Thursday, November 30, 2006

November 30 Flu Update

South Korea is going all out with a massive cull to stop the bird flu in its tracks.

China is urging vigilance to keep flu from spreading into China.

Gartner (a consulting group) is telling companies to have extensive planning done by the second quarter of next year.

Among the suggestions offered Wednesday by a Gartner analyst at the research firm’s data center conference in Las Vegas: Store 42 gallons of water per data center worker--enough for a six-week quarantine--and don’t forget food, medical care, cooking facilities, sanitation issues and electricity.

FlaMedic, on his blog "Avian Flu Diary" gives an anatomy of the Quebec rumor and how it played out yesterday.

Helen Branswell spells out pretty much the same rumor, quoting Revere along the way. Niman says he was "hoaxed" by someone who pretended to be someone he knew. Anyway, the best part of the story quotes risk communication guru Peter Sandman (emphasis is mine).

In the era of the World Wide Web, sorting fact from fantasy can be tough when concern runs high and one website looks as reputable as the next, said Peter Sandman, a leading risk communications expert based in Princeton, N.J.

"Everybody who knows HTML now has equal access to the world," Sandman said.

He defended the contribution of rumours to public health, saying they play a key role in bringing to light disease outbreaks by countries that might wish to cover them up.

"WHO relies enormously on rumours as its early warning system," Sandman said.

"Long before a government tells the World Health Organization that something has happened the rumour mill tell the World Health Organization that something might have happened."

But he suggested sites that go out early with rumours should make that clear, and should correct themselves if the rumour turns out to be false.

Here is Revere's post on the issue.

The Indonesian Bird Flu Relief Committee has a new bird flu website.

A Labour minister in Britain says that the nation must have its own bird flu vaccine supplies if it is to be secure.

They'll be doing bird flu surveillance in Great Falls, MT.

Japan says its bird flu stocks are below satisfactory levels.

Apparently, a company that sells Tamiflu is using the WHO logo on its packaging, and WHO is not taking it lying down.

A suburban Chicago blogger has found public service brochures on bird flu at SPEEDWAY! This is from the "who would have thunk it" category.

Wednesday, November 29, 2006

November 29 Flu Update---Rumor Free Edition

Internet rumors (snicker) reported a child with H5N1 in Quebec. They are not true and you didn't see it here.

Several Internet websites on pandemic influenza reported rumours that North America had its first human "bird flu" case in an unlikely spot - Rimouski, a city of about 42,000 people on the St. Lawrence River north of Quebec City.

Look who did, with a belated caveat.

Perhaps the day's most interesting story. Flu viruses may be preserved in glaciers and arctic ice, and then released when the ice melts to cause a pandemic.

The finding may help explain the constant emergence of influenza A-type viruses that cause seasonal epidemics and occasionally set off pandemics capable of killing millions of people. Disease trackers are monitoring flu viruses amid an outbreak of the H5N1 strain, known to have infected 258 people in 10 countries in the past three years, killing 153 of them.

``One expectation in relation to this phenomenon would be an increased rate of release of these microbes during times of global, or local, warming events and a decrease during cooler periods,'' said the authors, led by Gang Zhang from Ohio's Bowling Green State University.

Here's a more technical version from ProMed.

From the fact division: South Korea is culling/killing pigs and dogs, but not pets.

A pre-pandemic flu vaccine is ready for testing in Britain.

There's big flu news out of Alabama.

China has put an end to the construction of new poultry markets.

Effect Measure weighs in on the story of John Snow, who created epidemiology when cholera hit London...and how you can easily translate the "theories" on cholera to similar theories on bird flu. It takes some work, but it is worth it.

But the example of John Snow and waterborne cholera should remind us humility is also a scientific virtue.

Effect Measure comments on the culling of dogs in Korea.

CIDRAP on WHO urging that flu cases be investigated very carefully, especially to prevent false negatives.

Promed clears up the confusion on the death in Indonesia from yesterday.

Uganda has banned the transport of birds on passenger vehicles.

Highly recommended. Laurie Garrett of CFR with a podcast on the bird flu. Key quote: "there are no fools left who think it can be contained in one country."

Religious leaders are conducting bird flu training in Cambodia.

In Newton County, MO, they conducted a bird flu exercise.

Tuesday, November 28, 2006

November 28 Flu Update

Sorry for yesterday...needed rest more! Back at it...

A 35 year old woman in Indonesia died of bird flu today. CIDRAP reports. She was reported sick three weeks ago, and died despite receiving treatment for that amount of time.

ProMed is skeptical of this report, citing the lack of details.

CIDRAP also reports that bird flu has hit a second area in South Korea.

ProMed on South Korea--note mod comment lauding quick action by South Korean officials.

OIE report from South Korea provides official confirmation, via ProMed.

Today's news is about money--how much would it cost to fight the bird flu? The UN says it needs $1.3B more than what was pledged last January.

Would a cheap bird flu test help? Vietnam and Hong Kong are testing.

In Alberta, the nine health regions are getting $30 million to prepare for the bird flu.

The Philippines are preparing for major losses in the poultry industry if the flu comes.

Kaduna, a state in Nigeria, is preparing for the bird flu.

India is afraid the bird flu crisis in South Korea might cut down on Korean imports of Indian oilmeal.

