Saturday, September 30, 2006

September 29 Flu Update

ProMed with this bombshell. Bird flu might infect 25% of Indonesia's domestic bird population. A staggering figure that is interesting. I have said before that not only do we not have efficient human-human transmission, but we barely have efficient bird-human transmission. With that incidence in domestic birds, you could expect human cases to be through the roof.

Helen Branswell is back, with a story on International experts remind us not to forget the poor when preparing bird flu plans.

The meeting was funded by the Rockefeller Foundation and was held at the foundation's conference centre in Bellagio, on Italy's Lake Como.

The aim was to brainstorm on whether there are ways to mitigate the impact a flu pandemic would have on society's weakest members.

"The premise going in was . . . a shared set of assumptions that are pretty safe bets, that no matter how this falls out, the burdens - economic and social as well as in terms of burdens of disease and death and disability - will not fall equally across everybody on the globe," Faden said.

More on the Chinese sample sharing "breakthrough."

A new anti-viral is being developed. It can, reportedly, be given in very high doses.

CIDRAP has this on a journal article recently published. It says that current pandemic plans may not protect healthcare workers sufficiently. This is a big issue--healthcare workers are often the first infected, and communicate the disease. Also, some people have worried if healthcare workers will show up for work if they are not protected.

The Swiss government says its flu plan includes moving poultry indoors--but only poultry living near major lakes. Interesting way to try to minimize the impact.

Britain has ordered 10 million doses of a bird flu vaccine (for birds).

An official in the Philippines says bird flu is more scary than AIDS.

A Nigerian-born scientist based in the US warns people in Africa that bird flu threatens the world's population.

Relenza is on its way to Brunei as a cheaper alternative to tamiflu.

Jefferson County, MO, looked to 1918 in completing its bird flu plan.

Friday, September 29, 2006

September 28 Flu Update

Some worthwhile stuff today in the flu blogosphere.

WHO says that the bird is mutating, splitting into groups, and becoming resistant to anti-virals. Of course, this is the bad's most long-term significant story.

However, the virus has now been shown to mutate like seasonal flu viruses that require new vaccines every year. "We are going to have to come to the realization that these viruses are genetically variable," Perdue said. "The vaccines that we have predicted to be protective today may not be protective a year from now."

The two most effective anti-viral drugs currently in use are also in danger of losing their potency, according to influenza experts.

The sister of a bird flu casualty from earlier this year in Indonesia also has the bird flu.

First, with winter coming (frost on my windshield this AM), WHO is noting that the chances for a mutation of H5N1 are increasing. Why? Because H5N1 and the widespread seasonal flu could mix and cause a new, more transmissible H5N1.

Also, yesterday's story on the recreation of the Spanish flu is all over the place. Very interesting stuff. Here's NPR's take.

Revere @ Effect Measure has read the paper and this is a must read, as always. As it relates to H5N1, here is the key excerpt (emphasis is mine):

So far it appears the full 1918 genome is needed to produce the catastrophic response we associate with 1918 H1N1 and the current H5N1 subtype. We have yet to discover what parts of the 1918 virus are mirrored by current strains of H5N1 now circulating in many areas of the world in birds, with sporadic cases in humans, and incomplete knowledge of other possible reservoirs. It is possible that these virulence factors of 1918 are all present, given the clinical picture in humans. The question would then shift to those factors which govern the transmissibility of the virus from bird to human and human to human, since H5N1 currently is not easily transmitted to people as the 1918 virus was.

Helen Branswell on board, too. She notes that the lessons learned might help to study other immune system over-reactions.

CIDRAP also has this story. Interesting--notes (of course) that more study is needed, but also that perhaps a therapy could be developed that modulates the response of the immune system.

ProMed reports that China has finally shared the isolates from the Qinghai outbreak. This is important and very helpful, but as the mod notes, whether it is a true breakthrough in practice remains to be seen.

WHO experts also say that better diagnostics are needed for the bird flu--and if you're going to try to contain it, truer words were never spoken.

ProMed rounds the latest Indonesian death.

The economic toll for bird flu in Asia for 2003-2004 was $10B.

The UK held a bird flu summit.

A company in Britain is packaging pandemic treatment services for business.

A seminar in Cedar Rapids, IA, was designed to help business prepare for the bird flu.

After vaccinating 54.4 millon poultry, Vietnam says bird flu is under control.

Still, Vietnam notes the disease in neighboring countries and takes precautions.

Sign of the times: the FDA issues guidlines for developing cell-based vaccines.

Dr. Nancy Cox of CDC has won the Federal Employee of the Year award. She is an influenza expert.

The University of Alberta is doing a survey on pandemic awareness that has struck at least one observer as bizarre.

New England wildlife officials are preparing to fight the bird flu--just in case.

Wednesday, September 27, 2006

September 27 Flu Update

The 20 year old with flu in Indonesia has died. He is the 52nd death in the nation.

