Christmas Break
The Coming Influenza Pandemic? will take a break for Christmas, as we travel to visit family. The Blog will be updated again on December 29, 2007.
Along the way, on December 27th, we will pass our third anniversary and begin our fourth year of tracking flu news, which is pretty remarkable, when you think about it.
Thanks for reading and all your comments.
Happy Holidays to you and your family.
December 21 Flu Update
WHO's team confirms that close H2H contact spread flu, which is not unprecedented.ProMed has more contradictory reports from Pakistan. Read mod comment.New avian outbreak in Germany.New avian outbreak in Russia, too.Bird flu confirmed in Benin.Novavax bird flu vaccine moves forward.Pakistan's new goal is safer culling.Hospitals in Pakistan are also taking steps to contain infection.Pakistan gives bird flu advice to people in that region.Bird flu is not a contagious disease and does not spread with casual contacts or shaking hands, hugging or embracing. The only way it can spread to the human being is close and continuous contacts with the birds affected by this disease. These views were expressed by Chairman PMS Dr. Masood Akhtar sheikh while addressing the workshop in connection with the "Bird flu" under the auspices of Pakistan Medical Society.
Perhaps the day's most significant story....research confirms the ability of swine to be "mixing vessels" for influenza. Via CIDRAP.US State Department has second in series of avian influenza in SE Asia.Waterfowl in Massachusetts is being tested for bird flu.Revere blogs the Declan Butler interview with the Indonesian health minister, giving the statements the truth test. Generally, Revere is skeptical of what is said, but note that he notes that many scientists are hoarding isolates, not just Indonesia. See below.
Supari is neither rational nor responsible. Some very reputable scientists are rational but also irresponsible. There is more than a grain of truth to the fact that Indonesia and other developing countries have a problem which the developed countries aren't solving. The scientists can't see it because they are merely conducting themselves in the same ways as always. No one has ever said it was wrong or unethical. But this is a special situation.
I'm saying it, now. We can't keep pointing fingers at Indonesia when we refuse to put our own house in order.
December 19 Flu Update
WHO has told Pakistani authorities that the cluster in Pakistan was due to a combination of common infection sources and some H2H from very close contact. With what we know, this is plausible. There have been other H2H transmissions from close contact. It would be interesting to see if the onset dates match the theory. Finally, the ultimate point is to find out if the virus itself was any different.CIDRAP has this from FAO.....avian outbreaks were down for 2007, despite a recent spike.Voice of America has this from David Nabarro:
Bird flu is a problem that will likely be with us for some years to come, according to David Nabarro, senior coordinator for avian and human influenza at the United Nations. But citing data on the spread of the H5N1 virus from 146 nations, Nabarro emphasized the positive. "The first thing to say is that the situation has changed, between 2004 and 2007, the rate at which new countries are being affected by H5N1 has reduced, we've got a bit of a plateauing [leveling out], the number of human cases, which act as a sentinel, has slightly decreased, and the human deaths have also decreased." He said that broad epidemiological evidence suggests that the H5N1 virus situation is not quite so serious.
Declan Butler of Nature interviews the Indonesian Health Minister about its view on sharing virus samples.
We are willing to share viruses for research purposes but if a commercial company wants to create a vaccine from those samples, then it must negotiate with Indonesia, which has rights over the samples. But the key outstanding concession Indonesia demands is that all shared virus samples be subject to a material transfer agreement clearly setting out such rights. We already share our virus-sequence data with the Global Initiative on Sharing Avian Influenza Data (GISAID), a body created last year. I consider GISAID has established a fair and transparent mechanism for regulating genetic-sequencing databases because it includes a material transfer agreement.
The current US budget has slashed pandemic funds from $870M to $76M.The US State Department is running a series of articles on bird flu preparedness, featuring Vietnam here. Interesting point: they say that preparing for bird flu has strengthened the country's overall capacity to fight disease.....does Revere write for the State Department.Speaking of Revere, he does write on Effect Measure. Here, he blogs yesterday's news that Indonesia looks back at some past cases to see if they were bird flu. He notes how differently this is explained in different media outlets.A University in Pakistan is trying to raise awareness.Article details bird flu preparedness challenge in East Java, Indonesia.
“I’ve never been frightened of bird flu,” Maryati, a chicken-seller, told IRIN, while cutting up a bird. “I’ve also heard about cases of human avian flu but I’m not worried.”
Canadian experts say masks don't protect against flu.The world association of Chief Risk Officers has released a position paper on bird flu.Virginia is well prepared for a pandemic.
December 18 Flu Update
Whatever the reason, there are increasing reports of cases in Pakistan. CIDRAP here..... (Note, we could easily be seeing panic cases, not real cases).Vigilance engendered by the possible family cluster of H5N1 avian influenza cases in Pakistan has led to many more reports of potential cases there, a World Health Organization (WHO) official said today.
