic cases may not be going undetected--a key flu surveillance and virulence question.

ProMed on outbreaks continuing in Israel and Malaysia.

Bloomberg says cases will only increase as the virus spreads in Asia and Africa.

A lot of ink has been spent talking about Hungary's flu vaccine, and countries have contacted them to discuss purchasing it. The Scientist (UK) tells everyone to just hang on a minute--its unlikely to be all its cracked up to be.

Ian Gust, from the University of Melbourne in Australia, told The Scientist that the Hungarians employed a method that most of the developed world has not used in at least forty years. “It is a relatively crude process that was associated with a lot of reactions in people who received the vaccine in the past,” he said. “I don’t think developed countries would revert to this.” Most of the developed world’s manufacturers are working onHN1 vaccines, containing split and whole viruses, but are “using more sophisticated production processes.”

Some people seem surprised that an African flu conference discussed containing the virus without discussing how to prevent humans from getting it.

OIE report from Sweden, via ProMed.

GSK and Roche get big orders from the US Government.

A company called PPG is working with Roche to make (I assume) shikimic acid artifically.

US Hospitals are thinking about humans bringing the disease here, theorizing (probably correctly) that the first US cases will be in travellers returning from flu stricken countries.

At the University of Chicago Hospitals, any patient with flu symptoms who'd recently traveled to Asia and had contact with live poultry would be sent to an isolation room, said Dr. Stephen Weber, whose job is to control infection outbreaks.
Local NY upstate TV report on local preperations for the bird flu.

Michigan looks at its migratory birds and thinks flu.

Wow. Big day on the flu news from. Effect Measure adds needed perspective.

The best outcome will be if this pandemic never materializes. This is possible, although seeming less likely by the day. The advantage of strengthening community relationships and structures that foster mutual aid in prepration is that it will not be wasted. We get better, stronger, more resilient communities for whatever happens.

There is still time to fill the sandbags and get our treasures up off the floor. We can help each other. Let's get busy.

Tuesday, March 21, 2006

March 21 Flu Update

We've updated the death toll to 103, based on WHO figures, which said that 7 of 11 Azerbaijani cases were positive. 5 of the 7 were fatal. Key element follows:

There so far was no indication of direct exposure to dead or diseased poultry in some of the cases. That has been the usual source of exposure for humans who caught bird flu, which remains a difficult disease for people to catch.

WHO report from Azerbaijan.

Recombinomics sees a familial cluster.

Just as alarming, ProMed reports 14 suspected new cases in Azerbaijan.

ProMed on confirmed case in Pakistan, as well as suspected in Slovenia and Kazhakstan.

If a pandemic starts, only about three dozen nations have the resources and infrastructure to properly do surveillance and containment.

From Pakistan, a medical superintendent from a local hospital had this to say:

“It is not a deadly virus because only 83 people worldwide have died of it since its discovery,” he said, blaming the media for negatively highlighting bird flu by publishing sensational stories. “Neither have we prepared for the virus nor is there a need to do so,” he added.

At the same time, this story seems to say some positive results have been received in Pakistan, and they caused a "red alert."

Story looks at legislative efforts in US states on bird flu.

Four negative results are in from India.

Bay of Plenty (NZ) has rejected advice on stockpiling Tamiflu in favor of anti biotics....because they anti biotics they can use even if there is not a pandemic. (??)

Meanwhile US computer study says that closing schools won't help prevent pandemic...children will just meet at the movies, stores, etc. What will work, it suggests, is for people who are sick of who have contact with the sick to stay home.

WHO hosted a major flu summit in Africa. They are calling for a continent wide committee to monitor and do surveillance.

The WHO's Regional Director for Africa, Luis Gomes Sambo, told the conference in Gabon's capital Libreville that countries found to have bird flu must implement a minimum level of control measures, including confining poultry, improving veterinary controls and ensuring those involved used protective clothing.

Such measures are far from straightforward in Africa, where many areas lack basic public health and veterinary services and what clinics there are often run short of essential supplies.
Labs confirm India has been hit by the Asian strain of bird flu--the Chinese and Vietnamese version.

NY Times on WHO's call yesterday for sharing of flu samples.

The FDA has called for a ban on using human anti virals in poultry, to preserve their use in humans.

Alaska (likely first bird flu state) is stocking up on Tamiflu.

The Malaysian health minister says no human bird flu there.

More on the US government's interagency plan for fighting the flu.

