Wednesday, May 31, 2006

May 31 Flu Update

We're back. We were back Monday, meant to update yesterday, but blogger was down. So, we're here today...

In Indonesia, a 15 year old boy is dead from H5N1. The story goes on to detail an awful month in Indonesia, and how that country is on pace to pass Vietnam as hardest hit flu nation.

CIDRAP on Indonesia. A few key points.

  1. There is no one else infected around the cluster in Indonesia--leading one to believe that the family cluster was just that.
  2. The newer family cluster has a number of people quarantined. However, none seem to be sick. Seems to me this one is clear H2H.

On April 29, according to today's update, nine family members spent the night in the same small room as the index patient when she was severely ill and coughing heavily. Five to 6 days later, three family members experienced symptoms. These were her two teenaged sons and the surviving brother, who was from a village 6 miles away.

The sister of the initial patient developed symptoms at the same time, as did the sister's 18-month-old daughter. The sister, who lived in an adjacent house, cared for the index patient, accompanied by her young daughter.

WHO report that sparked this, via Promed. Note that the 54 quarantined people are receiving Tamiflu--a shot an containment itself.

Absolute must read from Declan Butler of Nature....on why containment didn't work in Indonesia, and on data sharing.

Effect Measure writes along the same lines--containment simply is unlikely to work.

Recombinomics with commentary based on the Nature story--is there a combination of factors leading to H2H?

Thus, the combination of a wild type HA cleavage site, amantadine resistance, and PB2 E627K would be a combination of changes that would be cause for concern.

This is also big news from CIDRAP. Azerbaijanis who died from bird flu earlier probably caught the disease from dead swans--the first infection of humans from wild birds.

While affirming that the Daikyand victims probably caught the virus by handling wild swans, the report says that limited human-to-human transmission can't be ruled out, given the incomplete information available.

In other observations, the report says the Azeri cases point up the importance of oxygen therapy in H5N1 infections.

"Severe hypoxia, caused by the prolonged course of viral pneumonia, appeared to be underrecognised and treated late in children," the report sates. "The early establishment of oxygen saturation monitoring and provision of continuous oxygen therapy is therefore crucial to prevent decompensation and multi-organ failure already observed" in H5N1 cases elsewhere.

Flu experts warn that there are several countries under-reporting bird flu cases--due, it says, to overwhelmed public health systems.

The EU sent out a warning: accelerate your pandemic prep, because its closer to midnight than it was before. Or, maybe not so clearly. Check this language out.

“The likelihood that [the H5N1 virus] might achieve any inherent potential in the near future may have risen.”

Governor Corzine, NJ, says that 2.6M people in his state could be sickened by the bird flu.

Flu experts are using Google Earth in their fight against the bird flu. (Google Earth is an awesome tool).

To see for yourself, check out the Google Earth Maps Declan Buter of Nature does.

EU says 741 wild birds with bird flu in 13 countries.

ProMed with report on this story.

In the state of Washington, they are monitoring snow geese for bird flu.

HHS officials joined the Governor of Kansas on the flu road show.

Teaching hospitals in Toronto are preparing for a pandemic.

Stockpiling anti-virals to protect all hospital staff from getting sick in the first place so that hospitals can keep running;
Canceling or scaling-back some programs and services (ex. elective surgeries) to create additional capacity in hospitals;
Redeployment of staff to other roles in the hospital to maintain adequate staffing levels;
Educating staff about the pandemic and the organization's response;
Using an ethical framework to guide decision-making.

Two Aussies write that despite the rush of cases in nearby Indonesia, its still mostly a game of wait and see.

A conference was held in Melbourne to highlight business planning for the flu.

More from Australia. Effect Measure notes how Australia once thought it had enough Tamiflu for 1 million people--but now, knows it does not. What happened?

Thailand had planned to participate in a vaccine program with Japan, but when Japan wanted all of the limited production, Thailand scuttled the plans.

The Michigan Department of Public Health did a bird flu briefing in Sturgis, MI.

Cruzell of Holland is doing clinical trials on its bird flu vaccine.

Update Coming

We'll have an update tonight. I was back, but blogger was down. See you later.

Thursday, May 25, 2006

May 24 Flu Update

We're taking a trip for Memorial Day, so this blog will not be updated again until May 29th. Have a good holiday, everyone.

The big news is that WHO is now suggesting that for the first time, the H5N1 virus has transmitted H2H to a third generation---from person to person to person.

Nick Zamiska of the WSJ sent this along--note that he has WHO telling us that they are not considering taking the pandemic to phase 4.

Helen Branswell comes along as well, noting WHO's statement that the pandemic phase is still 3.

Effect Measure has this covering the two ways to look at this story. On one hand, WHO is reluctant to go to Phase 4--noting that limited H2H has happened before. However, other experts note that the past cases were from sick person to a caregiver--ie someone who was in very close contact for long periods of time. In this case, two of the people infected were an 18 month old and a ten year old. Effect Measure finishes with an admonishment to the scientific community to quit hoarding flu data.

Newsweek on the Indonesian story.

Fears of bird flu hit the Asian markets, and rippled across to North America.

China is reporting a new outbreak among birds in Qinghai.

Canada is asking if business is ready for a pandemic. Big business conference to be held next month in Winipeg.

More on the Ames, IA, lab at the center of the US surveillance network.

CNN reports on bird flu drug counterfeiting.

A company in California is reporting preliminary success with a new anti viral.

The Secretary General of the UN praises Vietnam for flu control.

West Virginia University is preparing for a pandemic.

The Federal Health minister in Canada is proposing a global pandemic summit--in Canada.

USA Today had this--most cities and states not ready for pandemic.

Riverside County, CA, is buying $500K in Tamiflu.

A meeting was held to support the poultry industry in Italy--I guess. Translation a little weak here.

Tuesday, May 23, 2006

May 23 Flu Update

CIDRAP has today's biggest news, and among the biggest flu stories yet. WHO is coming around to limited H2H in Indonesia. Even so, we're talking prolonged exposure, as in the other documented H2H case from 2004. I don't think efficient transmission has been broached yet.

"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness," the WHO said. "Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing."


As yet, the investigation by officials from the WHO, the US Centers for Disease Control and Prevention, and the Indonesian Ministry of Health has found no evidence of avian flu spreading in the community, the WHO said. Investigators are focusing their search on any additional cases among family members, other close contacts, or area residents, as well as on an alternative source such as infected animals or feces.