News report on article in Nature today....the Spanish was deadly because it provoked the victim's immune system into an overreaction.

While this response is normally a critical part of the body’s defences against infection, when it is too strong it can cause as much damage as the disease itself. This could explain why the 1918 virus was so lethal.

“What we think is happening is that the host’s inflammatory response is being highly activated by the virus, and that response is making the virus much more damaging to the host,” Dr Kash said.

Revere looks back on 22 months of time in the flu blogosphere....and finds the Internet the only place where the flu is discussed as appropriate. (Thanks for the honor of mentioning this site, Revere!). Finally, he takes stock of where we stand.

There has also been evidence for some time of small clusters with all the hallmarks of person to person transmission. In a few cases this has been demonstrated, but mostly we are in the dark about how people are getting sick from this virus. Exposure to infected poultry probably predominates, but there are sufficiently many cases where no exposure history has been obtained that we need to also consider other reservoirs. Person to person transmission has occurred, but so far it has been rare. Yet today comes news of yet another suspected three person cluster in Indonesia, the country where the largest cluster to date (8 cases) also occurred.

ProMed says a bird is dead in Egypt with bird flu.

WHO Update on Thai case.

Zimbabwe is bird flu free, but preparing for the flu with a task force.

More on the possible cluster in Indonesia.

Not surprisingly, the man quarantined in Australia after a trip from Vietnam may have flu like symptoms, but he does not have the bird flu.

In fact, he may have been a drug courier made sick by heroin he was carryingg in his stomach.

Hospitals in North Carolina are preparing for bird flu to hit them.

“At some point, when there are more people who need ventilators than there are ventilators available, you would have extraordinarily painful choices about who gets those ventilators," Hensel said.

The Chamber of Commerce in Cedar Rapids, IA is conducting bird flu seminars for local businesses.

Montana is spending $800K on Tamiflu.

Article in Singapore says to protect healthcare workers, you have to treat them before they have symptoms. (This will also help to cut down disease transmission, but will drain Tamiflu supplies)

CIDRAP on the cases reported yesterday. In regard to the false negative in Thailand, the theory is that Tamiflu might have eliminated the virus from the lungs, which is where swabs were taken (not sure if this is possible, but it sounds unlikely).

Canada says Tamiflu can be produced "off patent."

Venezeula is preparing a pandemic flu plan.

Schools in New Zealand are told to prepare for bird flu.

Prohibiting students from attending schools was one way medical officers of health might try to stop the spread of infection, he said. Sick students may also be sent home by principals.
Correspondence schooling should be organised for those students, Mr Marshall said.

BioCryst is going to announce flu vaccines news this weekend. With that, their stock went up.

Asian pop star MIA has a new hit...with a "killer" beat...she calls it "Bird Flu"

You gotta give the Humane Society of the US credit. They read blogs. Today they asked me to blog on their cockfighting bill since it would also help to prevent bird flu. Candidly, I thought cockfighting was already illegal, but I guess we are still tying to crack down. If you're interested, here is a news story.

Tuesday, September 26, 2006

September 26 Flu Update

Some actual news today...

First, Indonesia is looking into whether there might be another cluster.

Indonesia is investigating a possible cluster of bird flu cases after a man died and his brother and sister were hospitalized, one of them testing positive for bird flu, a doctor said on Tuesday.

The man, 25, died on Sunday with bird flu symptoms after being treated at a Christian hospital in Bandung, the capital of West Java province, said Hadi Yusuf, head of the bird flu ward at the city's Hasan Sadikin hospital.

ProMed has official news on Indonesia and Thailand. Note the following mod comment:

The precise status of the 3-member cluster of blood relatives under investigation in West Java should become clearer when test results from the sister of the 2 brothers (one only known to be H5N1-positive so far) become available in the next 24 hours.

A man from Vietnam flew to Australia with flu-like symptoms. Now he's in quarantine.

Thailand is also reporting a third flu death for this year.

Recombinomics says the flu was diagnosed only on autopsy, and not from normal tests, which were a false negative.

Meanwhile, on the always controversial topic of what Pandemic Phase we are in, WHO has formed a committee of experts to help make the call. Helen Branswell reports.

The list of 20 or so international disease experts includes leading avian influenza expert Dr. Robert Webster of St. Jude's Research Hospital in Memphis, Tenn., Dr. Ab Osterhaus, a veterinary virologist at the Erasmus University in Rotterdam, and Dr. Nancy Cox, director of the influenza division at the U.S. Centers for Disease Control in Atlanta.

CIDRAP reports on their first meeting.

WHO also has a news release.

Effect Measures worries the group is too big to be led, and wonders how independent from WHO it will really be.

Early on, the group takes a stand promoting the sharing of virus samples.

Russia continues to worry about the migration that is on its way.

And Virginia tells its colleges--if a pandemic hits, you will get no aid.