Roche says that there is no evidence the flu is becoming resistant to Tamiflu.

Surveillance in South Dakota yields no birds with H5N1.

Companies in Hong Kong are no different than anywhere else--they are not ready for a pandemic.

Sunday, November 26, 2006

November 26 Flu Update

The New York Times is finally covering the NEJM articles from last week. They are focusing on the slow test results and how they impact treatment.

The Director-General-elect of WHO has pleaded with the world for transparency.

South Korea is ramping up its bird flu quarantine program.

Nebraska Wildlife officials are warning that cranes--a local favorite of nature lovers--could bring avian flu back with them next year.

Another great article on the 1918 flu, this time based in St. Paul, MN.

Planning is ongoing in Vermont, where they think 3,000 people could die in a pandemic.

Biologists in OK are testing for bird flu.

An educational program is being conducted in Eastern China.

And, it is the second blogiversary of Effect Measure. The Reveres write on what it means to them, and what they have to look back on. Effect Measure is a rock solid resource for those of us interested in this subject. For laypeople, the key is to find the people with the training who are still outspoken and original thinkers. The Reveres fill that bill. Here's to...I don't many more years?

(Hard to believe, but we're just a month and a day away from our own 2-year mark).

November 25 Flu Update

South Korea has now confirmed that the H5N1 in the southern part of the country is high path.

Taiwan does not expect problems from South Korea is bird flu.

Promed on the South Korea story. Note that the affected area is on a migratory bird path.

Recombinomics reports that nearly six hundred dogs were culled in South Korea as part of the response to the outbreak.

India has set up a bird flu research center in its major poultry production region.

Britain's financial services sector underwent a six week bird flu exercise, and concluded that it could survive.

"It was a bit daunting at 10am on a Monday morning dealing with this escalating pandemic. It was a bit like being in that film 'The Day After Tomorrow'," said a participant at a major bank who worked on the desk-bound exercise.

Nigerian poultry farmers have been urged to learn more about the bird flu.

The forums on the flu wiki have been redesigned and updated, as Revere notes here.

Friday, November 24, 2006

November 24 Flu Update

A new antiviral is out--Peramivir. Note: it must be injected.

Peramivir has two important advantages over the other therapies. Tamiflu, which is taken orally, and Relenza, which is inhaled, are difficult to administer to unconscious patients. Peramivir does not have this problem because it is injected, and the first human studies have shown that it also reaches the bloodstream in higher concentrations and remains active for longer.

The new drug would also provide a valuable alternative if a pandemic strain were to evolve resistance to Tamiflu, the front-line treatment that has been stockpiled by many countries, including Britain. Some H5N1 viruses have already shown resistance to Tamiflu, and if such a strain became dominant the drug would become useless. This week, a report from the Royal Society urged the Government not to rely on it exclusively.

ProMed reports that the reported avian case in Sudan was negative. Note the mod comment that they warned us to be careful on this one in the first place, and then the mod takes a shot at the media.

ProMed on the South Korea situation.

More on the NEJM studies...quick tests for bird flu are often inaccurate.

ProMed posts on the NEJM articles as well.

To date, surveillance in Ohio has revealed no bird flu.

Canada has added to its bird flu drug stockpile with more Relenza.

A researcher from Mass. went to Alaska to held in the surveillance effort and he spoke to the Pembroke Watershed Association.

A similar story from a woman on faculty at Central Michigan University.

Brunei and Malaysia continue to fight the bird flu.

South Korea says its bird flu was low path.

Revere writes on the international readership of flu blogs...noting that his readership has a strong Northern Europe contingent. He even ran a cool map.

A cranky professor asks if taking a "chicken little" approach to bird flu was right. (Perhaps the professor should acquaint himself with the work of Peter Sandman.)

We all saw the infamous "shelter in place" warning the US embassy sent to US Nationals living abroad...telling them to be prepared to survive on their own for 12 weeks in a pandemic. Rachel is a 26 year old living in Belgrade, and here is her reaction to the email.

Thursday, November 23, 2006

November 23 Flu Update--Thanksgiving (US) edition

Vietnam says it has successfully developed a human vaccine for bird flu. It has been tested on roosters and mice.

In South Korea, the bird flu has struck a poultry farm. 6,000 birds reported culled.

Some turkeys in Ivory Coast are confirmed H5N1.

An International Bird Flu Conference will be held in December in Mali.

The World Bank says that a serious pandemic would cost the US $623B.

Helen Branswell weighs in on the two recent studies (written up below) on how the bird flu spreads. So little is known that anything is important.

A myriad of questions continue to puzzle scientists:

  • How does a bird virus manage to infect people?
  • With so many people exposed, why do so few get sick?
  • Why do so many clusters of cases among blood relatives occur?
  • Why do children make up such a disproportionate number of the total cases?

But with cases occurring randomly in remote and varied parts of the globe, gathering information to accurately chart this disease will remain a challenge, Fukuda admitted. That's because dealing with human cases can place hospitals in crisis mode. And rigorous science is hard to do in a crisis.

WaPo editorial on whether, after all our technology and Tamiflu, we are no better off than our forefathers were in 1918...and whether we should do something about it.

Residents of a remote Alaskan village talk about what it feels like to be on the migratory path of bird flu.