ProMed also has the Pakistan story, with an interesting comment from the Mod CP, who is normally a skeptic, but notes that under some reports, conditions from Pakistan do roughly correspond to what you would expect to see from H2H transmission.This is a really interesting story. A man on Long Island was quarantined for three days because he was feeling ill and had just gotten back from Pakistan. Furthermore....CDC spokesman Dave Daigle said the man may have ties to people in Pakistan who have been infected with bird flu, but he was unable to elaborate.
Indonesia says it is investigating several cases where bird flu patients died, despite having no obvious exposure path.ProMed has this as well, noting that 20% of cases did not have any obvious route of exposure.ProMed on poultry supply fears sparked by Polish bird flu outbreaks.Some officials in Pakistan have canceled holiday leave due to the bird flu.Bird flu confirmed in Benin.Halifax paper says that if you think the bird flu was gone, think again.Computerworld runs down the blogs which are covering the bird flu, including this one:A carefully selected headline roundup.
The Poultry industry says it expects to recover from the avian flu "disruption" and resume steady growth.The Trust for American Health reports that budget cuts are threatening catastrophe prep.A study in Britain says people in the country fared better than those in the city during the 1918 pandemic.When Revere hears there is nothing to fear, he gets nervous.Culling has brought the price of turkey way up in Britain.Sweden has joined Denmark in raising its alert level with more bird flu in Germany.Qatar wants Indonesia to step up its bird flu fight.Australian group recommends 3 months supplies for a pandemic.A nurse speaks to a Lions Club in Alabama about pandemic flu.ProMed has an OIE report from Germany. Note the mod comment on the risk profile for backyard flocks.
Every outbreak presents the opportunity for either an formal or informal assessment of risk. Informally, in my opinion, backyard poultry present a mixed risk profile. It is good that such backyard flocks are not in the middle of a large, vertically integrated poultry company which then puts extremely large numbers of birds and
potentially employees throughout the company at some level of risk. On the other hand, backyard poultry outbreaks pose a highly variable risk depending on the knowledge of the backyard farmers, physical facilities, management techniques and many other factors that cover a wide range of risk possibilities.
There are numerous local stories that follow up on the US report on state preparation for pandemics and catastrophes. Below are some examples:
New Jersey/GoodMississippi/BadRhode Island and Massachusetts/Bad-bad South Carolina/Mostly badIndiana/GoodIowa/Bad
December 15 Flu Update
The Pakistan situation continues to evolve. There now appear to be 8 human cases, which is the most we have seen emerge in one place. We don't know if this is it, but we haven't seen something like this before, and it must have some significance.From the Canadian Press story....note WHO comment.The WHO said confirmatory testing must still be done. And a spokesperson for the agency said investigations are underway to try to determine how the various people became infected, but noted some human-to-human spread may have occurred.
"We can't rule it out," Gregory Hartl said from Geneva.
"There are other plausible explanations.... We don't know enough at this point. And in some of these cases, one never will know enough."
My note: Even if another plausible explanation emerges, it is still something which has not happened before.
Note2: There are many, many stories on the Pakistan situation, which are essentially all the same story and not listed here.
ProMed covers the Pakistan situation.Revere notes that his site isn't for breaking news, and neither is this one. However, he cites some places to go for updated flu info.IHT reports on recent flu developments.Effect Measure provides context to Myanmar and Pakistan. Must read.There's an avian outbreak in Germany.But hey! Armenia is safe.More culling in Saudi Arabia.Myanmar stresses flu prevention.
December 14 Flu Update
Big news. Today's news from Pakistan indicates that there may now be five cases. If true, this is the most alarming news yet on H5N1.CIDRAP has this as well. Note sense of urgency in post, and this: Khushnood Akhtar, secretary of Pakistan's health ministry, said the cases occurred in November but said that four brothers are involved, Deutsche Presse-Argentur (DPA) reported today. One of the men, who worked on a poultry farm, may have contracted the H5N1 virus after he helped cull sick birds, Akhtar told DPA.
The man survived but may have infected three of his brothers, none of whom had been at the farm or in contact with sick birds, Akhtar said in the DPA report. The DPA report appears to contradict the KUNA story, which said the two men in its report were farm workers.
ProMed has the Pakistan information. Note this rather alarming phrase in the mod comment, from the normally skeptical CP.....An unstated number of other people are suspected cases and are under surveillance awaiting the outcome of diagnostic tests.