Wyoming is going to drop $800K on bird flu medicine.

The Chief Health Officer of Maine will address a municipal audience on bird flu.

The paper in Fond du Lac, Wisconsin says that beyond just preparing for the impact of seasonal flu on business, this is a good time for a pandemic plan as well.

Monday, September 25, 2006

September 25 Flu Update

WHO has gone along with local authorities and confirmed the two recent cases in Indonesia.

University of Michigan study says that the world would be better off if we spent $$ developing cell culture vaccines rather than more plants for egg based production.

The Baylor College of Medicine says it has an additive (MF59) that reduces effective flu doses by one quarter.

Perry County (IN) is preparing to use state and local plans during a pandemic.

Panasonic announces it has an air filter that eliminates the bird flu virus. Now, if only you could take it on the bus with you.

Russian takes flu shot as part of what the nation calls a "successful" trial of its human flu vaccine.

Thailand is screening for herbs that will help fight the bird flu.

But a new development has been helping in the fight - Kasetsart University's "Chemiebase", an Internet database of herbal extracts which could be used in simulating tests on whether certain herbal substances were worth further trial.

Containing about 100,000 3D chemical structures of herbal substances, the new database allows scientists to find herbal medication to fight bird flu.

Australian researchers are going to do work in Asia.

The entire Tamiflu stockpile has been delivered to Britain.

Recombinomics claims there is a canine connection in a recent cluster in Indonesia.

Sunday, September 24, 2006

September 24 Flu Update

There's a new death in Indonesia, a 9 year old boy.

ProMed on this report.

Recombinomics has local reports of additional clustering in Indonesia.

Meanwhile, a new outbreak is being reported in West Java.

A meeting was held in Vietnam to raise awareness of bird flu.

Mallorca (ah, Mallorca) is preparing for bird flu.

Serbia is making its bird flu plans, including "preventive and offensive measures."

An informational caravan will spread bird flu news through a remote part of the Philippines.

The DNR will be testing wild birds for bird flu in Minnesota.

Local officials are preparing in Springfield, MA...

Letter to Editor in California on how Dr. Osterholm's talk on bird flu scared him into action.

September 24 Flu Update

The BBC on the bird flu death reported yesterday from Indonesia.

Recombinomics says that cases in Jakarta (such as this most recent death) have different cleavage sites than the virus found in poultry recently in the area. His view is that to say that the disease in the dead boy came from a bird is to "misinform"

WHO says bird flu is still the top health threat.

A Chinese paper issues a report that says that this Winter or Spring China is in for a major bird flu outbreak.

A Commissioner in the African Union has joined recent efforts in Africa calling for more intense preparation for the bird flu.

Here, EU and FAO give money to Nigeria.

The Bishop for Episcopalians in Arizona has urged Church leaders to join the fight against the bird flu.

An article has dire warnings for Bangladesh as well.

Saturday, September 23, 2006

September 22 Flu Update

On the vaccine front, with WHO warnings of more flu problems, China is preparing to vaccinate 23 to 25 million people.

A boy who died September 18 in Indonesia is said to have died of bird flu.

Indiana health officials say that due to poor immune systems and even poorer hygiene ;) children are more susceptible to bird flu than adults.

Farmers in the US will be fully compensated if they participate in programs to prevent the flu from spreading--ie culling.

With flu in the Sudan, other nations are now on alert.

Lee County, FL, did went through a flu exercise.

The World Bank has approved $13M for fighting bird flu in the West Bank and Gaza.

Cheshire, UK, is reminded that the bird flu could be catastrophic.

Navajos in Arizona are preparing for the bird flu.

An additional tribe in the Dakotas remembers its brush with the bird flu.

Pennsylvania, Maryland, Virginia and West Virginia had a joint flu conference.

Newport AR also did some flu planning.

Wednesday, September 20, 2006

September 20 Flu Update

The CDC's bird flu czar says the International community is not bearing its share of the burden of the bird flu fight.

The USAID administrator begs to differ, and he employs facts.

Secretary Leavitt responds, too.

More on the potential existence of mild flu cases--and a lower death rate.

WHO apparently disagrees about the retrospective cases in Indonesia.

France is sponsoring $7.6M in research on flu monitoring and detection in Vietnam.

Japan is also sponsoring a similar project.

Apparently, there are claims of bird flu cases in Iraq, which are being denied.

Weymouth, MA, is planning for the flu, including quarantines.

The Liberian government is also planning to fight the bird flu.

Lawrenceville, GA, is emphasizing the "simple" steps in fighting the bird flu.

The best advice for the flu is to "be prepared"--Ft. Wayne, IN.

Labor Union in Canada says that front line health workers have to be included in pandemic preparedness planning.

We ran a story recently from the Wall Street Journal about how flu is competing at WHO with TB, AIDS, for attention and resources. Revere responds with ample evidence that while the flu threat might be perceived to be receeding, it could be seen to be getting worse.