The Canadian commercial real estate industry is recommending that building owners communicate with tenants on the potential risk of the bird flu....after all, with 40% absenteeism, rents might be late.

Here's a link to their letter template.

Here's a really good piece from Scribemedia. Talks about fickle year ago, avian flu was everywhere. Now? Well, it is last year's news. Here's a post on that topic, and a some video of a symposium with medical/flu experts...

Africa is being urged to find the resources to fight the flu.

In Mongolia, seeing a migratory bird sends a shiver down the spine of local residents...

A Florida blogger gives thanks this day for the contributions various people are making to fighting the bird flu.

Here's an interesting map that assesses the global risk of bird flu.

Happy Thanksgiving

You cannot be at peace until you can be thankful. Happy Thanksgiving.

Wednesday, November 22, 2006

November 22 Flu Update

Well, here we go again. Dr. Robert Webster, in conjunction with a Elena Govorkova (also of St. Jude's) say in NEJM that the flu virus changes everyday, and could make the leap to H2H anytime. And along comes Marc Siegel: nothing is certain.

A clinical problem...bird flu is hard to diagnose quickly, sometimes after the patient has died.

CIDRAP on the story above. Note this, too:

In other findings, the Indonesian report says that the source of infection for the first patient in two of the clusters was never identified. The three patients in the first cluster reported no contact with birds, other animals, or sick people other than family members before they fell ill. In the second cluster, patients reported no contact with birds, other animals, or sick people, but the index patient used fertilizer containing chicken droppings that tested positive for H5N1.

The report says limited person-to-person transmission could not be ruled out in the first two Indonesian clusters, since the patients had no other known exposures to the virus.

Baxter Pharm. is releasing preliminary data on a cell-based bird flu vaccine.

Bird flu fighting in Turkey is being featured in a documentary.

The sick bird in Greece did not have high path H5N1.

Thailand is reconsidering vaccinating fowl for bird flu.

A plant in Britain will play a role in delivering bird flu vaccine to the US.

In Wisconsin, a local media story sounds just the right note on pandemic probability....

Today, bird flu seems more like the punchline of a joke.

But experts say it remains just as dangerous — and just as able to cause a worldwide outbreak of flu like none seen since 1918, when as many as 50 million people died.

“The reality is this virus is continuing to spread,” said Christopher Olsen, a virologist at the UW-Madison School of Veterinary Medicine. “It’s continuing to infect birds. It’s continuing to kill human beings.”

A nursing home in Australia had an influenza breakout. And they are applying what they learned to a potential pandemic.

Australians in New South Wales are calling for a revamp of pandemic plans.

The Philippines is sending a bird flu task force to Indonesia.

Recombinomics says WHO is hoarding sequences from Azerbaijan.

Owego, NY is holding a bird flu seminar.

November 21 Flu Update

Helen Branswell on the US decision to buy more pre-pandemic vaccine. A US official responds to the criticism that the virus could mutate and render the vaccine less effective or ineffective....

"We're doing this for preparedness. And we started this because we wanted to make sure that companies and the (vaccine) regulators had experience with making pandemic-like vaccines at full commercial scale," Dr. Bruce Gellin, director of the U.S. National Vaccine Program Office, said from Washington.

Gellin said the U.S. government understands the H5N1 virus will continue to mutate, as all flu viruses do. But he said it is important to learn what implications that has on the effectiveness of vaccines that aren't a perfect match for later strains.

"So while we know there's a possibility that the vaccine we're making might not have the full effect that the perfectly tailored pandemic vaccine would . . . there's still the possibility that it could provide some protection," he said.

Branswell also writes about a triage protocol developed in Canada which will determine who gets carefully considers whether the elderly should be given priority.

CIDRAP with more on the discovery of the two mutations needed for flu to become human-human.

Recombinomics had reported a potential outbreak in the Sudan. Note, here, some confirmation from ProMed, though reports of a human case are doubted.

Citing "receded" bird flu fears, the Dutch are now letting poultry outdoors again.

More outbreaks--this time in household poultry--in Egypt.

Austria has an option to buy 16 million doses of vaccine.

Israel and the Palestinian Authority met to discuss the bird flu. (Bird Flu Brings People Together).

The Council on Foreign Relations has some new flu information. Highlighted by the always stimulating Laurie Garrett, the report (and podcast) emphasizes that we are still a long way from where we need to be.

Alberta has spent $30M on bird flu equipment and supplies.

Meanwhile, the US has donated equipment to Botswana.

Tuesday, November 21, 2006

November 20 Flu Update

WHO's David Nabarro makes a vital defenses to the flu are one thing, but the first and perhaps deciding response might be local.

But he also said governments around the world must be poised to aggressively contain any localised outbreak in humans and to limit the fallout - and keep essential services running - in the event of a human influenza pandemic.

"It doesn't require a lot of thinking to understand what the magnitude of the impact of a pandemic will be," he said. "We are not talking about a health crisis, but a social, economic and governance crisis."

President Bush says that bird flu is still a priority for him.

Britain is being warned by a leading scientific society that the country's reliance on Tamiflu leaves it vulnerable if a resistant strain emerges. (I think this concern is overstated in that I don't think the meager stockpiles of Tamiflu that countries have will really impact a raging pandemic even if the virus is sensitive to the drug).

