Saturday, January 27, 2007

January 26 Flu Update

Revere looks at the crystal ball and finds it as cloudy as everyone else does.

Story looks at flu around the world, mostly on Indonesia bringing troops in to fight the bird flu.

ProMed on Indonesia (cats), Hungary and Japan.

ProMed on a suspected outbreak in Azerbaijan.

Culture clash in Indonesia. The people love their birds. I mean, they love their birds. Yet, they are being told they have to be culled. (Revere has compared this to asking people in US to turn their dogs over to be culled).

Does bird flu mutate more quickly in cats?

Ukraine and Russia have banned imports of Hungarian poultry following an outbreak there (now, why are countries hesitant to be transparent).

The US donated 100,000 sets of personal protective equipment to Indonesia.

Japan has a cull of 50,ooo birds scheduled.

China says it had success with bird flu (thanks to the Central Government) and is determined to continue the success.

The US Society of Infectious Diseases says all US healthcare workers should get the flu shot.

Columbiana County, OH, is preparing for a pandemic.


At 1:25 PM, Blogger Wulfgang said...


Nice set of news articles you posted today. I mostly dismissed the China Daily article as propaganda which mostly appeared to be communist spin from their controlled news media.

The remaining articles, starting with Revere, and ProMed, and the news about infected cats and exotic pet birds, got me thinking about how to put the whole bird flu situation in the proper perspective. I started by pondering - what are the most prevalent infectious diseases that kill and disable people throughout the world? And knowing that, why are they, as well as H5N1, continuing to emerge, re-emerge and become endemic in society ?

Here’s what I found out… the source: WHO and HHS infectious disease statistics.

The top ten Infectious diseases, ranked by annual mortality in the world, are:

1. Lower Respiratory Infections – 4.5M (pneumonia, influenzas, bronchitis)
2. HIV/AIDS- 3.0M
3. Diarrhoea- 2.2M (cholera, botulism, E. Coli)
4. Tuberculosis- 2.0M
5. Malaria- 1.3M
6. Measles- .530M
7. Whooping Cough- .300M
8. Tetanus - .214M
9. Meningitis- .174M
10. Syphilis- .157M
11. Tropical Diseases - .030M (dengue, , yellow fever, …)

The most significant characteristic that each of the top four diseases have on this list is – they are all continuing to evolve and mutate into highly drug resistant parasites. Lower respiratory infections, including influenza, is the number one killer in the world.

Annual normal influenza epidemics only affect 5-15% of the populations and affect high risk groups – mostly the elderly and ill, but looking back upon the history of related epidemics and pandemic are some really revealing statistics and facts. The Black Death which occurred between 1347 and 1352, killed 25M people in Europe, which was nearly 50% of the entire 500M world population at that time. Between 1518 and 1568, due to the introduction of smallpox, measles and typhus by European explorers to Central and South America, the population of Mexico fell from 20M to 3M. The first European influenza epidemic occurred between 1556 and 1560, and had a mortality rate of 20%. The Influenza Pandemic of 1918, had a mortality rate of approximately 2.5% and killed 50M people, or about 2% of the 1.7B population of the world at that time.

Here is what really complicates the current infectious disease problem, in my opinion…the proportion of the global population living in cities has increased dramatically since 1918 – it was only 15% in 1918, now it is 50%. One third of the worlds total urban population presently live in slums, and an astounding 70% of the urban population living in under-developed countries, live in slums. Influenza will spread very rapidly in crowded conditions – it doesn’t take a scientific genius to figure this out.

The world, in my opinion, is vulnerable now to infectious diseases like avian influenza, more so than ever in 2007, due to inadequate water and sanitation, high population density (contact rates), high levels of imported infections, and inadequate health care (including warning and control systems). Add to this, all the other environmental and social factors, like encroachment on wildlife habitats, changes in agricultural conditions and proximity to animal hosts (like exotic pet birds as pets), destruction of the natural habitats and closer proximity to unknown microorganisms, uncontrolled urbanization, and rapid modern transportation – and we have the potential for pandemic that would rival those of the last few centuries.

We have unwittingly created the perfect natural situation for opportunistic viruses like H5N1, which have the capability to mutate rapidly in this open loop environment and with multiple hosts, to suddenly become highly pathogenic, contagious and infectious – with high attack rates and case-fatality rates.

So, I am not surprised when people like Revere say, “The H5N1 crystal ball is cloudy”, or Albert Osterhaus of the U. of Rotterdam say, “we know the 1918 pandemic was a bird flu virus that adapted to mammals in some intermediate mammalian host, possibly pigs. Maybe for H5N1 the intermediate host is cats”, and “…I am not surprised the 20% anti-body infection rate isn’t worse”. I think what we are currently seeing is that H5N1 is now very firmly endemic in these indigenous countries due to all the factors mentioned. Suddenly sounding the alarm and calling out the military to help fight the disease is really a futile token gesture. In my view, the military in Indonesia is primarily being surreptitiously used to keep social order.

The real solution to the current H5N1 problem, is just like all the other top ten infectious disease killers - it is to rapidly continue developing effective modern vaccines, to combat the resistant virus. Cranking out hundreds of millions of more oseltamivir anti-viral tablets and flooding poor villages with them in third world countries is only a delaying tactic. Somehow, giant pharmaceutical companies and world nations are going to have to team up and develop the necessary vaccines.

This means biting the bullet and mass producing a whole lot of expensive pharmaceutical’s for people in poor developing counties, like Indonesia. Yes, for people who can’t even afford shoes.



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