Effect Measure has an analysis of this story...and the logic that points to H2H, even if there are other possibilities that cannot be ruled out. Note the final parts of the story, where genetic sequences are available, but not yet posted.

Note: WHO says there is no evidence of a mutation.

Official WHO report on Indonesia.

ProMed on Indonesia (note mod comment from CP, who immediately minimizes H2H concerns.

Follow ups from yesterday's news blizzard:

CIDRAP on the US putting its Tamiflu stash in an undisclosed location.

Here's the speech Secretary Leavitt gave on the topic.

Effect Measure weighs in...FOR transparency, and against information vaccums that lead to speculation. Note that the natural speculation is that the containment strategy is about to be launched in Indonesia, but Effect Measure's sources say there is no triggering event--and it does seem to be a contained cluster.

CIDRAP also follows up on the apparently reactionary quarantine in Bucharest recently.

Inimaroiu was sharply criticized by Miorara Mantale, general administrator of Bucharest, over the quarantines. "There is no logical reason for putting 13,000 people under quarantine when only two farm yards have been contaminated," AFP quoted Mantale as saying. "If you had been a civil servant and not elected, you would have been fired."

The Romanian PM has also denied bird flu came there from the EU.

ProMed with a couple of articles from Romania.

In Iran, the Health Minister denies claims of H5N1 positive people.

Recombinomics has reports of a new family cluster in Indonesia.

Scientists are fighting back against the "dire" projections of the bird flu. Note this from Dr. Gary Butcher:

"It's a great story, a disease that can wipe out mankind as we know it," Dr. Gary Butcher, a University of Florida veterinarian specializing in avian diseases, told the newspaper. "Fortunately, the facts are contrary to what's being reported. This disease is going to fizzle out, be forgotten in the near future and be replaced by another 'potential worldwide threat.'"

Bangladesh is urging WHO to take better steps to protect health.

To protect against fake Tamiflu, there's a website by Roche to help people protect themselves. (Hint: buy at a pharmacy).

Here are trial results from an adjuvanted vaccine, via press release.

The Pan American Health Organization wil hold a flu conference on May 24 in DC.

Radio stations in Liberia spent three days broadcasting information on cholera and bird flu.

A lab in Ames, Iowa is preparing to play a role in the flu surveillance network.

The Mayor of Cagayan de Oro City in Philippines has formed a bird flu task force.

The Indonesian situation has caused the dollar to rise in Asia.

The Australian dollar weakened as well.

May 22 Flu Update--Today, there is a large amount of breaking news.

Helen Branswell from late last night (via Crofsblogs) on WHO edging closer to an H2H diagnosis in Indonesia. A father may have caught bird flu from his son. (Note, too, that the man picked up his Tamiflu and ran away from health authorities.)

“There's no supporting evidence to suggest that this is a continuing environmental source that we've uncovered yet in the investigation,” said WHO spokesperson Dick Thompson.

“The investigation is still ongoing. We wouldn't discount the possibility that it is human-to-human transmission.”

Recombinomics says this is evidence of Phase 4.

Two siblings in Iran have been confirmed H5N1 deaths. Three of their relatives are in the hospital after they all took a trip together. (Family cluster?).

ProMed on Iran.

Malaysia looks back across the Straits of Malacca at cases in Indoensia and has concerns.

ProMed on the shuttlecock maker in Indonesia, and on two more deaths in that country.

Birds have died in three districts in Siberia.

The bird flu continues to spread in Burkina Faso.

Comprehensive summary of Romanian situation in ProMed.

CIDRAP summarizes: three new cases in Indonesia, and two in Iran.

Scientists are still concerned about limited H2H in Indonesia.

``An extremely high priority should be to determine whether the virus has undergone any significant genetic changes,'' Jennifer McKimm-Breschkin, a virologist at Australia's Commonwealth Science and Industrial Research Organization (CSIRO) in Melbourne, said in a phone interview today.

Indonesia says it is not H2H, but the statement below is not reassuring--nor do they have much credibility.

``The virus is still the H5N1 strain based on the sequencing DNA examination but we need to confirm'' with the World Health Organization's lab in Hong Kong, Indonesian Health Minister Siti Fadilah Supari told reporters in Jakarta today. ``But I think it will not be much different.''

Thanks to the alert reader who got me on this. The Washington Post says the US is sending Tamiflu to Asia. Apparently, the country where it is headed is a secret. And Secretary Leavitt says that its a US stockpile and under US "control." There are two ways of looking at this.

1) We're overcautious.
2) There's something going on in Asia (ie an outbreak) they want to keep quiet--AND they are preparing to launch their "containment plan, (via crofsblogs).

Recombinomics is more on the 2 side, saying that with our supplies already short, we wouldn't send more there unless a situation was underway.

Yesterday, we noted the quarantine in effect in Bucharest. Effect Measure thinks this is a vigorous response for another bird outbreak.

Excellent, must read Effect Measure. WHO continues to say all cases are from "close contact" with sick birds. Revere persuasively disputes the certainty of that claim, and then notes the following.

Given the evidence, we should keep our minds open to other possibilities, namely, contaminated food or water, an as yet unidentified animal reservoir or vector, and of course person to person transmission. At this point I believe WHO is probably right in substance: most cases probably are of proximate bird origin. But they don't have the evidence that they claim and I find that bothersome.

Finally, Effect Measure writes that even people in the scientific community are feeling the bird flu threat has receded...yet, as evident from this update, the virus continues to march on.

The OIE representative from Southern Africa says there are few signs of migratory birds carrying the flu. Rather, trade appears to be the culprit.

The World Health Assembly is ongoing in Geneva. Sadly, the Secretary-General of the organization died just before the assembly began.

CIDRAP on the tragic death of the Secretary-General.

We cannot have missed the message of the Federal government since last Fall: "Local governments should not look to us for help." Yesterday, the National Association of City and County Health Departments did just that--namely with equipment and help distributing vaccine and antivirals. This is interesting, too.

The officials also briefed staffers on some of the innovative approaches that communities have undertaken to prepare for a pandemic. For instance, Marty Fenstersheib, the health officer for the Santa Clara, Calif., County Department of Public Health, said his community is developing a three-step triage system.

The county's 2,300 hospital beds would be filled in about three weeks during a serious pandemic, so most patients would be treated in their homes, Fenstersheib said. Sicker patients would be sent to "influenza care centers" in places such as hotel ballrooms. Only the sickest of the sick would get care at the hospital.