The US government ordered 2.7 million more doses of pre-pandemic vaccine.

CIDRAP has this story as well.

The BBC gives a reasonable answer to the question of whether people should be worried about the bird flu.

Professor John Oxford, a virologist at Queen Mary School of Medicine, London, said: "Things have changed tremendously over the last 12 months.

"Every major vaccine manufacturing group has now got an H5N1 vaccine in production. A year ago, that didn't seem possible.

"And the stockpiles of antiviral drugs are increasing."

Recombinomics on a potential human case in the Sudan.

Russia has opened a "big" bird flu lab....(I'd note here that I don't think size is exactly the top criteria).

UN article on how government intervention has paid off in Vietnam.

University of New Hampshire specialists are using satellites to track the bird flu.

Finally, a set of must read articles. CIDRAP has HHS guidelines on mass casualty events, including a significant section on an influenza pandemic. These guidelines are mind-boggling, and we can hope they remain on a planner's bookshelf forever. (How would you like to be your city's bed czar)

A centerpiece of the report is a case study on pandemic influenza. The authors list preparations for and responses to each stage of a pandemic, from the current prepandemic period to increased and sustained transmission in the United States. For example, during the worst stage of a pandemic, the authors suggest a "bed czar" be appointed to monitor the supply of hospital beds and equipment and make assignments based on availability.
Nov 2006 AHRQ report "Providing mass medical care with scarce resources: a community planning guide"

Sunday, November 19, 2006

November 19 Flu Update

Inolesco--an RN Flu blogger--has this on Thai officials ordering the disinfecting of poultry farms, especially in flooded areas.

More on industrial farming--are feedlots putting animals and people at risk of bird flu?

Critics say that Australia's pandemic plans do not take into account the potential loss of electricity in a pandemic.

November 18 Flu Update

Believe it or not....Australia's Chief Medical Officer says that a bird flu epidemic might already have been averted.

ProMed on the recent report that a wild bird in Greece had bird flu.

Recombinomics says that use of chicken eggs to test for H5N1 may be contributing to false negatives.

People say Indonesia doesn't vaccinate they say they have vaccinated 100 million birds.

Serbia has begun its bird flu program.

Canada says that it is worried about "Crown Corporations" and whether they have continuity programs for bird flu.

Saturday, November 18, 2006

November 17 Flu Update

A six-year old child has died in Indonesia, and is reported to have had bird flu. Promed reports. Note this:

Siti Fadilah said the spread of bird flu in Indonesia was unique, as the causes of the spread differed from one place to the other.

"After appearing in Karo (a regency in North Sumatra), where the virus was spread by wild birds, it reappeared in Tangerang, Java, where it was spread by contact between wild birds and domestic poultry," she said. "This means as long as we cannot control the migration of birds, it will be very difficult to stop the spread of the virus," Siti Fadilah said. The minister reiterated that if in a certain region local poultry was found to have the virus, the local administration had to make a quick decision to cull the infected chickens. A fast decision was needed because the infected chickens could transfer the virus to humans, she said.

CIDRAP has an HHS clarification that degrading of the virus stockpile is only 20%, not 50% as originally reported.

There was an outbreak of respiratory disease in a Canberra nursing home, but it was not H5N1, as feared.

Promed on the latest state of play in Egypt and the former case, they have a new outbreak in birds, and in the latter they are confident it won't happen.

A Canadian epidemiologist says that during a pandemic, children should be vaccinated first.

If surveillance reveals that your bird has low path H5N1, USDA will pay the indemnity costs for destroying the effected birds.

Australia says it will back the ASEAN bird flu fight.

Though Recombinomics says otherwise, this media reports says that there has been no H5N1 founds in bird surveillance.

A public meeting in Regina, Saskatchewan reveals that a little scaring can help to motivate people.

Excellent Cincinnati Post column...looks back at 1918, and wonders how far we have really come.

It was not long after I met my future mother-in-law 40 years ago that I first heard the story about her mother's death. On New Year's Eve 1918, before Margaret Schneider was 3 years old, her mother suddenly became ill. Ruth Schneider, whose wedding photo hangs in an oval frame in our dining room, was a beautiful, healthy, wife and mother. Her daughter, Margaret, remembers her father carrying her mother - who had become suddenly very ill - upstairs to bed. She never saw her alive again.

Sarasota County, FL, is using school absence reports to look for early warnings.

Recombinomics reports on the genetic sequences in birds in Egypt.

Friday, November 17, 2006

November 16 Flu Update

The US government had stockpiled enough flu vaccine doses for 4 million people. However, in storage, the vaccine is degrading, and there is now only enough for 3 million people. CIDRAP reports.

Hall said not very much is known about the shelf life of flu vaccines, "because the main experience is with seasonal vaccine. At the end of the season the vaccine that's not used is thrown away. We don't keep it around, so no one really knows how long it would stay good for." With many flu virus strains circulating at any given time, seasonal flu vaccines have to be adjusted every year to match the strains expected to be dominant.

Recently, HHS recommended respirator usage for healthcare workers during a pandemic. However, clinicians are worried about supplies, which they say are strained now. CIDRAP reports.

ProMed on the two mutations required to make a flu virus a pandemic strain.