A survey business conference attendees says that a large majority don't believe the government is ready for the bird flu.

Effect Measure on continuing stories about whether the flu strains should be public, which of course they should. Gives a tip of the hat to leaders in science and journalism who were at the forefront of this issue.

More Effect Measure. A couple of days ago we ran a story from the Boston Globe that talked, in our view, about states and the federal government having responsiblity, and not relying so much on the local system. Revere has a different view "dumb and dangerous" and you can read it here.

ProMed on yesterday's report about two strains of bird flu.

Recombinomics with ample reasoning behind the theory of recombination as opposed to random mutation.

Monday, March 20, 2006

March 20 Flu Update

Nick Zamiska is back in the Wall Street Journal, with a story on WHO discussing opening genetic databases.

Meanwhile, in an apparent effort to increase the amount of data available to scientists, the WHO will ask its 192 member states to adopt a resolution in May that includes a pledge to share virus data, Margaret Chan, the WHO's pandemic-flu chief, said yesterday
From the Christian Science Monitor (via an alert reader), a Harvard grad student says the bird flu is being sold through "a language of fear." He notes that tests have been reported to show millions of people with H5N1 antibodies.

To deal with this issue, it was addressed at length back in December. ProMed shot it down as unfounded because no data was actually reported with a N subtype.

Effect Measure came back the next day to show how these kind of reports spread--and stay in the media for months.

Finally, Helen Branswell is back, as flu communicators fear a bird flu backlash.

"We earned a lot of trust during SARS and we could blow it all on H5N1," he says of the WHO. "But I don't think that that's a big gamble as long as people understand exactly what we're saying. And it's not a bumper-sticker statement . . . we don't know what the next pandemic is going to look like."

Effect Measure looks at the whole "crying wolf" effect.

Malaysia has bird flu in three states now.

ProMed on the Egyptian death, and a suspected case in Malaysia (their first, if true).

US Government officials once again say that bird flu could be present here in the US this year, but that won't signal the start of the pandemic.

Same story. US says bird flu is now in two strains, complicating efforts to build a vaccine program.

One strain, or clade, made people sick in Vietnam, Cambodia and Thailand in 2003 and 2004 and a second, a cousin of the first, caused the disease in people in Indonesia in 2004.

Still same story, also noting that genetic changes are moving the virus toward human transmission.

The bird flu virus spreading around the world is mutating into more variations with genetic characteristics that increase the risk of infection in humans, according to a U.S. government study.

US details surveillance plans.

CIDRAP on the surveillance program.

WHO confirms death in Egypt.

CIDRAP on Egypt.

India says all 11 samples from Jalgoan were negative.

ProMed confirms Danish bird flu.

The UK says based on migratory bird patterns, the flu might reach there, but problems aren't expected during the winter.

With 500 million birds migrating through Israel each year, a local expert decides the bird flu can't be stopped.

In Cameroon, birds are continuing to die, and people are more and more convinced bird flu is there.

EU speeds up aid to farmers.

Missoula, MT, has looked back to 1918 to prepare for the pandemic.

An excess demand on hospitals is certainly something to plan for, she said. Extrapolate to 2006 numbers, and an influenza pandemic could mean 20,000 people getting sick in several weeks with thousands needing hospitalization.

But, Leahy said, “There's a lot of people that will just need care at home. Their whole family's going to be sick, and they're going to need care.”

Pakistan is launching a public awareness program.

The same effort is underway in the Virgin Islands.

ProMed on the migratory bird debate...again (this is a "for.")

ProMed cites OIE reports from several countries.

Sunday, March 19, 2006

March 19 Flu Update

Egypt is now reporting a second case, this time in a man. The two cases are said to be not connected.

Um Mohammed, 35, said that although she had told authorities that her birds were dying, "They did nothing to help me. Day after day, I watched my chickens die. I felt as though I was handcuffed."

Official Israeli statement that there are no positive H5n1 tests, and that poultry is safe to eat.

The Jerusalem Post tells us a woman is in the hospital with suspected bird flu.

Massive culling in Israel.

3 more people are hospitalized in Jalgaon, India, under suspicion of bird flu.

The three are being treated with Tamiflu.

ProMed reports on a large new outbreak in Russia, as well as more dead birds in Denmark.

India continues to report trouble in the poultry and egg markets.

Uganda has added a "bird flu testing machine" to its arsenal.

This story contains news of a possible outbreak in the Congo.