"Hospitals have told us to keep people away from our rooms, keep them away from our facilities as best you can," he said.

Fenstersheib said the California hospitals believe they can use cafeterias, hallways and other space to increase their bed capacity by 10 or 12 percent. They also would send home people scheduled for elective surgery.

There is news of a breakthrough on a poultry vaccine.

Another story on the Alaska surveillance, and the lab in Madison, Wisconsin where the work will be done.

In the UK, the Medical Research Council has grants for bird flu research.

Lee County, Florida, will hold a public forum on the bird flu.

The US has provided some avian flu equipment to Pakistan.

The same thing will happen in Tippecanoe County, Indiana.

CIDRAP on WHO's two anti-viral recommendation.

Nick Zamiska and the Wall Street Journal on the WHO's two anti-viral plan.

More ProMed on the migratory bird debate, which continues to rage. Here is the mod comment:

I don't think that anyone can deny that there are crossing wild bird cycles of pathogenic AI infection and infection cycles and transmission in commercial and backyard poultry. The bigger questions are where in the avian ecology will the changes occur that will facilitate the H5N1 virus (and other AI viruses) becoming demonstrably pathogenic for humans, if it persists and why, and the economic impacts of the industrial and domestic costs of AI. Neither are simple. One might argue that any AI virus that had successfully mutated to chronic infectivity in birds and suddenly acquired the ability to infect significant numbers of humans, might find the latter of negative advantage if there were no humans to infect. Put another way, if a mutation does not provide a competitive advantage or benefit, the new organism disappears.

Sunday, May 21, 2006

May 21 Flu Update

There's another human case in Indonesia--he's a (I swear to God) shuttlecock maker.

Lab tests have confirmed H5 in Bucharest.

Helen Branswell is back again with a fine report on the difficulties in doing surveillance in China--difficult, but important. Note that its even more important given the number of vaccines given in China to birds--potentially masking potential problems.

"The point I think we should at least learn from Thailand and Vietnam is that likely the key is to have a strong surveillance system at the really local level, at the rural level, with a willingness to respond quickly and effectively," Bekedam said.

Louisiana African American newspaper does bird flu from that perspective.

Mississippi is taking special notice of the bird flu, since its on the Gulf Coast, with lots of migratory bird visits.

"Yes, we are concerned," said Scott Hereford, the senior wildlife biologist and crane specialist at the Mississippi Sandhill Crane National Wildlife Refuge near Gautier. "We do not have any detailed plans for dealing with the avian flu at this time. The Department of the Interior is doing preparation work in case the flu reaches this country. We are also working closely with the National Wildlife Health Center."

More on Bird Flu Surveillance work ongong in Alaska.

Richmond, Indiana is preparing for the bird flu--they know a pandemic is overdue.

Excellent article on memories of 1918 haunting US. Note especially efforts to get around quarantines.

WHO's Director will miss a major pandemic meeting due to brain surgery.

Toronto Star writes about "preparing for the worst."

"There's planning and there's nutty planning," says Gardam. "If you type `bird flu' into Google, oh my God, some of what you're getting is weird. They're preying on people's fears."

In total, WHO says there have been 216 cases of bird flu, with 122 fatal.

On that note, some people are writing that the flu is getting more deadly by looking at the percentage of cases proving fatal. Effect Measure has a warning to take this with a grain of salt--there are more variables involved than just the virus.

ProMed has the news from Burkina Faso.

Saturday, May 20, 2006

May 20 Flu Update

Dateline Romania, where parts of the capital are sealed off and bird flu outbreaks were found in two more regions.

Earlier on Saturday, Bucharest's head of veterinary services said the districts of Andronache and Luica, home to 2,000 people, were being quarantined, with traffic diverted and disinfection measures put in place.

There were two more outbreaks of Burkina Faso among birds.

Nigeria also suspects a new outbreak among birds.

Egypt denies a new human case of bird flu in that country.

ProMed on new bird outbreaks in the Czech Republic, and Russia.

China's Vice-premier is "not optimistic" about the future course of bird flu--interesting how Chinese officials--even when they posture--are different from US officials when they posture.

The US Deputy Surgeon General was in Oklahoma, talking about a pandemic, and how if there is one, it will hit Oklahoma.

Helen Branswell writes on what the situation in Indonesia has to say about the containment plan...namely, it says it puts it in doubt.

"This was never about wanting to contain the virus. It's about the reality of what happens in everyday life," Osterholm said Saturday from Minneapolis, where he is director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"One of the problems models can't address is the impact of politics, fear, panic and lack of compliance on written guidelines for public health actions."

This is very interesting. A 92-year old woman in Buffalo who survived the 1918 flu has given 10 vials of her blood to help today's pandemic vaccine efforts.

My mother and father and sister and I, all four of us had it and all four of us survived," she said Friday. "That was a miracle."

"All we did was lay in bed. I don't remember eating," said Horsch, whose mother hung a camphor bag around her neck to ward off germs.

She drifted in and out of consciousness with fever; she doesn't know for how long. The family eventually recovered, helped by twice-daily house calls from their doctor.

Associated Press with further withering criticism of Indonesia's pandemic response.

China announced that two boys--who had been released from the hospital months ago--have fully recovered from the bird flu.

Bolivia has strengthened its airport security plans....

The Dons at Oxford are helping to develop a flu vaccine, including some research with local citizens. Work funded by Sanofi.

From Effect Measure, a story on the infection of cats with H5H1, the virus that continues to be full of surprises.

ProMed with OIE report on Denmark.

Recombinomics with translations of reports of a new family cluster in Surabaya.

Greenhammer notes that Sen. Joe Biden is calling for more money to fight bird flu.

Friday, May 19, 2006

May 19 Flu Update

OK, maybe we overreacted a little---this pigs in Indonesia are now said to be negative.

Promed notes (see mod comment) that official OIE lab confirmation would be appreciated.

However, as CIDRAP notes, there's been another death in Indonesia, this time outside the cluster.

Speaking of the cluster, Helen Branswell is back, with the idea that there is something genetic about that family (and not a mutation in the virus) that made the family get sick and not the people in their area.

News that six members of one family have been confirmed to have contracted the virus (another likely had it but died without being tested) inevitably points suspicion to some genetic feature of this family's make-up that rendered its members more vulnerable than others in their village in the Karo district of North Sumatra.

"It makes perfect sense. It would not surprise us at all," said Dr. Richard Webby, an influenza virologist at St. Jude Children's Hospital in Memphis, Tenn.