Effect Measure also comments on this story. What he says is that researchers have a tendency to overstate their conclusions for the media, because the real conclusion from most studies (especially about nature) is usually not great copy, because they simply cannot be conclusive and often require additional work.

President Bush is going to tour the facilities Vietnam used to launch its much lauded bird flu program.

Elsewhere at the APEC meetings, people are urging that bird flu still be a priority.

There are some new outbreak areas in Northern Egypt.

Recombinomics notes that H5N1 is being found in surveillance in the US, though it is low path.

Surveillance is being done in Northern California.

Nacogdoches, TX, had a pandemic exercise.

A panel discussion at MIT is reported here--the gist is that science is gaining ground on the flu virus.

A focus group in Kansas was held to discuss a pandemic response.

A trial is being held in China for people accused of selling fake flu drugs.

This columnist is glad that a pandemic didn't hit before his Thanksgiving dinner.

This blog post talks about the "hype laden" pandemic scare.

Thursday, November 16, 2006

November 15 Flu Update

CIDRAP reports on the gene chip--to diagnose H5N1 quicker and more effectively.

The US and Mexico are working on cross-border pandemic issues.

Scientists have identified the two mutations that would need to occur for the bird flu to become tranmissible between humans.

The new report provides a molecular blueprint for the genetic changes required to transform a virus that only infects birds to a virus capable of easily recognising human receptors. Receptors are molecules on the surface of cells that permit the virus to dock with the cell and commandeer it to initiate a cascade of infection. By knowing what genetic changes are required for the virus to easily infect human cells, it may be possible to detect the emergence of pandemic strains earlier, providing public health officials and vaccine manufacturers with precious time to prepare for a global outbreak of highly pathogenic influenza.

CIDRAP on OSHA guidelines for people who might work with infected animals.

You can't have missed the stories out there about the side effects of Tamiflu including abnormal behavior. Effect Measure weighs in--also noting concerns about how Tamiflu works against N1 subtypes.

South Korea is going to train other officials in Asia on detecting bird flu.

Romania's goal is more bird flu outbreaks.

Lufkin TX is preparing for the flu.

Jamaica is holding a FIVE-DAY regional bird flu conference.

Pandemic planning is also going on in Cass County, MN.

Ft. Collins CO--on the frontlines of the bird flu surveillance effort.

Tuesday, November 14, 2006

November 14 Flu Update

APEC nations are preparing for the bird flu, and asking for private sector support.

In the draft statement, the APEC leaders urge a "deepened engagement of the private sector to help ensure continuity of business, trade and essential services in the event of a pandemic outbreak.''

Two cases reported yesterday in a fatality, and one in critical condition.

Recombinomics has reports of two more fatalities.

Japan has brought a great deal of help to Azerbaijan, including bird flu assistance.

The health departments around Jacksonville (NC) are preparing for the bird flu.

Surf City police and fire officials were recently trained in how to recognize and handle bird flu. They are the first in Pender County to be trained in how to prepare for such a pandemic. Pender County is currently finalizing its countywide plan to train other municipalities.

A European Food Service Agency wonders if wild bird imports should continue given the risk of bird flu.

CIDRAP on the report that Tamiflu may have psychiatric side effects.

An interview with Dr. Lam, a Canadian flu author, on his latest book.

Your plan in the book is so detailed, right down to the level of suggesting people keep a large supply of contraceptives handy.
We're all about detail! Given everything that might be going on during a pandemic, you might want to think about whether that's the ideal time to procreate.
OK, some people were not comfortable with the idea of Homeland Security...I'm not sure we were thinking Defense Department, as we see here is proposed.

HHS soldiers on (get it?) with an update to the pandemic plan.

Monday, November 13, 2006

November 13 Flu Update (Update)

Two new human cases in Indonesia, with a 2 1/2 year old boy dying of the disease.

ProMed on these Indonesian cases.

This is not the first report of its kind--Tamiflu causes delirium in some patients. As before, these reports are coming out of Japan, but they have caused the FDA to change the warning labels. (I wonder how this will effect Roche's marketing plan using children's movies for Tamiflu).

The added precaution comes after reports of more than 100 new cases of delirium, hallucinations and other unusual psychiatric behavior in children treated with the drug. Most were Japanese children.

Egypt expects more bird flu outbreaks this winter.

Effect Measure with an excellent article on a journal piece about how the flu spreads. As he writes...

The depths of our ignorance in this age of sophisticated molecular biology is truly impressive.

More warnings in Britain that say that companies in Britain are vulnerable to the bird flu.

Vets from Romania are in Delaware to study bird flu control at the University of Delaware, which has formed a group to lead the fight.

This news report says that governments are pledging to use the army to protect GSK vaccine plants in the event of a pandemic.

"People don't realise the disorder which comes from a scary event such as a true pandemic. It is not going to be the time to line up to your friendly pharmacist because there will be hundreds of people there. There will be panic episodes," Mr Garnier said.

Here's little profile on the guy in charge of the strategic national stockpile.

Sunday, November 12, 2006

November 12 Flu Update

Yesterday, we ran a story on the projection of a pandemic having severe health effects, but not a huge effect on the economies of large nation's. We had some comments on it, and now Effect Measure weighs in...saying we shouldn't base policy on something this uncertain.