Tuesday, September 19, 2006

September 19 Flu Update

Some people have told Nick Zamiska of the Wall Street Journal that WHO is emphasizing bird flu at the expense of other diseases like TB and AIDS.

Now there's a retrospective case in Iraq...a young boy in March who survived.

CIDRAP on the Iraqi case.

Effect Measure on board with a highly scientific article. Here's the question: does the bird flu have to moderate as it mutates toward a pandemic. That's the convention wisdom, but Revere warns that we might want to think twice about that one.

The UK will screen birds for H5N1 primarily in areas where it has been most likely to have occurred.

WHO says it only has half the money it needs to fight the bird flu.

The International Red Cross has lauded efforts to fight the flu in Indonesia.

Prince William County (MD) is beginning to look at a bird flu plan.

Ugandan traders have been warned not to eat chicken if they are doing business in the Southern Sudan.

The article tortures the metaphor a little, but makes the point that there are bigger things (like bird flu) to fear then terrorrism.

Monday, September 18, 2006

September 18 Flu Update

Helen Branswell is back on one of the keys questions of the bird flu. In recent days, missed cases of bird flu have been identified retrospectively. The question it raises is this: are there mild undiagnosed cases--and is the overall case count much higher than thought. Mild cases are also part of what we can expect when a pandemic hits.

Experts say the evidence to date points away from that notion. But they add that it is important to continue to search for mild cases. Understanding the true number of human infections and the range of symptoms experienced could help scientists better assess the pandemic risk posed by the virus.


"We need to keep monitoring it," Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy, said Sunday.

"Because frankly, one of the indications that there may be a changing epidemiology (disease pattern) with this is in fact if we start seeing larger and larger percentages of individuals who are asymptomatic or only mildly ill that we can clearly confirm as having H5N1 infection."

LaSalle County, IL, will release its bird flu plan as soon as it is approved.

The Department of Agriculture and the Department of Health in the Philippines are working together to fight off the bird flu.

Dr. Nabarro has linked political crisis in Thailand to the resurgence of flu there. (My note: our ability to fight the bird flu is only as good as our systems and our leadership are).

There is an investigation in Vietnam of bird flu funds that are alleged to have been misappropriated.

The Asian-Pacific countries continue to gear up to fight the bird flu.

Britain is increasing its bird flu surveillance among wild birds.

Yesterday, we noted a negative test in Vietnam. ProMed writes today (CP the mod) that it highlights the success Vietnam has had controlling the disease.

Here it is, boys and girls. Slate Magazine's The Survivalist on how to survive the bird flu.

Here's how to survive a severe pandemic: Prepare to become self-sufficient for several months; stockpile nonperishable food, water, disinfectants, prescription medication, office supplies, batteries and generators, air-filter masks, cash (small bills), portable gas cookware, entertainment for the kids, and so on.

Sunday, September 17, 2006

September 17 Flu Update

While WHO acknowledges that there may be some public fatigue on the bird flu issue, the threat of a pandemic remains "high." My comment: we live in an instant gratification society, and I think most people in the public have moved on....until something happens to make it hit home. Like any issue, it will require something greater than what happened prior to the fatigue setting in.

ProMed has a story we ran earlier that said that research in Vietnam showed that Tamiflu was needed very quick to stem the tide of H5N1, confirmed the cytokine storm, etc. Note the mod comment from CP:

To what extent, however, their observations are specific for H5N1 influenza is debatable. Their 2 groups of patients were not precisely comparable, the seasonal influenza patients being hospitalized at an earlier stage in the disease process and possibly from urban rather than rural communities. Of greater relevance may be the genetic constitution of their patients, since most humans are vulnerable to seasonal influenza, whereas few contract avian influenza.

Furthermore, detrimental chemokine and cytokine cascades can be an accompaniment of other respiratory virus infections, such as severe respiratory syncytial virus (RSV) infections in infancy.

Roche says it has a US based Tamiflu supply chain, including fermented shikimic acid.

Note: The World Bank also joined in the warnings.

A 30-year old Vietnemese has died, but tests say it is not bird flu.

Texas paper with first of three part series on bird flu.

Revere asks what will happen to those who are in US prisons if there is a pandemic.

Recombinomics says the genetic diversity of H5N1 is shifting more rapidly in Indonesia, increasing a pandemic threat.

September 16 Flu Update

Recombinomics claims that genetic information shows a "hidden reservoir" of bird flu in Indonesia. (This means that animals other than birds may be the source of infection.)

For more info, see this Fluwiki post.

The Czech Republic scrapped its bird flu vaccine contract and will seek a more favorable contract.

Fairfax County, VA, is projecting 700 deaths in a pandemic, along with other impacts.

Azerbaijan recognizes that bird flu could be back in the fall and the winter....

and the Health Minister warns that human-human could still happen...

and the country says it has enough medication for 500 patients.