Effect Measure takes an important look an Indonesia, which he feels is showing a lack of competence and transparency on the bird flu.

This is no longer a matter that can be made subordinate to national pride, diplomatic pique or a habit of passive aggression by bureaucrats. The Indonesians need to feel the heat of the international community because their behavior is a danger to their own people and to everyone else. Many countries have been overwhelmed by the bird flu crisis and have thrown their doors open to international experts. Time for Indonesia to do likewise and act as a responsible and civilized member of the community of nations.

WHO has issued some new recommendations for bird flu--including "dual antiviral therapy" in some cases.

"This is the first time we clearly state the possibility of dual therapy to be considered in case you are facing a H5N1 outbreak," Shindo, who advised hospitals in eastern Turkey during the country's outbreak last January, told Reuters.

"Even if you are in the middle of an outbreak, dual therapy can do good. You can even start at the early stage of illness," the Japanese doctor added.

The story from Indonesia is the same--no sign of a mutation, but also no plausible explanation for the family cluster.

Tests show bird flu is in the Romanian capital of Bucharest.

FAO says it needs $300M to fight the bird flu--double what it thought it needed a couple of months ago.

While China says it hasn't had an outbreak in 80 days, a minister says it should still remain vigilant.

The Safe America Foundation in Chicago has released its "Prepared. Not Scared" campaign.'

The UN has a new Pandemic Coordinator.

CIDRAP on FAO and Denmark.

GSW Worldwide won a $30M contract to do advertising for Tamiflu.

Recombinomics says onset dates are being withheld by WHO.

May 18 Flu Update

WHO says its unlikely the Indonesian cluster was H2H, citing the family gathering as a possible cause, not commenting on the mother being sick prior to the gathering.

ProMed on Indonesia and Egypt (as reported elsewhere).

More ProMed on Indonesia, not ruling out, not ruling in.

Recombinomics says there are three family members from the cluster who are showing symptoms, though mild. He sees this as more evidence of H2H.

Thanks to the alert reader who sent me this. Deep in this story, there's news that the H5N1 may be found in pigs in Indonesia, which introduces a whole new player to the mutation game.

``We have not yet found any evidence of the ongoing transmission among chickens in that area,'' Omi said. ``That's why we want to know what is happening there.''

Ten of 11 pigs in the district where the infected people lived were found to have avian flu antibodies in their blood, Indonesia's Agriculture Minister Anton Apriantono told reporters in Jakarta today.

The presence of antibodies is an indication of an existing or previous infection. Antibodies were also found in the blood of chickens and ducks by a national laboratory in Bogor, and confirmatory tests on the animal samples are under way, Apriantono said. He didn't give more details on the location of the animals.

``If the virus is in pigs, that would be a major concern,'' Ton Schat, a professor of virology and immunology at Cornell University, said in an interview today.

ProMed has this story, too, with a request for lab confirmation before too much is made of it.

This also has the potential to be important. ProMed has the news that there are reports of a Chinese Goose Farm located near Qinqhai Lake, with obvious implications for the spread of the bird flu since last year.

Egypt has its sixth fatality from H5N1.

Here's a guy we haven't seen before--the Chief Medical Officer of the Department of Homeland Security. He says most states are not ready for "inevitable" bird flu.

More from the US government--Dr. Fauci says the flu is as likely to burn itself out as start a pandemic.

US is getting started on its goal of testing 75,000-1000,000 migratory birds in Alaska.

Canada is doing a similar survey.

CIDRAP says who experts are in Indonesia to inspect the cluster.

FAO makes a point that it feels compelled to pop in and make once in a while--they think the most logical place to fight the flu is among animals.

Denmark has H5N1 on a poultry farm.

ProMed notes this comes despite great efforts by the Danes to prevent it. First case in a domestic fowl (plenty in wild birds).

Bird flu is now shown to be reducing tourism in Asia.

The Bird flu is not in Michigan yet, but the state was showing off its shiny new flu lab.

There's been some talk about this already....Nature writes about the SARS experience and whether curtailing air travel would help. Answer: once there are a sufficient number of cases, not much will help.

Businesses in Charlotte, NC are warned about the bird flu.

A statewide flu summit will be held in Montana on May 23.

Also, a local planning summit was held in Monticello, IN.

CIDRAP on the fired Romanian vet.

Recombinomics calls for the immediate release of the Indonesian sequence.

Excellent Effect Measure post, covering all kinds of things. Says weight of evidence is on Recombinomic's side--there probably is limited H2H going on in Indonesia. Why no healthcare workers have gotten sick is a good question....also muses on Henry Niman, Marc Siegel, and the world energy crisis (:-). Must read.

ProMed with another interesting post on the migratory bird debate. Note that some people have gotten sick swimming in water infected with bird dung, which is apparently a fish farming practice.

At present, a new theory is gaining ground that the outbreak in wild birds near Qinghai Lake may be linked to fish farms around the lake. As early as 1998, scientists cautioned that human health hazards like an influenza pandemic could arise from the practice of bringing together fish farms with farm livestock. Some researchers say that bird flu may be spread by using chicken dung as feed in fish farms, a practice now routine in Asia.

According to Le Hoang Sang, deputy director of the Ho Chi Minh City's Pasteur Institute, Chicken excrement is one of the main carriers of the H5N1 virus, which can survive in a cool and wet environment for a month and slightly less if in water."

In January 2006, a 9 year old boy died from bird flu in the Mekong Delta province of Tra Vinh after he caught it while swimming in water in which the bodies of infected poultry had been thrown. BirdLife International, a global body for bird protection groups in more than 100 countries, is calling for an investigation into the possibility that the fish in these ponds, which are fed with chicken dung, may be the means by which the new strain of avian influenza, H5N1, is being spread. It says that outbreaks of H5N1 have occurred this year at locations in China, Romania, and Croatia where there are fish farms.

US AID official says when it comes to bird flu, little things mean a lot.

A flimsy bamboo fence, a little ditty about washing hands, a mat to wipe the feet on -- simple and inexpensive measures can go a long way to slow the spread of bird flu, a U.S. aid official says.

Thursday, May 18, 2006

May 17 Flu Update

WHO has confirmed the Indonesian bird flu deaths in the Sumatra cluster....but wait, there's more.