Revere blogs this as well. Read to see what the phrase "The unexpected part is the thing that worries everyone. The unexpected part we are all expecting, that is," means.Here's an AP story that rounds up the recent flu news. More than anything, this shows that the recent flu news is getting MSM attention again.They are working to confirm the two deaths in Pakistan were H5N1. They were, by the way, poultry workers.China says not to worry, the two cases of bird flu have apparently not spread around them.Burma has its first case of bird flu.ProMed reports on Burma has well, noting the disease extending its range.CIDRAP on Myanmar.In Hong Kong, a heron at a nature reserve has tested positive.Story on community surveillance in Ho Chi Minh City, Vietnam.The UAE has banned Polish poultry.A Poultry Farmer's union protests recent moves by the UK government.Australian paper has a shopping list for bird flu.Rwanda says that it is successful in controlling bird flu.More work in the Philippines on fighting bird flu.Pakistan feels it will be important to educate poultry workers.
Finally, perhaps the most important piece of the day. CIDRAP looks back at ten years of the bird flu...what happened then, what have we learned now. This is a must read.
December 11 Flu Update
A woman has died of bird flu in Indonesia. Key paragraph:
Muhammad Nadhirin, an official at the centre, said that a team of five experts had been dispatched on Monday to the victim's neighbourhood.
The team said that "the source of infection could be from poultry 100 metres (yards) away from the victim's house, but we're waiting for test results on whether the poultry is infected with the virus," Nadhirin told AFP.
He said the victim, who had sold ornamental plants, bought plant fertiliser from the neighbour which may have been contaminated by the faeces of infected birds. No birds however had died in the area in the past six months and the poultry appeared healthy, he added.
CIDRAP on the Indonesian death.ProMed notes that while bird flu is persistent in Indonesia, reported cases are coming forward only sporadically.ProMed has some info on a discrepancy in reports about the father-son flu case in China, havin to do with the critical fact of when the second case showed symptoms.
Bird flu is back in Russia, as well.As noted yesterday, a fifth outbreak in Poland.There is a suspected outbreak in South Korea.ProMed reports on study that says three strains of H5N1 reached Germany.David A. Halvorson, DVM, a veterinary pathologist and avian flu expert at the University of Minnesota in St. Paul, commented that the similarity between the German and Russian isolates doesn't necessarily mean the viruses were brought to Germany by wild birds.
"What is clear is that related viruses were introduced into Germany and they were observed in wild waterfowl before they were observed in domestic poultry," Halvorson told CIDRAP News. "This suggests that waterfowl may have been the source of introduction, but it doesn't
prove it. This was known before the viruses were sequenced."
Virginia paper has op ed on being braced for a pandemic.A FEMA region is hosting a pandemic exercise.
December 7 Flu Update
Just noticed that my last hiatus post was my 1,000th post to this blog. Dang. Thanks for reading!
The big news today is that the Father of a previous bird flu victim in China now has bird flu. This brings up all the normal concerns--has the virus mutated to H2H. In fairness, this has happened before. On the other hand, when it starts, this is how it will start.Brent [a WHO official stationed in Beijing] said there was no evidence the man had been infected by his 24-year-old son, who died on Dec. 2, but could not eliminate that possibility.
"Because the possibility of human-to-human transmission cannot be ruled out, we will be monitoring this case closely," Brent told The Associated Press. "If it is found to be easily passed between humans, we would be concerned."
CIDRAP notes that China seems to downplay contact with sick birds. (My note: a common infection source is a likely possible answer).Revere blogs this as well.....says keep an eye on this case....and the rest of them.Suspected games are now reported in Benin, in West Africa.ProMed on a European assessment of how the virus travels.A US bird flu expert in the US is critical of the global surveillance program.Meanwhile, CIDRAP notes international donations to bird flu fund, including from the US.The UK is backing down its flu protection measures.New Zealand is saving some bird flu vaccine for first responders.Russia is watching bird imports from Poland.Australia is financially supporting Laos' flu efforts.
On the road
I'm on the road. We'll update again on Friday morning.
November 30 Flu Update
WHO says bird flu remains entrenched in six countries.CIDRAP has this report as well. Nabarro said H5N1 is being "continuously transmitted" in at least half the districts of Indonesia, according to an Agence France-Presse (AFP) report .
"Intensive control efforts—including vaccination of poultry—are being mounted in these settings [countries where the virus is entrenched] to get the disease under control and eliminate outbreaks when they occur," the UN said. "Under present conditions, most other countries are able to control outbreaks when they occur in other settings."
Reuters quoted the report as saying, "Outbreaks are being detected more rapidly and the response is more effective. However, animal health services are still substandard in most countries—they lack necessary regulatory frameworks, budgets, laboratory capacity and implementation of biosecurity measures."
Revere blogs all this, saying that some people are tired of hearing about the need to prepare, which has been going on for years. When does a new record play?
Romania says it has determined it has no bird flu on a farm but is testing....you guessed it....a cat.More culling in Saudi Arabia, where outbreaks continue.More on the source of infection in Britain--Telegraph notes that they don't know, so migratory birds cannot be ruled out.Vietnam is turning its attention to bird flu and its duck population.Azerbaijan reports an absence of bird flu.Wild story of Irish man who is deaf and had suspected bird flu symptoms while in SE Asia.