Morocco says it has been working for one year on preparing for bird flu, and is better prepared.

Wild bird surveillance is going on in Hawaii.

Saturday, September 16, 2006

September 15 Flu Update

It seems to be the time for retrospective flu analysis. Indonesia went back and found some cases, and now South Korea says it has found five cases from 2003-2004. None were seriously ill. They were poultry cullers.

Recombinomics is calling for more retrospective work like this to search for family clusters.

In my view, the single most important thing we can do for a flu pandemic is develop an effective flu vaccine before a pandemic starts. Then, we need the political will to vaccinate people before the pandemic hits in full force. Here, the New Scientist talks about progress on the first issue.

Most flu vaccines are injected, and contain killed virus. But H5N1 vaccine has been stubbornly ineffective prepared this way – two shots containing large amounts of virus or novel, still-unlicensed additives have been needed for recipients to develop immunity, and even then not in all people tested. H5N1 vaccine virus also grows very slowly in production plants, for reasons as yet unknown.

Worse still, what little information is available suggests that these killed vaccines do not induce immunity that cross-reacts with other strains of H5N1. This is crucial if we are to stockpile vaccine ahead of any H5N1 pandemic, as it is impossible to predict the precise strain (see Today's bird flu vaccines will have to do here).

Swift protection

So the new trials, led by Kanta Subbarao at the National Institutes of Allergy and Infectious Diseases in Bethesda, US, represent good news. The researchers used a live, weakened flu virus carrying surface proteins from H5N1. Squirted up the noses of test animals, the spray protected mice and ferrets completely after just two doses, and kept mice from dying from later H5N1 infection after only one dose.

On yesterday's new Indonesian case in which h-h transmission could not be ruled out, a ProMed mod notes that the circumstantial evidence is strong.

Michigan State University has a team working on a bird flu plan.

The US has pledged $47 million to Indonesia to fight the bird flu.

However, Nabarro also says the aid is too slow.

There is a meeting in West Africa on bird flu control. (In the US, we don't appreciate the role of NGO's overseas. This meeting is sponsored by the The Network for Smallholder Poultry Development, a Denmark NGO)

ASEAN nations are sharing experience on the bird flu.

Malawi says that it has taken "control" of some donated veterinary equipment and is ready for a flu outbreak.

From the UK, a fictional flu scenario.

San Bernardino, CA, is preparing for the bird flu.

Businesses in Kalamazoo, Michigan, heard the flu preparation message.

Gina Kolata, author of the book that got me fascinated in the flu, "Flu: The story of the great influenza pandemic, spoke at Princeton on the bird flu.

Her discussion was part of a evening program on the flu that also featured a discussion by a public health expert

"I would worry when scientists say it's been spreading from person to person rapidly anywhere in the world," she said.

Thursday, September 14, 2006

September 14 Flu Update

There have been two more cases of flu recognized retrospectively in Indonesia, including one where person-person trasnsmission cannot be ruled out.

CIDRAP on the human-human aspects here.

The man reported no contact with diseased or dead poultry before he became ill.
Investigators determined that human-to-human transmission resulting from
exposure to his sister could not be ruled out.

Here's the WHO update on the two latest cases in Indonesia.

Revere says that the recent vaccine news out (the weakened virus with cross protection) is good news, as far as it goes. First, vaccines that work in mice often do not work in humans, and these are still egg-based vaccines, which limits production. Most of all, he says it is a shame we didn't start sooner.

New information from the Republic of Indonesia indicates that the country's vaccination and biosecurity issues mean that bird flu is there to stay.

Article says the secret to fighting the bird flu is to strengthen your immune system.

The City of London (Britain's Wall Street) is going to have a pandemic bird flu drill to see how it would react.

Romania says that it is prepared for the influx of migratory birds from Russia.

A homegrown vaccine for bird flu for poultry will be used in Vietnam next year.

When it comes to fighting bird flu, Vietnam is everyone's favorite son. Here, the nation receives praise from FAO.

The bird flu watch in Thailand is over in three specific provinces...restrictions are being eased.

Yale is planning for a bird flu outbreak.

Roche says it is ready to make 80M doses of Tamiflu.

September 13 Flu Update

Indonesia has gone back and reported an additional death from this summer as a bird flu death. Takes their national total to 49.

CIDRAP on the additional case in Indonesia, but also on the development of a system in Britain to gather data on patients with flu like symptoms in order to speed up an informed response.

Helen Branswell on an interesting study. According to the study, air travel in September each year helps to spread flu...and after 9/11, with air travel strong curtailed, we saw a much lighter flu season. Study is lending strength to the idea of air travel bans during a pandemic.

CIDRAP also reports that a vaccine using live virus from H5N1 and other flu showed cross-protection against a number of H5N1 strains.