The University of Wisconsin has founded the Institute for Influenza Viral Research, as a home for the laboratories of Yoshihiro Kawaoka, a world-renowned influenza researcher.

With its increased capacity, Roche says its capacity well exceeds its current orders.

Meanwhile, India has quit buying Tamiflu from's why.

Health secretary Prasanna Hota told FE that no fresh orders would be placed with the companies, as “indiscriminate use of Tamiflu could be a health hazard.” He, however, added that order for another 20,000 doses already given to Roche would not be retracted.

This is an ongoing theme...the Chinese are now testing Tamiflu.

ProMed with some genetic sequence data....noting that this type of thing is why the sequences should be public.

Finally, ProMed surveys Africa and Asia.

Interesting article from a physician from Stony Brook U in NY. He notes that the bird flu focus is missing the larger picture...which is that poverty is creating the conditions for the emergence of infectious disease--and bird flu is just an example.

The flu writer everyone loves to hate is back. Wendy Orent writes that factory farms are to blame for the spread of the flu.

Hey, and to make it a two-fer, Marc Siegal is on board, too. Effect Measure critiques Siegal's criticism of Dr. Webster's statement (quoted at the bottom of the right sidebar) that people don't want to accept that 50% could die.

Saturday, March 18, 2006

March 18 Flu Update

The first death has been reported in Egypt. They say it is lab confirmed.

Excellent bird flu graphic at WaPo, showing its spread.

Bird flu is still likley in Israel. H5 is known for sure. Either way, culling is underway.

9 more cases of H5 in Denmark, likely N1.

In India, 75,000 chickens were culled.

In Bangkok, the Municipal Authority is speeding up bird flu education.

Secretary Leavitt is in Illinois, on the Flu Tour ''06.

IHT on the problems being caused by counterfeit flu drugs.

Here's what can happen. Panic ensured in Salem, India, when some chickens were found dead. Eventually, it was discovered they had eaten rat poision.

March 17th Flu Update

The story from Serbia worsens--now three teens are in the hospital with suspected bird flu.

Sweden has confirmed H5N1 on a game farm.

Ethiopia says all its test from last month were negative from an Italian lab, and the country now worries about the economic impact.

Malaysia is denying a reported H5N1 case.

Human cases are closer in Israel than I think we suspected. They are reporting four people were tested, but were all negative.

More on the Tamiflu front. Its clear to me that WHO is becoming uneasy with the reliance on Tamiflu in its containment plan. They are calling for more research on an urgent basis.

"There is no direct clinical trial evidence that shows that oseltamivir is effective in human H5N1 disease because such studies have not yet been conducted," the WHO said in a statement posted on its Web site "Because the optimal dosage has not been resolved by clinical trials, and because H5N1 infections continue to have a high mortality rate, prospective studies are needed urgently to determine optimal dosing and duration of treatment for H5N1."


"It is possible that severely ill patients might benefit from longer duration of therapy (for example 7-10 days) or perhaps higher doses (for example 300 mg/day), but prospective studies are required," it said. Children should be given the drug preventively for the same length of time in weight-adjusted doses. "For people with repeated or prolonged exposure such as healthcare workers or personnel involved in bird culls, pre-exposure courses, repeat post-exposure courses or continuous treatment may be necessary," it said.

Here's the full WHO statement.

Effect Measure on Israel and Egypt.

Typical excellent Effect Measure post on the genetic hoarding story. You'll know that Nature and the Wall Street Journal, and now WHO, have written that the sequences need to be opened up. Note also criticism for private companies with extensive flu plans for keeping those secrets.

Science has little to lose from this as sequences currently being kept secret are lost anyway. Science has a great deal to gain in terms of a head start on crucially important scientific information now being sequestered for private gain, reputation or credit by scientists who should behave better.

Look to the future, part I. Georgians are "overtaken" by bird flu panic.

In a similar story, Forbes is reporting from the CDC that New Yorkers began buying anti virals seven weeks before seasonal flu was reported--in other words, in reaction to the fear of bird flu.

WaPo on WHO's calling for an open public database on the flu virus, as you have no doubt been following here and elsewhere.

The British government plan, which, it is asserted, was developed to protect the poultry industry, is being criticized as more likely to actually spread the virus.

The Times has learnt that Britain successfully proposed easier movement of birds at a crunch European Commission committee meeting last month agreeing a common response to bird flu. Supporters of organic and sustainable farming yesterday accused ministers of a “daft” change designed to help trade which risked repeating the swift spread of foot-and-mouth throughout Britain.