The Philippines has Tamiflu which will expire this month, so they are donating it to Indonesia and Cambodia.

We blogged this before, but it is worth another look. From Nature, a call for research during seasonal flu to find out how basic interventions like hygiene might effect flu transmission.

This is something others have done as well....the Macon County Department of Health is going to vaccinate large numbers of people (for seasonal flu) in one place and time, to see how it goes.

November 11 Flu Update

A new outbreak in birds has been reported in Egypt.

ProMed on this outbreak, and a recent one from China.

China's first reported bird flu case--a 10 year old boy--is alive and well a year later.

The Atlanta Journal Constitution has the story of another projection on the damage of a bird flu, which in a worst case, is suitably catastrophic. Interesting that it suggests investment might flee less stable countries for old world countries.

A computer model of an "ultra severe" flu pandemic shows it would leave more than 140 million people dead worldwide and cost the global economy more than $4 trillion —- but that its effect on the economies of the United States and Western Europe would be relatively mild.

The State of Utah is working on its pandemic plan.

A Connecticut woman has taken the advice on how to prepare for the flu seriously--she monitors

Florida State is using a magnet to learn how the bird flu works.

Saturday, November 11, 2006

November 10 Flu Update

China says it had 10 flu outbreaks that killed 47,000 birds. So, that's transparent.

China Friday announced that it would share flu sequences with researchers--but did not release any from this year.

CIDRAP on this story, noting that the Chinese are miffed that researchers have been "misusing" Chinese samples and not giving ample credit.

Recombinomics on why the hoarding of the virus sequences should be stopped.

Revere on a Chinese National heading WHO. Will it help or hurt efforts for the Chinese to be more open---will they not want to embarrass someone from their own nation?

India says it is bird flu free.

CBS News with a story on animal diseases that threaten humans--including bird flu.

Pandemic planning has progressed in Milford, MA.

Mick Fulton of Michigan State University travels the world fighting disease, including a trip to Rwanda to fight bird flu.

Thursday, November 09, 2006

November 9 Flu Update

Effect Measure has an interesting piece on bloggers catching the US government in a contradiction. Recently, US Nationals in foreign countries were advised to be prepared to shelter in place for 12 weeks, which is different from the official advice on their website of two weeks.

Indonesia says it is far from having a pandemic of bird flu in the country.

The Nigerian government has asked its farmers not to vaccinate poultry against bird flu.

The UN has developed (w/Microsoft) a real-time portal that can be used to track the bird flu and other infectious diseases.

The American Public Health Association has called for pandemic preparation in US to move from Homeland Security to HHS. The choice of DHS never made sense to me, ever.

CIDRAP on the Chan appointment.

The Japanese are going to publish a manual on what their nationals should do overseas during a pandemic.

The UK government has critiqued how it handled an H7N3 outbreak in Norfolk and found a number of shortcomings.

McGill University (Montreal) is hosting some of the continent's top immunologists at a meeting to discuss flu, among other things.

More on Jamaica's bird flu exercise.

Flu Planners in Kansas City are beginning public focus groups on pandemic plans.

Wayne County,NC, is preparing a bird flu plan.

More on bird flu drills in New Zealand.

Here's a story on bird flu as an emerging threat in a publication targetted to dentist's.

Recombinomics says that surveillance has turned up H5N1 in wild birds in the Crimea.

November 8 Flu Update

The WHO Director-General election is over. Hong Kong flu expert Margaret Chan will held the organization.

Effect Measure comments on the choice of Dr. Chan.

The WHO has urged Chinese Scientists and non-Chinese scientists to stop squabbling, share data and work together.

Nick Zamiska of the Wall Street Journal also has this story--from the context that the rift shows the difficult road China has in doing this work in a single-party state.

WHO reminds its readers that it will be importantly to continually monitor poultry vaccines to check for mutations.

GSK is projecting that a couple "important" countries will order large quantities of pre-pandemic vaccine.

Recently, we blogged that the Chinese had identified a part of the flu virus that made it virulent. Effect Measure chimes in about the potential importance of the research.

Still, this is very interesting and elegant work. It directs our attention to NS1 and its ability to inhibit interferon production as a characteristic sufficient to turn an avirulent virus into a virulent one. It is like a big sign in the ground that has the letters, Dig Here, written on it.

Imogene has received an R&D grant to develop "technology that enables identification of naturally infected and vaccinated birds."

India is lowering its expected poultry exports due to the flu.

India is looking at developing poultry health standards to protect against its poultry stock from bird flu.

A national influenza drill is being held in New Zealand today.

Scott County, VA officials say they are ready in the event of an influenza pandemic.

Here's another positive vaccine press release from a pharmco.

Tuesday, November 07, 2006

November 7 Proposition 1 Bird Flu Update

An Indonesian teenager has died of the bird flu. He is said to have contact with sick birds.

ProMed on this story as well. Note mod comments that says that the family found exposure 30 days before the young person died, but that there must have been a more recent exposure.

The US government has advised its employees overseas to stockpile food and water to last 12 weeks in the event of a pandemic. CIDRAP reports.

Perhaps in counterpoint, France says that for this Fall, the risk of its domestic poultry getting the bird flu is negligible (Note: in the past, statements like this have created notably bad karma.)