Recombinomics is concerned about the lack of new case reports in Indonesia when there is plenty of disease in birds and cases would be expected.

Dr. Osterholm is speaking at a Church in North Carolina as part of a flu conference.

More on the study of the disease...apparently, bird flu is more in the nose than regular flu (past research has talked about H5N1 being deep in the lung, which is why it isn't more contagious).

If you travel to Vietnam, infrared machines will take your body temperature to attempt to screen for bird flu (I can't imagine this will help).

A Newcastle (UK) company has developed an anti-biotic hand cream to help fight bird flu.

The bird flu test that allowed the UK to diagnosis H7N3 in Norfolk quickly is now available across the country.

Wild birds in Alaska have not shown bird flu in surveillance.

Effect Measure on the somewhat tangential race for WHO DG. Notes Security Council members citizens are running for the spot, against tradition. One of them is the man who founded Doctors without Borders--an outspoken man who would be a big change at WHO.

Wednesday, September 13, 2006

Update Coming

I am on the road on business. Look for an update tonight. I apologize for any delays.

Sunday, September 10, 2006

September 10 Flu Update

Sorry no update this AM. Extreme connectivity problems--much chatting with Comcast Tech Support.

What makes the flu interesting to me is its savage beauty...the mystery of what makes it so deadly. Nature today published more research on this topic. Helen Branswell on the case:

The severe disease that H5N1 avian flu provokes in people appears to be caused by the virus's ability to replicate at unusually high levels for a prolonged period - an overwhelming assault that triggers a massive and devastating immune system response, a new scientific paper suggests.

According to the article, the answer is to stop that replication before the disease reaches the "tipping point." But do we have the right tools--neurominidase inhibitors like Tamiflu--especially given that the peak replication times hits just as the disease becomes symptomatic?

"The question I worry about is whether treating patients now with neuraminidase inhibitors may be very much like shutting the barn door after the horse is already out," said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

CDC regrets its role in keeping Chinese flu sequences from going public--or so it says in the Chinese papers.

The World Bank is helping Romania prepare for the bird flu.

Pandemic preparation continues in Tennessee.

Youngstown, OH looks at bird flu as part of its overall homeland security program.

Saturday, September 09, 2006

September 8 Flu Update

WHO has recognized three more flu from June 2006, and two from 2005. That is 63 cases in Indonesia and 48 fatalities.

Official WHO update from Indonesia.

China is looking for hundreds of volunteers for its second clinical trial. Children and the elderly are to be included.

People have also volunteered children for testing in Hungary of their vaccine.

Vietnam has also completed worked on a vaccine developed in a monkey's kidney. They will be using US $ to expand the tests to human trials.

Egypt reports more bird flu in birds.

Revere says the bird flu marches on, yet our decision makers seem to be looking at other things.

Recombinomics on more apparent clusters in Indonesia.

Governor Doyle in Wisconsin accepted the state's pandemic preparedness plan.

The CDC says it has ironed out virus sharing snafus with China in sharing sequences.

PETA in Alabama understands their could be culling--but wants in done via carbon dioxide poisoning.

Westborough MA has a town plan for the bird flu.

Planning is also ongoing in Salt Lake City...

and in Nipawin Saskatchewan.

CIDRAP covers the blood transfusion treatment that has been all over the news recently. Good perspective--logistical problems, but there is some interest.

Friday, September 08, 2006

September 7 Flu Update

Indonesia is reporting that two June death were, in fact, bird flu. Apparently, there were some testing snafus.

Vietnam, fearful of a bird flu comeback, is calling for a second round of bird vaccination. The article seems to imply that the virus has mutated enough that previous vaccines might no longer be effective.

The Lancet publishes the Chinese vaccine news. If have been skeptical of this, but could this be real?

CIDRAP provides a little analysis.

Stephenson cautions that whole-virion vaccines have been associated with febrile reactions in children and emphasizes that careful investigation is needed before such vaccines can be widely used.

It remains to be seen whether whole-virion vaccines can induce the broad cross-reactive response that would be needed to treat a variety of H5N1 viruses, Stephenson writes.

The Chinese vaccine hits the US mass media.

Officials in Kansas met at a bird flu summit.

A bird flu hotline is being set up in Azerbaijan.

Bird flu regulatons in Thailand are tough on small farmers. And their ducks.

To be a duck in a modern poultry farm, that conforms to bio-safety measures against bird flu, is to be condemned to a brief, joyless life bereft of sunshine or a pond to take a dip in.

Canadian surveillance has not turned up any wild bird with H5 to date. (If you buy the migratory bird theory, this would appear to indicate the date of the true onset is still sometime off).

Radio Free Europe tracks reductions in effective doses in vaccine programs.

The Barbados reminds everyone that smuggling is an open door to bird flu.

The Weekly Professor of the Poconos is tackling bird flu.