The Prime Minister of Vietnam has chastised local governments who let their guard down in the recently quiet bird flu period in that country.

The Ag Minister in India says bird flu is under control. (Normally, a major outbreak follows statements like this.)

Malawi has asked for $400,000 from the US to help protect against bird flu.

The presence of bird flu in India has been good news for people who produce fish and mutton for human consumption.

The Asian Development Bank has reported a $38M US grant.

Uganda says it has imported 1,000 cases of Tamiflu, and is partially lifting a poultry import ban.

WHO has announced two technical meetings--one on flu and refugee populations, and one on "social mobilization."

Secretary Leavitt is in Pennsylvania, on his Magical Mystery Flu Tour. Governor Rendell says the state is preparing.

Howard County (MD) is holding a meeting for decision makers and stakeholders on the bird flu.

One of the fascinating under the radar stories is this Hungarian vaccine. This link (which may later be active but is dead now) says they are not submitting their vaccine to the EU drug authority.

Australia is showing interest in the Hungarian vaccine.

The Managing Editor of the American Journal of Infection Control wrote this editorial in the Boston Globe. His point? Pandemic response cannot effectively be coordinated at the local level--action should take place at least at the state level.

ProMed on Israel and Indonesia....

and on Israel, Sweden and the Netherlands.

Thursday, March 16, 2006

March 16 Flu Update

Today's lead story....scientists have identified mutations the flu virus might make to cause it to be transmissable between humans.

As reported in the March 17 issue of Science, the researchers used a technique called functional glycan microarray, which studies specific sugar molecules that allow the virus to attach itself to cells. There are a few known mutations that can convert other viruses with H2- and H3-type components from bird to human infections, but the new study showed that these mutations do not cause the H5 bird flu virus to switch to a preference for infecting human cells.

There was a slight change in the virus found in the Vietnamese boy. "This paper concludes that this change might be sufficient for the avian virus to get a foothold in the human population, but not sufficient for the virus to have full virulence in humans," Paulson said.

There is a teenager in Serbia from an area with sick birds, and the teenager is sick with flu like symptoms.

Sick birds found in Myanmar and Malaysia.

A number of chickens are sick in Orkney (Scotland) and its being looked into.

There's further concern of a new outbreak in India.

Bird flu is confirmed in Afghanistan.

There may be bird flu in Southern Israel.

CIDRAP updates the outbreaks...

as does ProMed.

Nick Zamiska is back again in the WSJ today, with a profile of a vet who is applying what he learned fighting rinderplast to bird flu.

The New York Times has an excellent story summarizing what we have heard for a long time--business is behind government in pandemic planning.

India says it is taking proactive steps to protect against the bird flu.

Roche has picked Martek Biosciences to help it produce shikimic acid, and therefore, more Tamiflu.

CIDRAP on Roche upping its production schedule for Tamiflu...and evidence from CDC of hoarding in NYC.

USA Today on upped Tamiflu production. Production target is 400 million.

Still on Tamiflu, there's been a lot of talk about how effective the drug is against bird flu. Doctors on the front line have even said it did nothing. In SE Asia, they are pilot testing a double dosage to see if that helps. Of course, that lowers the number in the link above to 200 million.

The long awaited Dutch bird vaccination program is underway.

Yesterday, we reported sick Azeri dogs. Effect Measure says that might or might not pan out, but reminds us not to be distracted from Indonesia, which he feels is the real trouble spot, noting a lack of the normal flu protection measures there.

Effect Measure on the Bush Flu Guy stepping down.

Effect Measure on the leader of the Russian Community party, who says bird flu is an American plot.

Jasper FL is using an accessible metaphor for pandemic planning...a hurricane.

Wednesday, March 15, 2006

March 15 Flu Update

ProMed on Azerbaijan..noting death toll over 100 globally.

In Azerbaijan, a dog has now died of bird flu.

We're 2-3 days from results being confirmed in Myanmar.

Reuters on news from around the world. Denmark has its first bird case.

More on Denmark...bird was 70K from Copenhagen. (Note only H5 confirmed).

More survey from around the world. France and India are culling.

Guangzhou calls off its bird flu emergency after 10 days.

CIDRAP surveys the world....

and then also tells us the HHS is going to try to ramp up egg-based and cell-based vaccine production.

Promed on Europe, nothing especially new here.

Effect Measure looks at the world, including slow and apathetic responses from India.