Effect Measure on a paper that questions how good our bird flu data really is.

Turkey says it is ready to fight the bird flu.

In Nigeria, media executives are being called upon to subsidize the cost of bird flu education.

The BBC is the latest to produce a docu-drama on a bird flu pandemic. It is, as they all have been, suitably apocalyptic.

A bird flu response exercise was held by the veterinary service in Jamaica.

A similar exercise was also held in Wicomico County, VA.

At Texas A&M they say that hygiene and vaccines are the key to fighting the bird flu.

Scottish businesses say the skills gap is a bigger threat than bird flu or terrorism.

Recombinomics on how a change in the virus in China is increasing pandemic risks.

Monday, November 06, 2006

November 6 Flu Update

Effect Measure on the question of whether the flu must be less virulent as it gets less transmissible.

USA Today a story on bird flu in two countries today. First Indonesia..

Indonesia only threw off the yoke of dictatorship in 1998, holding its first free national election in 2002. One of the main objectives of the new democratic government has been to decentralize power.

That has meant that Indonesia hasn't been able to mount a strong, centralized assault against avian influenza in poultry and humans. Instead, it's fighting an outbreak-by-outbreak battle. Just last month, four people died.

and then Vietnam.

The soup, made with raw blood, is a traditional source of protein revered for its supposed strength-giving property. Now its consumption is discouraged, along with other traditional practices, such as raising chickens in cities and selling them at live-animal markets, because of the risks of exposure to the deadly H5N1 virus.

"What we're talking about is trying to change behavior people have embraced for years," says Richard Brown, a World Health Organization epidemiologist in Hanoi.

Scientists in China are claiming to have isolated the gene that determines the virulence of bird flu.

Note here: Promed looks at the story from above, and adds some interpretation.

This is a significant piece of research indicating that a single amino acid substitution in the NS1 protein of H5N1 avian influenza virus disables the interferon response in infected chickens, a factor contributing to the pathogenicity of the virus. This observation does not necessarily confer enhanced vaccine potential, and significantly, the abstract does not claim this.

In Monticello, IN, they held a mass vaccination clinic in a public place--to test how it work if they had to do it under emergency conditions, such as smallpox or avian flu. In an absence of panic, it seemed to work smoothly enough.In Canada, HR professionals are advised on how to plan for a pandemic

The US has approved the use of firefighting foam to cull birds instead of gassing them and exposing workers to them more directly.

Rivers State, Nigeria, is planning a surveillance effort.

Migrating swallows arrived in a Thai town, and bird flu fears were raised.

The last lab analysis of surveillance in Azerbaijan showed no bird flu.

Tests are being conducted of a skin patch vaccine.

Roche is doing a product tie-in with a kids movie about penguins.

Generex is beginning human trials of its bird flu vaccine.

November 5 Flu Update

A little while ago, we had a story from WHO suggesting that there was a genetic element to people's ability to get the bird flu. I said I thought it made sense, since so few people get bird flu--even directly from birds. Effect Measure now weighs in with the idea that while it is possible there is a genetic component, it is not the whole story.

There is much more to the question of genetic influence on H5N1 infection than the implied inference that the reason someone gets bird flu lies in their genes. Infectious disease is an interaction between a host, its environment and the agent. Isolating one element can provide important information but doesn't correspond to the real world.

In Australia, near Asia, a pandemic business plan is a must.

Bird flu test kits have arrived in Uganda.

Britain apparently could order 3M body bags in pandemic alert.

Anchorage Daily News says that one year ago, all you heard was doomsday flu prophecies. Today, not so much. Still, Alaskan officials have their eye on the ball.

Sunday, November 05, 2006

November 4 Flu Update

CIDRAP on the Fujian-like strain. It appears that the virus has outwitted the people again, especially a vaccination effort in China that was probably not well executed. So, the strain is widespread in Southern China. Not to raise an alarm, because I don't know that is warranted. But assurance that the situation is not getting worse is equally unwarranted.

Effect Measure on the Chinese transparency issue, and why WHO lacks the credibility to effectively make an issue out of it.

Recombinomics makes much the same point.

A flu drill in Manitoba apparently set off a little concern.

Roche's Tamiflu advertising campaign is raising eyebrows.

Thursday, November 02, 2006

November 2 Flu Update

Helen Branswell on a WHO report that says there is no guarantee that H5N1 will become less deadly if it transforms into a pandemic strain. This is a key point. The assumption has always been that it would be less deadly if it went pandemic because if the disease is too virulent it kills hosts before they can transmit the virus. Not to be a doomsayer, but if it did become a pandemic at 60% virulence, we're talking an event that could be significant in geologic time. Note: it didn't say it wouldn't be less virulent, just that it might not be.

There's no guarantee the H5N1 avian flu virus would become less deadly to people if it triggers a pandemic, a new report from the World Health Organization warns.

A group of eminent influenza scientists gathered by the WHO last month concluded there is no reason to believe that the virus, which kills roughly 60 per cent of people who become infected, would become any milder if it evolves to become a pandemic strain.

CIDRAP on WHO warnings that countries should NOT stockpile pre-pandemic vaccines because not enough is known about the requirements for this kind of vaccine.

China rejects the notion that there is a new flu strain in the country.