In a day of fast-moving events, the WHO also said a caterer from Surabaya city in East Java had died of bird flu, while Indonesia's health ministry said local tests had confirmed a 12-year-old boy from Jakarta who died four days ago was infected with H5N1. Both cases are separate from the Sumatra case.
CIDRAP on the Indonesian situation...note this (emphasis added):

However, Hong Kong virologist Guan Yi told Reuters that the lag reported between symptom onset in the first victim and in the second wave of victims in the extended family was unusual.

"If they were all infected by the same source," Guan said, "their onset time [of illness] would have been closer. . . . They may have infected one another . . . but we have no evidence."

Recombinomics says a family barbecue is being positioned as the cause of the cluster--but the mother was sick two days before, according to his data.

A Romanian minister has taken the fall for the re-emergence of the virus there...he was ''sacked."

ProMed reminder that the human case there was negative.

A duck has been found H5N1 positive in Laos, their first positive case since 2004.

Omsk region of Russia has reported case...

and a bird smuggler is being investigated to see if he caused the outbreak.

This is short, but very interesting. One of the things Dr. Osterholm has been persuasive on is food--with just in time delivery, how will we move food during a pandemic? Apparently, grocery companies are being urged to think about a couple issues--note the phrase "home delivery."

The Harris County Health Board (Houston, TX), held a seminar to urge all schools in the country to prepare for the bird flu.

"Any of us who have any experience with young children know they are very efficient and effective transmitters of germs."


In the event of an outbreak, Love said, public health officials would have the authority to close schools, though such a decision would not be made lightly or in a vacuum.

Some studies have shown that even though closing schools can be disruptive, doing so at the outset of a pandemic could decrease the attack rate in the community by up to 33 percent.

Providing tools, guidance

"That's very significant," said Love. "Therefore, we ... are encouraging our schools and providing them with the tools and guidance they need to develop their plans to respond in a pandemic influenza."

New Zealand has upped its biosecurity to meet international standards.

An alternative paper in Richmond reminds readers that there is no assurance in a plan.

The IBM bird flu plan made Fast Company today.

Here's an additional article. The leader is Dr. Brilliant from Google, who also used to work at WHO. He's trying to apply open source technology to fighting the flu. The geek in me is interested in this.

HHS released a checklist for long-term case and other residential facilities, and how to deal with a pandemic.

The Ornithology lab at Cornell has been asked to do some research on the migratory birds and bird flu.

Even though no bird with the deadly A(H5N1) strain has yet been detected in North or South America, Cornell ornithologists have already pointed out that bird migration routes are "leaky" - they are broad pathways rather than narrow corridors, and birds are known to get lost frequently. Birds from Asia that breed in Alaska could be found elsewhere, such as along the U.S. Pacific coast.
But even if an infected bird landed in the lower 48 states, the poultry industry is probably safe.
"It's a whole lot easier to see someone smuggling an infected gamecock or parrot into the U.S. through Mexico or Canada," Kevin McGowan said, a research associate at the lab.

More from Cornell, as they get educated on the bird flu.

Indiana is preparing a cross-agency effort to fight the bird flu.

Mayo Clinic fact sheet on the bird flu....

Viruses are masters of interspecies navigation. Mutating rapidly and often grabbing the genetic material of other viruses, they can jump from animals to humans with a quick flick of their DNA. Sometimes, as in West Nile fever, the transfer occurs through an intermediate host such as a mosquito. But viruses can also make the leap directly.

Here's an interesting, practical perspective. If you did had Tamiflu during a pandemic, how would you get a kid to take it? Apparently, it tastes bad. (Been to that movie).

CIDRAP notes that tests show Flu Mist is more effective for children.

Breaking that law and counterfeit Tamiflu continue to be problems.

Effect Measure comments on Homeland Security's biosecurity system.

ProMed summarizes news seen elsewhere.

In this update:
[1] Europe, surveillance results, wild birds
[2] Romania (Brasov), commercial poultry farms
[3] Egypt
[4] Indonesia (Papua)
ProMed also has an OIE report from Sudan--confusing, but an apparently step back.

Recombinomics wonders if a novel cleavage site is present in recent Indonesian cases.

Recombinomics also wonders if swine might be involved in Indonesia.

Tuesday, May 16, 2006

May 16 Flu Update--500th post...official celebration may begin!

Nick Zamiska of the Wall Street Journal says bird flu has not spread beyond the cluster identified in Indonesia, easing mutation fears.

In that vein, Effect Measure warns us that after a while you start to view these clusters with a grain of salt, waiting for more confirmation. (Personal note: certainly, early on in this blog, and anxious to spot the trend when it emerged, we (as Revere did) jumped onto some "clusters" which did not turn out to be anything, and we try to be more cautious now. The thing is...if it happens, that's how it will start.

There's a suspected human case in Romania, in an area with reported bird flu. Here's an alarming phrase:

Romanian health authorities are on the hunt for several dozen tonnes of chicken products produced at a farm in Codlea, central Romania, where the deadly H5N1 strain of the flu was found last weekend. They fear the virus may have contaminated chicken products shipped to supermarkets.

Note: Late reports say bird flu ruled out.

ProMed on Indonesia and Djibouti.

Recombinomics says that the size of the cluster in Indonesia does not, on its own, signal the start of a pandemic. Also notes families (due to close contact) are different.

The EU is imposing a ban on Romanian fowl.

Australian companies are warned that a pandemic could wipe out 40% of their workforce.

The Swiss diligently continue their bird flu prep.

Bird Flu "czars" are being requested of every country in Europe.

As it did in Asia, Roche is working with a local company in Africa (Aspen) to license Tamiflu and boost production.

Chinese Chickens are being smuggled into the EU--raising bird flu fears from that source.

This Omaha TV station held a phone bank during Fatal Contact, and are telling people families should prepare now.

CIDRAP on last week's flu-in-the-blood story.

A laboratory manager and an infection control expert both downplayed the idea that the finding suggests a need for new biosecurity or infection control precautions in dealing with possible H5N1 cases.

"This doesn't change anything, in my opinion," said John Besser, MPH, director of the clinical laboratory at the Minnesota Department of Health in St. Paul. "In the microbiology world we use universal precautions, we treat everything like it's dangerous."

An analyst says it is impossible to predict the impact of bird flu on pension funds.

Western Mass is revealing its pandemic plans.

The AgSec in Malawi says migratory birds still pose a threat to that country.

The USAID blows its own horn on flu assistance.

From Ashville, NC...asking key question..."will we be ready?"

Africa's Astral Foods has conceded bird flu represents a threat to its business.

Monday, May 15, 2006

May 15 Flu Update

WHO is investigating Indonesia cluster, where six of eight have died. H2H is not being ruled out, and the cases are being watched.