CIDRAP on the news from earlier about the study of other people in the village where the Cambodian died. As other studies have shown, mild cases of bird flu are rare. I have never seen any reason to think there are large numbers of mild, unreported cases.

ProMed on the same story, and including a reference to previous research I mentioned.

Effect Measure on the 13 WHO candidates. Read to find out why the US and China should avoid endorsing a candidate they like.

Wednesday, September 06, 2006

September 6 Flu Update

After successfully trying an Italian poultry vaccine, Vietnam will be vaccinating ducks against bird flu.

The Chinese continue to insist their bird flu vaccine is effective. Low dosage is getting huge press on this one.

ProMed on the continuing spread of bird flu in North Sumatra, in spite of culling.

Austria, Germany and Switzerland, are undertaking some initial cooperative efforts around Lake Constance. There will be wild bird surveillance.

Myanmar says it is bird flu free.

British paper offers ten things its readers should know about the bird flu.

The race for WHO Director-General is underway, and avian influenza has made the stakes higher than ever.

Effect Measure looks at the race--and looks dubiously at claims that the election of Margaret Chan will create a more transparent China.

Swans are being given transmitters so that we can truly track their migration patterns.

The University of Michigan has set up a website with original documents from the Spanish Flu Pandemic. Introducing a new concept to me: that of an escape community. See below.

Howard Markel, MD, Phd“The website is the result of a project funded by the federal Defense Threat Reduction Agency to identify and research a very important group of American communities. These are called escape communities and they experienced extremely low morbidity and mortality rates during the 1918-1920 influenza epidemic,” says Howard Markel, M.D., Ph.D., George E. Wantz professor in history of medicine and the center’s director.

Webpage is here.

Utah has formed a task force to take pandemic planning further than the plan level.

Tuesday, September 05, 2006

September 5 Flu Update

Bird flu continues to re-emerge in Asia, this time in Cambodia. There were 700 dead ducks there.

ProMed on Cambodia--and on China admitting it has handed over no flu sequences since 2004.

600 birds also died in West Java, Indonesia.

Here's a jaw dropper. China has vaccinated 4.88B fowl. One at a time. Of course, the benefits of vaccinating fowl aren't clear because they can mask the the same time, is that what has worked so well in Vietnam?

Indonesia is looking at a massive vaccination program as well, one of its first large-scale flu efforts.

Effect Measure has interesting news from Emerging Infectious Diseases. It tells the story of a man who was exposed to sick chickens, got bird flu and died. Meanwhile, hundreds of other people who similarly exposed, and no one got sick or has the antibodies to the flu. What could explain this?

Both lead to the conclusion that at the moment exposure of humans to this virus leads to illness only rarely.

In other words, not only do we not have H2H, we barely have B2H.

The Indonesian government is building a bird flu handling centre in Antara.

Britain is testing wildfowl killed during legal hunts.

Belgium is going to institute bird flu control measures, keeping flocks from wild birds.

Bird flu planning efforts are moving forward in Guam.

Promed has comments on the WHO case definitions....comments say that aytpical cases could bring down the overall subclinical case count.

Indonesia is looking to up its Tamiflu supply with some homemade versions.

Monday, September 04, 2006

September 4 Flu Update

Eastern Ukraine has found bird flu in birds. This was found in their blood during surveillance.

Vietnam has more dead birds, and continues to have bird flu concerns.

Promed with a journalistic account of the April cluster in Indonesia. Note mod comment....CP is convinced it's the a case of human to human, but also notes no evidence of another cluster.

While unveiling a statute of an Indonesian physician, an offical calls for physicians to fight bird flu in the honoree's name.

Recombinomics notes that quick confirmation of bird flu in Egypt may signal higher transparency.

Will County in suburban Chicago is doing bird flu planning.

A new sampling program has begun in Africa as migrating birds create concern around the world.

Thailand is also intensifying surveillance as migratory bird season starts.

September 3 Flu Update

Not much news today! Enjoy the official last day of summer here in the Northern Hempisphere.

Bird flu has been found in Egypt again.

ProMed on Egypt.

Bird flu has been found in Omsk, Russia as well.

More LPAI in Pennsylvania.

Recombinomics notes that H5 was the dominant avian flu found in the US in 2006 and wonders why.

New Scientist, employing a "publish or perish" metaphor, says that bird flu research has to be shared faster. Turns out GISAID only requires data to be published six months after research. Well, if that's the best they can do, that's the best they can do, but somehow I missed that in the initial flush of publicity.

Saturday, September 02, 2006

September 1 Flu Update

Reader's Note: Holiday weekend. Our next update will be September 4, 2006.

Promed on four people in hospital in Indonesia suspected of bird flu--potential mini cluster. It can be hard to track, but I believe this is the same one we mentioned a couple days ago.

There was much publicity on the woman in Indonesia being given Tamiflu. Apparently, she miscarried. (I believe it has to be the same woman). Of course, as Revere has noted, no one can conclude a thing from this.

