Sunday, February 11, 2007

February 11 Flu Update

A 20 year old woman died of bird flu in Indonesia. (reported yesterday). In addition, two of her neighbors are in the hospital.

ProMed on Indonesia.

The four cases in Turkey were negative...

as did the six potential cases in Egypt.

There could be criminal charges in the bird flu importation case in Britain.

There's another avian outbreak in South Korea.

Promed sweeps the world....nothing not already reported here.

Editorial in Southern Mississippi follows up on article series this week by comparing pandemic to something familiar---a hurricane.

USDA wants Chinese chicken imported again into the US.

ProMed on the story that we ran yesterday that wondered if people born before 1969 might not have some immunity to H5N1. Note the mod comment:

If an element of immunity to avian influenza A (H5N1) does exist in older populations, its possible association with geographically widespread (intercontinental) influenza A events before the late 1960s merits further investigation."

Finally, Revere weighs in on this story. What is the explanation for this phenomenon? He doesn't seem to be buying the immunity theory...this is a little dense, but it argues that H5N1 is less noticeable in older people, and therefore less likely to be reported. In other words, the age difference is not real....or as stark as it appears. Blog post is a must read. (My note: this story is one to watch. It could be used to generate a false comfort zone, or to discourage further prep.)

Yet another possibility (and one we favor) is that the unusualness of the disease is less obvious in older individuals for reasons unrelated to prior exposure but possibly related to different immunological or other biological responses to infection (e.g., cross reactivity with other infections). Serious and rapidly evolving respiratory disease in a young and healthy person attracts considerably more attention than in the elderly.This could result in reduced ascertainment of respiratory disease against a background of high prevalence from the usual circulating respiratory viruses in the older age groups. Diagnosis of H5N1 infection depends critically on index of suspicion, a threshold likely met in only a small proportion of influenza-like illnesses which might be H5N1 and less so among older patients than younger. If the disease in the over 40 age group is also somewhat less severe, this could impart an ascertainment bias and the question of whether the cases match the age structure of the population would again be something to consider.


At 7:15 PM, Blogger Wulfgang said...


Interesting cross-section of articles you have on the website today. Don’t let ever let it be said that you don’t have a broad selection of interests and perspectives.

I’d like to comment on the easiest predictable target article first, “USDA wants to let China sell chicken” in the US. I don’t know about anybody else, but it will put this entire proposal into the same political compartment as the war in Iraq: dumb, misguided, grounded on faulty information, against the public opinion, and we will regret it in the long run. I think our government in their eagerness to assuage the Chinese, have overlooked some fundamental health questions: what’s to prevent the poultry from still becoming infected in the food process, even after the cooking it (my answer – nothing); who performs the bio-security and poultry meat inspections (my answer- the communist party), and what happens if China were to suddenly become the epicenter of human-to-human H5N1 transmission ? (my answer- you wouldn’t want to even use the stuff for dog food) Sorry, this all sounds to me like a case where it might be whole lot smarter just sticking to Pilgrim’s Pride or Armour products.

The Mississippi article on being prepared was a good follow up to their prior series. I have only one important question though: I’m having a whole lot of difficulty understanding and reconciling in my mind, what an “alarmist” is, in the context of avian pandemic preparation. If the author means sensationalizing the topic, or extreme or unwarranted speculation, then I understand. Other wise, she’s lost me in the translation and the application to what it means to adequately prepare for a worldwide epidemiological emergency.

Now then, my comments on the ProMed and Revere articles about some people born before 1969 perhaps having some form of inane immunities to the H5N1 virus. As you can tell from my dissertations yesterday, I fall in the camp of ProMed’s viewpoint on the data so far: it is in my mind, a very likely association with geographical widespread influenza Type A clinical illnesses before the late 1960’s, causing this skewed data. The immune system is complex and genetic factors play a crucial role, but other critical factors could be at works also, such as social urban density, environmental, viral and host factors. Even average body temperature’s, humidity and climate may have a role - who knows at this point. I do agree with your position - the danger of misinterpreting this preliminary data is that it may put some in a “false comfort zone or discourage further pandemic preparations”.

The bottom line of the present H5N1 situation still remains unchanged for everyone at this juncture. For example, even though 1918 pandemic caused an extraordinary number of deaths world wide, the fact is the vast majority influenza cases then, were relatively mild and not much different than ordinary common day Type A flu epidemics – we still shouldn’t let our guard down.

Something unexplainable definitely caused in excess of 50 million people to crater in 1918 and 1919, in three separate and distinctly different waves of infection. A real smart person wouldn’t bank on any immunity at all when it comes to H5N1, which has a proven > 50% fatality rate to date.

Keep that adjuvant research cranked up full throttle …we may need the boosters throttled up to the max, before all is said and done.



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