Bird flu was found in Papua (Indonesia) in birds, marking an eastward path.

CIDRAP on the Indonesian cases. Noting correctly that H2H doesn't necessarily mean a mutation...there are proven H2H cases where it was simply very close family contact that caused the transmission.

Recombinomics looks at some translated reports and see efficient H2H transmission.

Effect Measure covers the cluster could still be H2H or B2H, or P2H (pig)...but it bears watching.

Recombinomimcs notes that tests are being conducted of contacts of the family cluster (my note---it its efficeint H2H, you'll see it there, too)

Helen Branswell writes today on a rather squeamish topic. Could bird flu vaccines be used in people--if actual human vaccine was in short supply.

"I think it's something that does merit consideration," says Dr. Jesse Goodman, director of the U.S. Food and Drug Administration's Center for Biologics Evaluation and Review. (Vaccines are considered biological products.)

Goodman and others would rather not have to resort to this option, hoping a pandemic is far enough off and new investment in novel production methods and facilities is sufficient to vastly expand output within the human influenza vaccine sector.

Cambodia is looking for "village vets," or local volunteers to held locals fight the bird flu.

The situation in Nigeria is improving, but they are warning against complacency.

The enigmatic Dr. Nabarro is back on the "congratulations tour," this time in Egypt, praising their response to bird flu.

IBM is donating software to a cooperative global flu fight, promoting communication and the spread of information right down to the village level.

Smaller countries in the Pacific are at risk, like Papua New Guinea, which is very closer to Papua in Indonesia, where bird flu was found recently.

A seminar in Indonesia was held for journalists to help them cover the flu better (mildly interesting given comments from bloggers about the lack of reports from journalists during the latest Indonesian incident).

In the Ag Industry, they wonder if bird is to birds as BSE is to cattle.

The UN reminds us that the fight will cost more than what has been pledged.

Australia asks, should seniors be last in line for bird flu vaccine.

Sunday, May 14, 2006

May 14 Flu Update

Today, the big news is from Indonesia. Is this cluster H2H? It is a large cluster, but as time goes on and new clusters don't crop up, you begin to wonder. Crofsblog is all over this one, as five of the family members are now reported to have died....but Crofsblog is frustrated by the lack of consistent information.

Here's Crofsblog linking Recombinomics linking Nick Zamiska at the Wall Street Journal saying there are actually six deaths.

Direct link to WSJ story.

WaPo on Indonesia.

Promed on Indonesia....noting (if nothing else) that the cases are not WHO-lab confirmed yet.

Recombinomics with reports on the ground of a sick healthcare worker (a H2H canary in the mine), along with other cases not being reported by the mass media.

WaPo on the ethical question of who gets the first flu medicines...evoking Titanic and triage.

Djibouti is looking for help on the bird flu.

More reports on ongoing outbreaks from Romania.

ProMed on the Nabarro success in Asia and with news from Romania.

This is an amusing piece....a reporter details conflicting email messages he got from public health authorities around Fatal Contact.

New Jersey reporter looks at how business--one in particular--is preparing for the bird flu.

As an employer of 25 people at Cumberland Advisors, a money-management firm that is entrusted with $800 million of other people's money, Kotok said he does not want to be shopping for food and emergency supplies in a potential panic.

The Quad City newspaper in Iowa tells people to prep not panic after watching Fatal Contact.

They are planning in North Central Mass....even to the point of finding locations for mass graves.

More local planning, Stamford, CT.

Vietnam says that bird markets must be reformed to fight the bird flu.

Long Beach newspaper gives local readers Flu 101--including comment from a local official.

Effect Measure on a Vancouver official who thinks pandemic prep money is being wasted and would be better spent on cancer...and wonders about leaving it to the "experts."

Saturday, May 13, 2006

May 13 Flu Update

Dateline Indonesia, where nature is kicking ass. As noted yesterday, is the current cluster proof of human-human transmission? This remains one to watch closely.

ProMed on Indonesia and Djibouti. Note mod comment that says that "common exposure" is likely cause of Indonesian cluster.

Naturally, Recombinomics is taking the opposite tack.

Dr. David Nabarro is back making headlines again, as only he can do. He says that Thailand and Vietnam are "fabulous success stories."

Romania culled 2,000 birds in response to recent outbreak.

Recombinomics says that bird flu is back in the Ukraine.

Canada is upping its plans to fight the bird flu.

Bird flu has been good...for the poor and underserved in the US. As exports are down, unsold poultry is being donated to food depositories.

A Regional meeting is being held on the bird flu in Chambersburg, PA.

Plans are also shaping up in Nebraska.

Luke Shockman of The (Toledo) Blade, quality healthcare reporter, looks at a local pandemic exercise that uncovered some "grim" possibilities.

How many dead bodies? Under the imaginary situation played out yesterday, 800 people were dying each day from bird flu in northwest Ohio over the course of several weeks. To give you some idea how severe that is, in a normal five-month flu season around 3,000 people die from the flu - in the entire state of Ohio.

Alabama says there's no bird flu problem there.

The Philippine public health system will now cover bird flu.

The Georgia Agriculture Commissioner says some people may be mislead by Fatal Contact.

Greenhammer cites an interesting article with an angle I had never thought of before. People fleeing densely populated NYC and Montreal could swell the population in Vermont from 600,000 to 2M, based on local estimates.

May 12 Flu Update

There's the potential of a relatively large cluster in Indonesia, reported here from Effect Measure (its in the second half of the story, following news about Djibouti.

Previously two other bird flu suspects, Roy Karo-Karo, 19, and his mother, Puji Br Ginting, died on May 9 and May 4 respectively. Five other of their close relatives are also being treated at Adam Malik for bird-flu symptoms, while another eight-year-old boy from the family has been moved to the Elisabeth Hospital, also in Medan, due to medical reasons.

Effect Measure writes that the cluster is continuing to cause concerns, as it is slowly confirmed. Note that human-human has not been ruled out.

ProMed on Indonesian cases.

The Chinese have fired some local officials for responding "incompentently" (ie, not at all) to reports in their area of bird flu.

There are reports of a new outbreak among birds in Romania.

Interesting response to Fatal Contact, including criticism of the real Governor of Virginia from the real Director of Health of Alaska.

In France, they are easing up their bird flu curbs.

In British Columbia, experts say there will be 6,000 deaths in a pandemic.

