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.
FlaMedic, on his blog "Avian Flu Diary" gives an anatomy of the Quebec rumor and how it played out yesterday.
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.
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.
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.
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.
But the example of John Snow and waterborne cholera should remind us humility is also a scientific virtue.
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.
You cannot be at peace until you can be thankful. Happy Thanksgiving.
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....
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.
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.”
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....
Branswell also writes about a triage protocol developed in Canada which will determine who gets care...it 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.
"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.
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.
November 20 Flu Update
WHO's David Nabarro makes a vital point....global defenses to the flu are one thing, but the first and perhaps deciding response might be local.
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.
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."
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"
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
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.
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.
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 pandemicThe 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.
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.
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 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.
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.
"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?' "
Tamiflu is launching a major advertising program this year. Some people wonder if the drug is worth all the hype.
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.
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.
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.