CNN Money reports that with the new strain, new therapy activity is expected to increase.

A deceased dog with bird flu was found in Thailand. More evidence of the disease creeping over into mammals.

This report tries to answer one of the key questions (in my mind) for bird flu. Not only is there no efficient human-human transmission, but there is really no efficient bird-human transmissions. WHY? (That's the key question). This reports says genetics are the answer.

More...outdated farming and sales techniques are the real culprits.

Here is the source report.

Here we go again....FAO officials speaking in China say migratory birds do not play a major role in the spread of H5N1.

Evidence indicates wild migratory birds play a minor role in the long-distance spread of the virus, he said, adding that the main causes of the deadly disease are the trade of poultry and poultry products.

Malaysia is increasing bird flu surveillance.

Nigeria "denies" presence of bird flu in country.

Bali now has the ability to conduct bird flu tests without sending samples out of the country.

Province in East China says it is now monitoring for bird flu "around the clock" (?)

Vietnam is establishing partnerships to continue the fight against the bird flu.

Washington County, OR, ran a bird flu drill.

Poinsett County, AR, has a pandemic flu program.

November 1 Flu Update

Now that we know that the Fujian-like strain is widespread across Asia, WHO has criticized the Chinese for not being open and transparent about it. Helen Branswell reports.

LA Times story on the Fujian-like strain that quotes Dr. Niman of Recombinomics.

Finally, Effect Measure weighs in on this, wondering on what it means. It includes the questions of why vaccinating birds is thought to be successful in Vietnam but not in China.

Recombinomics with his take on what this all means.

Remember the big scare when a man showed up in Australia with flu symptoms, and had been to Cambodia....then it turned out he was a drug mule? This is an excellent story on how healthcare workers improvised their response to this potential crisis.

"He had come from Cambodia, he had a respiratory illness, on the plane he had been acting a bit differently and often people who are hypoxic can act strangely … In fact, he had become comatose prior to leaving the plane," Rawlinson says.

"We have to ask ourselves, 'Is this hypoxia because they have got pneumonia, is it about drugs, alcohol, is it some other illness such as malaria?' "

I think this is an important effort--to the extent that the migration vs. smuggling issue of how bird flu spreads has been resolved. Britain is getting better understanding of the migratory patterns in its nation.

More credits to Vietnam for its bird flu program.

Tamiflu is launching a major advertising program this year. Some people wonder if the drug is worth all the hype.

The company's tactics drew sharp criticism from a Harvard Medical School professor who said it is irresponsibly promoting Tamiflu. Dr. Jerry Avorn , who is the author of "Powerful Medicines ," called Tamiflu's effectiveness marginal. Such advertising misleads consumers by overstating the drug's "slender" benefits, he said.

"It's not as if this somehow cures the flu or treats the flu. It just will shorten the symptoms by a day or so," Avorn said.

He also worries that the drug's indiscriminate use could reduce its value when the stakes are highest: Combating a perilous avian flu outbreak.

Cibola County, NM, estiamtes it could have 74 deaths in a pandemic.

Bird flu as economic development driver??--Ithaca NY talks about its new bird flu test being a job creator.

Not in Indonesia, where bird flu is hampering poultry production.

Another vaccine press release, this one for an inhaler-based vaccine delivery system.

A Tuscan mallard is found to have low path bird flu....

though not before culling was underaken.

Wednesday, November 01, 2006

October 31--Halloween Update

The news continues to revereberate concerning the report of the Fujian strain--a new strain from China. There are a couple different perspectives.

First (of course) is Helen Branswell. She says WHO reports that the virus does not appear to be more dangerous to people.

"The virus isn't necessarily more pathogenic, more virulent. The fact that you have a virus that has mutated or has changed somewhat and that humans have become infected with the more dominant virus when it has occurred is logical, because that's the virus that is circulating," he said.
There's also this take--that it could (and probably will) spark a new round of global outbreaks.

ProMed moderator has this story, with a comment that says it is more important for animal cases than human cases.

Following up on yesterday's comments...Bloomberg has this report on how the bird flu deaths this year are more than the last two year's combined.

CIDRAP reports that a Minnestoa vaccination rationing program should favor the young.

The vaccine allocation recommendations released last week by the Minnesota Center for Health Care Ethics (MCHCE) look much different from the ones proposed by the federal government. The vaccine rationing recommendation in federal pandemic plan is aimed at saving the most lives, and might favor the healthy 75-year-old over the 25-year-old utility worker.

The Minnesota group’s approach is designed to prevent not only deaths due to influenza, but also deaths related to public infrastructure breakdowns. It is weighted toward those whose immune systems are more likely to respond strongly to a pandemic flu vaccine. As such, it would put the 25-year-old utility worker ahead of the 75-year-old.

Along the same lines, CIDRAP cites research in Turkey which shows a strong link between the young and flu.

ProMed with a report on the death in Egypt.

According to the University of Rhode Island, Plavix interferes with Tamiflu.

Britain is stepping up its surveillance program.

A bird flu test kit won an Asian innovation award.

The State of New York is helping an Ithaca company do the same here in the US.

Reuters has an update on global case counts.

Effect Measure notes that you have to take vaccine stories with a grain of salt...especially in press announcements.