This might not be a bad model---Penn State University has put together a comprehensive pandemic plan. (It seems to be giving that the disease currently targets young people, that universities would be a high priority planning target.)

Africans are replacing poultry with new food choices, including hedgehog.

Pennsylvania took part in an online drill for bird flu.

A flu drill was held in the Arkansas/Louisiana/Texas borderland area.

CIDRAP on the study on older anti virals.

CIDRAP on the Sanofi results.

ProMed on the migratory bird debate--note mod comment that we have to be careful as we start to think that migratory birds are only playing a minor role that we don't stop collecting data on them.

The University of Maine is holding a seminar on the proper disposal methods for routine and catastrophic bird mortalities.

Crofsblogs looks at a book about the SARS outbreak, and compares its lessons to the bird flu. Why would we react any differently than Hong Kong did?

Here's the answer! Man in Ivory Coast invents bird flu dance....

Friday, May 12, 2006

May 11 Flu Update

Updates on the vaccine front today. French researchers say they have promising work on a bird flu vaccine.

Meanwhile, Helen Branswell is reporting that vaccine makers are actually finding it harder to make vaccine than they thought--and they thought it would be hard. (As always, Branswell is a must read).

The problem lies in the concentrations of hemagglutinin that manufacturers are getting when they grow the H5N1 vaccine prototype virus in eggs. Hemagglutinin is the protein on the virus's outer coat that a vaccine would teach the immune system to recognize and attack.

Dr. Klaus Stohr, the WHO's special adviser on pandemic flu vaccine, confirmed Wednesday that at a recent meeting in Geneva vaccine makers reported the H5N1 prototype virus produces roughly a quarter to a third of the hemagglutinin yield when compared to production runs with seasonal human flu strains.

Effect Measure gives an analysis of the vaccine news.

Speaking of vaccines, what if you only had enough for 10% of the population? (and you might). Sounds like a group exercise in a freshman philosophy class, but no, it is a serious question in Science magazine. Argument is for young people, since they have longer lives ahead of them....(my note, and are more afflicted by bird flu).

Djibouti has one human cases and three cases confirmed in birds, based on this ProMed account. (Bottom of article also reports a bird outbreak in the Sudan).

Note the mod comment:

Combined with a human case, it might signal the presence of a widely spread, established epizootic.

The Ivory Coast says the bird flu is under control.

Morocco says a suspected bird flu case tested negative.

ProMed also updates on Russia, Nigeria, China and Denmark.

Jackie Chan is doing public service announcements warning children about the dangers of bird flu.

Here are global report cards for national preparedness for a pandemic. US gets a C-.

Laurie Garrett, of the Council of Foreign Relations, was a consultant to Fatal Contact. A Pulitzer winner, here's what she said about the show.

"The film is very grim. But I don't think it is sensationalistic," Garrett told WebMD. "I didn't think they exaggerated, but it is a worst-case scenario. A virulent, highly contagious flu comes to America. There is no viable vaccine on tap. The drugs have limited or no efficacy. There are shortages of essential supplies and goods that become acute later in the epidemic."

A bird farm in Virginia has extensive precautions for visitors.

Transcript of a chat held in Kansas City on bird flu.

Pennsylvania has opened its pandemic preparedness website.

Here's a link to a site.

The City of Ottawa, Canada, has announced the "Are you ready" campaign.

Thunder Bay, ON also has a local campaign.

Congressional testimony says that if teleworking is required, Federal workers are behind the private sector in being ready to do it.

Midwest City, OK, has a bird flu plan (comments spurred by Fatal Contact, as were many similar comments by local officials across the US)

In Ireland, they have relaxed rules on pigeon racing.

Effect Measure notes that a South Carolina State Rep is proposing a $1,000 fine for violating a quarantine.

Partly due to bird flu, the price of fish is going up.

Recombinomics has a report on whether fertilizer might have caused a cluster of cases in Indonesia.

Thursday, May 11, 2006

May 10 Flu Update

New York Times says that the bird migration from Africa to Europe has occurred....without the predicted bird flu outbreak. More momentum moves away from the migratory bird theory...

"Is it like Y2K, where also nothing happened?" asked Juan Lubroth, a senior veterinary official at the United Nations Food and Agriculture Organization in Rome, referring to the expected computer failures that did not materialize as 1999 turned to 2000. "Perhaps it is because it was not as bad as we feared, or perhaps it is because people took the right measures."

Still, he and others say, the lack of wild bird cases in Europe only underscores how little is understood about the virus. And scientists warn that it could return to Europe.

"Maybe we will be lucky and this virus will just die out in the wild," Mr. Lubroth said. "But maybe it will come back strong next year. We just don't have the answers."

The French report success with a vaccine, but....

"This vaccine is more successful appearing than the last one that was published but it's not an overwhelming immunological response and we don't know if it works against cross strains," said Dr. Marc Siegel, author of Bird Flu: Everything You Need to Know About the Next Pandemic and clinical associate professor of medicine at New York University School of Medicine. "This has potential but it's not an automatic problem-solver."
Nick Zamiska is also back in the Wall Street Journal with more medicine news...this time, that some generics may be just as effective as Tamiflu. (There has been to and fro on this issue for sometime).

The study, which will appear in a coming issue of the Journal of Infectious Diseases, reports that the vast majority of strains of the deadly avian-influenza virus, H5N1, found in China and Indonesia would respond to the drugs, known as amantadine and rimantadine. The research further erodes the conventional wisdom that these older drugs are useless against bird flu in humans. It raises the possibility that they may be employed selectively alongside Tamiflu, made by the Swiss drug company Roche Holding AG, to treat victims of the virus and
to bolster government stockpiles of antiviral drugs.

Here's an interesting angle to the bird flu in blood story from a few days ago. Does that mean that H5N1 might be able to have a blood test--much easier than the current method of testing respiratory secretions.

Six people in Egypt were tested for bird flu, but were negative.

Recombinomics notes more bird flu in Siberia.

State health departments had to answer public calls on the bird flu after Fatal Contact yesterday.

US officials also went on Nightline (on ABC, where the show aired) to seperate fact from fiction.

Pinellas County (FL) is also putting out the "don't panic" message following Fatal Contact.

Thai editorial on bird flu..kind of hard to summarize.

Pakistan now has bird flu vaccine ready for use in poultry.

Vietnam has announced the same thing.

Nigeria says the spread of bird flu has slowed there.

Greene County (IN) is preparing for the bird flu.

Here's another similar story from Indiana.