The Wall Street Journal's Nicholas Zamiska is back with a story on some old-school anti-virals that may be coming back into play. Others have commented as well we might be too reliant on Tamiflu, given the possibility of resistance.

ProMed with OIE reports from seven countries.

Bird vaccination is gaining acceptance, and spreading outside of Asia.

China says it is working hard to prevent spring outbreaks.

The Fed has told US banks to prepare for a pandemic.

DEFRA (UK) is looking more closely into the science of feline infection.

Santa Clara County (CA)'s area health director does a Q&A for local readers on the bird flu.

Q What can county residents do to prepare?

A We want people to understand the common elements of infection control: covering your coughs, staying home when sick, not sending kids to school when they're sick, washing hands. We're recommending keeping a two-week supply of food, water and medications in the house, along with face masks, gloves and disinfectants.

Australian TV wonders if Hungary hasn't stolen the act of rich countries with its human bird flu vaccine.

The University of Iowa is involved in research to test additives (adjuvants, I assume) in vaccines.

Tamiflu is back in ordinary Canadian pharmacies.

Wisconsin holds pandemic planning summit, declares itself to be a "national leader."

Tuesday, March 14, 2006

March 14 Flu Update

Things appear to be serious in Azerbaijan. Three women are dead and WHO is saying that their tests are apparently reliable. They are 17-21. Two other deaths have pending results, including a family member of one of the dead girls. (These push death toll over 100).

Helen Branswell on the case. She notes there are 12 other suspect cases...also, despite family "clusters," there appear to be no cases among health care workers.

Newsweek on the Azerbaijani cases.

Finally, CIDRAP on Azerbaijan.

Bird flu is back in India.

ProMed on India, and more suspected bird cases in Romania.

H5 is confimed in Afghanistan. N1 is still being considered.

Effect Measure on the continued spread of the virus, and his view of where the US government's priorities are.

Losses to the poultry industry in India continue to mount.

US AgSec Mike Johans says US treats bird flu as "inevitable."

The Dutch are starting their long-delayed bird vaccination program, which is voluntary.

Novavax stock is benefitting from kinds words for its vaccine from an analyst. Clearly, many people are looking for the right investment angle on the pandemic.

More on the flu in North America by Spring.

Last summer, researchers collected samples from about 6,000 birds that travel between Asia and Alaska to test for H5N1 infection. About 10 percent of the birds had a low-level strain of the virus that usually doesn't kill, but could mutate into the lethal version at any time.

Government and university scientists plan to check at least 75,000 more migrant birds this year. They also will do what they call "sentinel sampling" of Alaskan chickens, ducks and geese to see if they've been infected.

All the recent avian flu cases occurred along wild bird migratory routes.

"I can't think of any outbreak that was not on a migratory flyway," Ip said. "Birds have most of the globe covered. They don't leave any niches unexplored."

Hungary continues to work on its own human vaccine.

An additional factor is the FDA requesting $30M for 2007 for development of vaccine and tests.

OPEC donated $1 million to the global fight against the pandemic.

Ghana is gearing up a committee to fight the bird flu.

An awareness program began today in New Zealand....

while today a health commissioner in North Carolina discussed his county's plans as well.

Vietnam says it will vaccinate all duck flocks (!!)

Recombinomics on the Azeri cases. Notes similarities to Turkey, and high level of WHO involvement.

Recombinomics on the similarities between the Italian and the Iranian flu samples.

Generex Biotech will announce its vaccine program at an upcoming conference.

One of the major challenges facing immunization with many of the currently available vaccines is the need for refrigeration, often referred to as maintenance of the cold chain. This is a particularly difficult problem in developing countries with limited medical resources. One of the advantages of a vaccine utilizing peptides and DNA is that both of these components can be lyophilized, stored at ambient temperatures and reconstituted "on-site" with saline. "We have promising data in an animal model suggesting that we will be able to achieve levels of immunity consistent with protection from H5N1," said Dr. Powell. The company has recently completed a pre-IND meeting with the FDA and hopes to enter human clinical trials of its peptide vaccine against H5N1 later this year.

We conclude today on a quote a reader sent me, from Dr. Robert Webster on ABC News. Dr. Webster is a titan of influenza research. You can mock the blogosphere, but his words carry weight.

"Society just can't accept the idea that 50 percent of the population could die. And I think we have to face that possibility," Webster said. "I'm sorry if I'm making people a little frightened, but I feel it's my role."