Here's an interesting one. From the Safe America Foundation, as published in the Atlanta Journal Consitution...the future of social distancing to fight the bird flu. This is an odd one out of left field, and I am not sure of the agenda here.

Pagano said he and a team of medical experts would leave for Paris early next month to work with the French government and Parisian companies, which for several days will try to persuade employees to stay a few feet away from each other.

At the same time, Pagano said, several Fortune 100 American companies will conduct similar exercises. It's probable that employees of companies involved in the experiments will be asked to utilize social distancing for as long as a couple of weeks. Employees will be watched by monitors.

Pagano, whose nonprofit foundation has held summits for business and health leaders in Kennesaw, Chicago and New York, said others will be held in months ahead in Atlanta, Philadelphia, Washington, D.C., Kansas City, Tulsa, Okla., Los Angeles, San Diego and Omaha, Neb.

More low pathogenic H5N1 was found in wild birds in Maryland.

Recombinomics says that while this case (and the one in MI) do not present immediate danger, they could recombine into highly pathgenic bird flu.

The Thai government tells people not to worry. There is no evidence a dog has infected a person there, despite that a dog was recently found to have bird flu.

Indonesia continues to backpedal on the funding issue, says $100M targetted.

UNICEF highlights again the tremendous obstacles faced in fighting flu in Indonesia.

"There are so many diversities. When you talk to different people, you have to use different languages in terms of the messages you convey," said Rotigliano, adding that officials should be more flexible in spreading the message.

CIDRAP on the Indonesian "media blitz" to educate on bird flu.

IBM and Scripps Florida were in a parternship with the state to fight bird flu. It would appear as if the state has changed priorities and is not coming forward with funds.

Will the ipod fight bird flu. In Thailand, they are writing songs to educate on bird flu.

The USDA has updated its fact sheet on bird flu.

Belize has concluded a national bird flu seminar.

Antibiotic resistant staph is now an epidemic...noting role of pneumonia in the Spanish Flu.

Effect Measure looks at the WHO case definitions, and notes for us that they seem reasonable, but that the cause of the disease can only be determined on a case by case basis.

Friday, September 01, 2006

August 31 Flu Update

A 60M has been hospitalized in Indonesia with suspected bird flu.

ProMed on the latest batch of suspected cases in Indonesia.

There has been much criticism of how Indonesia has been fighting the bird flu. This on the ground report notes that they do face obstacles---a lack of funds and resistance in local communities.

In the isolated mountain community of Dairi in north Sumatra, about 200 villagers file into a packed meeting house. Everybody is talking about a frightening rumor that has been circulating all day.

Bupati Tumanggor, head of the local Dairi district, addresses the restless crowd over a loudspeaker.

He confirms that someone from the village has been hospitalized for avian influenza. Five chickens have tested positive for the H5N1 virus as well. He tells them the next morning all birds within a one-kilometer radius will be killed, to keep the virus from spreading.

Here's another obstacle...local reliance on "black magic." In this story, a local man was avoiding treatments. Authorities allowed the witch doctor to treat him in exchange for a blood sample.

Agenda Purba, a witch doctor from Jandi Meriah, chanted over 21 betel nut leaves, filled with blossoms, a pasty white lime, brown chunks of an astringent and bits of an orange-colored nut. He prayed for the young man's recovery, then chewed the first of the leaves and softly spit onto Jones' forehead. Purba repeated the process until he had finished the leaves, slathering the torso, arms, legs, hands and feet, making sure to cover all the joints.

From the "not a shocker" category...there are questions on the Chinese flu vaccine.

"This strain is different from the one in Indonesia and new ones that have emerged in other places," Guan said, calling for a more systematic and mature criteria on selecting the vaccine strain and the manufacturing process. "The vaccine could bring a small reaction for other H5N1 strains, it won't be completely ineffective. But when you create a vaccine, you try to make one that confers the most widespread protection, but the coverage of this one is narrow," he said.

China continues to say that its vaccine is ready to go.

To fight bird flu, Taiwan is asking market vendors to stop slaughtering birds "on demand."

Vietnam remains concerned about border biosecurity.

Japan is giving $20M to the fight against bird flu in Asia.

Hamilton County (OH) has a website for the area to fight bird flu. (This is Cincinnati).

The URL to the website.

CIDRAP on the dog with flu.

Following that report, European Union veterinarians in Brussels urged people living in areas experiencing avian flu outbreaks to keep their cats indoors and their dogs leashed. A German humane society said publicity about the cat case prompted hundreds of German cat owners to abandon their pets at shelters.

Effect Measure also looks at the dog with the flu. Revere notes the wider mammalian host range than people expect.

ProMed has the story of the transfusion treatment...note mod comment questioning the practicality of the idea.

Recombinomics says a duck in Indonesia with bird flu had a novel cleavage site, causing concern.