Generally, I have avoided reviews of Fatal Contact. But here's one from CIDRAP, which says credible information was in the mix.

Effect Measure on the "gut transmission" news, saying that a virus that would invade through routes other than the lungs raises many "red flags."

OIE reports via ProMed from Germany and Denmark.

Tuesday, May 09, 2006

May 9 Flu Update

Welcome, Fatal Contact viewers, and our regular readers, too. If you're here because the TV program has inspired you to learn more about bird flu, I think you are in the right place. We cover the news of the flu each day with an eye toward a dispassionate view of the flu. We're not here to scare--or reassure--anyone, but to help provide the facts. Check back often, we update 7 days a week.

Bloomberg reports research on...something that isn't especially news. You can get bird flu from the gut and diarrhea is often the first symptom.

ProMed has this article, note mod comment.

While it is reasonable to suggest that human infection has been associated with a gastrointestinal route of infection in Viet Nam because of the practice of consuming raw duck blood, it is a less satisfactory explanation for the variable mortalities recorded elsewhere.

Vietnam is now producing poultry vaccines.

Recombinomics looks at one year of the Qinqhai flu.

Here's an interesting angle--Cambodia is running bird flu semnars for journalists.

Louisville is holding a pandemic summit to prepare for the bird flu. Here's what Mayor Jerry Abramson (who I once saw in the stacks at Powell Books in Portland, BTW), said:

"Maybe we'll spend more time in houses of worship throughout the community as difficulties arise," Abramson said.
Or maybe not, due to a quarantine.

The poultry industry is clearly getting more aggressive with its message on bird flu--measures are taken here to protect birds and people...almost it can't happen here.

Athens, OH held a plannning meeting for bird flu.

BC article has small farmer saying that "everyone" knows factory farms are the source of the problem.

Australia is preparing to spend $44M (AUS) to fight bird flu in that country.

Florida company has nano masks--or "bird flu" masks for sale.

Pennyslvania says it will not stockpile Tamiflu--relying instead on the Federal stock.

The Bird Flu Bill in New Zealand has passed its first hurdle.

Effect Measure looks at Sen. Frist communications obtained by Public Citizen relating to immunity for flu vaccine producers.

Ad Age writes about major poultry producers, and their efforts to communicate the safety of their product to the public.

Also in response to Fatal Contact, Roche is warning against counterfeit Tamiflu.

Effect un-reviews Fatal Contact, and notes the ABC news site I linked yesterday.

The Chicago Tribune says that Fatal Contact is scary but not entertaining--making it like life.

(No, I did not watch).

Monday, May 08, 2006

May 8 Flu Update

An April 26 Indonesian death is now confirmed H5N1.

CIDRAP on Indonesia.

ProMed on Indonesia...note mod comments.

The reason for the higher mortality in Indonesia than elsewhere has not yet been established.

The Palenstinian Authority says bird flu is present in six areas.

ABC News says it has a flu "fact and fiction" page--a perfect resource for viewers who watch tomorrow night's fludrama.

Study in Egypt identifies that the poultry breeders were most likely to get sick.

In Asia, the mantra has been rapid response. They are especially worried about Burma.

In business, the major challenge will be for sick employees to stay home.

The race for a flu vaccine has led to other scientific it often does.

Pennsylvania is polishing its pandemic plan.

The UN is establishing a crisis response center to send out teams to answer emerging crises. It will be in Rome.

China is asking local officials to keep a closer eye on monitoring the bird flu.

Seattle Times editorial--bird flu a time to be "steady."

"Transfer Factor" in bird flu vaccines?

Ontario is also preparing for the bird flu.

Effect Measure has a dispute with new theories which say that who gets infected and who doesn't might be genetically determined.

Recombinomics looks back--one year of Qinghai disease spread.

Reuters on how companies are preparing for the bird flu.

To deal with SARS, the plastic molding company Nypro, with 8,000 employees in China, ran skeletal staffs, staggered shifts and closed its cafeteria, all to minimize personal contact, Cotton said.

"We even went so far as to set an hour with the lights out and let everyone take a nap," he said. "It allows you to stretch out the work day."

H7N3 has not affected poultry sales in Britain.

Sunday, May 07, 2006

May 7 Flu Update

Promed/OIE. Bird flu remains present in 7 Russian regions.

ProMed...stronger measures being taken in the Ivory Coast now that flu has been confirmed.

Candidates for EU membership are being pressed on food safety prior to being admitted.

The Ameircan Veterinary Medicine Association is critical of the upcoming TV movie on the bird flu, saying it could inspire unneeded panic.

Helen Branswell back today---Dr. Nabarro says too little money is earmarked for Middle East and Africa, our newest flu fronts.

"No part of the UN system has got anything like enough money for the work it's trying to do," Nabarro said in an interview with The Canadian Press.

"And frankly, the resources for African nations and the resources for Middle Eastern nations are really very, very slight."

Bermuda is beginning to educate the public on the bird flu. Interesting note, as I am currently reading Collapse by Jared Diamonds. Bermuda wonders what it would do if the US--which it is heavily reliant on for trade-closed its borders.

In Pennsylvania, they are worried about the potential for infection of free range they interact with wild birds.

Ohio is beginning surveillance of chickens and wild birds for the bird flu.

Mekong conducted a major exercise to plan for a pandemic.

The Government in India says the bird flu is under control.

Two years after the first bird flu scare, India's poultry breeders are finally beginning to put things together again.

WHO tells Middle East countries to start producing Tamiflu on their own, and not to rely on outside suppliers.

Effect Measure crticizes WHO for continuing to press its pandemic containment plan. While I continue to be surprised that the idea continues to have currency, I'm not sure that talking about it is dishonest.

Interesting. Bangkok editorial says that bird flu is something to worry about. Check out their response to the US "don't look to the feds" warnings.

Apart from the Da Nang conference and its realistic approach to fighting a biological threat, the United States provided a model to consider. The central government told states and towns that they would be responsible for battling a disease outbreak. In the first hours and days of such a problem, Washington could provide few supplies and little help.

This attitude should be applied in a suitable manner to Thailand. Distances are shorter, yet time saved in isolating and fighting an epidemic is of the essence. Filling forms and arranging transport for medicine, for example, will not just cost lives but allow the disease to spread beyond the first houses and villages. The local response will be the key to containing an outbreak, and more people need to be brought into the disease-fighting network.

Apparently, there was debate in Pakistan about whether to broadcast the health secretary eating chicken.

Reuters on firms with bird flu backup plans.