The Coming Influenza Pandemic?

February 27 Flu Update

Sanofi, in a report submitted to the FDA panel, revealed that two 90-microgram (mcg) doses, administered 28 days apart, generated a protective immune response in 45% of patients. That level is less than the 54% rate reported almost a year ago in the New England Journal of Medicine. The higher rate was based on interim findings, the AP reported yesterday. The researchers used a neutralizing antibody titer of 1:40, a fourfold or more increase in antibody titer, to define adequate immune response.

“I would think this is almost a Step 1,” said Dr. Robert Couch, an expert in respiratory viruses from Baylor College School of Medicine in Houston. “This is not the answer to the H5 vaccine problem, but this is a first step.”

“We have to look upon this as an interim vaccine,” added Dr. Robert Webster, an authority on avian influenza who is based at St. Jude Children’s Research Hospital in Memphis, Tenn.

The amount of viral antigen needed to protect less than half the subjects required two doses of 90 micrograms each. That's twelve times as much antigen as in the current seasonal flu shot, although current flu vaccines have antigen for three different flu viruses (two influenza A and one influenza B), so plausibly these results represent only a factor of four lower productive capacity to make this vaccine. Other vaccines have now been produced with much better ability to produce comparable antibody levels with less antigen, so why the government would put in an order for this vaccine is a bit of a mystery. This vaccine uses egg-based technology and seems doomed to be too ineffective and result in too little productive capacity to make it worthwhile investing in at this point.

posted by Orange @ 10:03 AM 1 comments

February 26 Flu Update

But we need to recognize two things. The first is that the non-traditional sources such as local news media and chatter on internet boards contain potentially valuable information more timely than the usual sources. And second, that making mistakes is unavoidable in the face of uncertain data.

posted by Orange @ 8:55 AM 3 comments

February 25 Flu Update

During the past several days, there have been reports of suspected human cases of avian influenza from Indonesia, the Philippines, Russia, Turkey and the UK, but none have been confirmed. Although there have been recent outbreaks of poultry disease in Laos as recently as mid-2006, it seems unlikely that this single human will be confirmed positive, as there appears to have been no contact between the patient and poultry. Further information is awaited.

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February 24 Flu Update

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February 23 Flu Update

Sanofi and other drugmakers are developing quicker ways to produce vaccines in DNA cultures. Seasonal flu vaccines, as well as bird flu vaccines, could be produced through this more advanced method.

"The government has adopted a programme for the prevention of the spread of avian flu in the Republic of Kazakhstan for 2007-2008, and a plan of operational measures to combat avian flu," Anatoliy Belonog, Kazakhstan's chief epidemiological official and deputy health minister, told IRIN from the capital, Astana.Kazakhstan has set up special laboratories to diagnose avian flu and bought antiviral drugs to deal with a possible outbreak among humans. Bird flu could affect up to one million out of a population of 15 million.

"One of the things we fear is people panicking, so one of the things we can do is make them aware," said Bob Higgins of the Michigan Department of Education.

posted by Orange @ 10:24 AM 3 comments

February 22 Flu Update

All the outbreaks around Moscow have been traced to birds bought in the last two weeks at the city's pet market. The market was immediately closed down and a 5-km quarantine zone was set up around it. Health officials said the bird flu had not affected any of the 23 big poultry farms around Moscow.

A thousand body bags. Computer chips to plant on corpses to better track the dead. More saws for autopsies.

The Health Director in this Eastern North Carolina town gave a bird flu talk.



(Chart...poultry outbreaks in 2007...from WHO via Effect Measure). Effect Measure also blogs this chart--noting that the virus is still out there, and that it would be foolish to assume it will not mutate to H2H).

posted by Orange @ 7:45 AM 1 comments

February 21 Flu Update

"This time last year we were saying it was inevitable," she told councillors. "Now I would say probable or possible."

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February 20 Flu Update

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February 19 Flu Update

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February 18 Flu Update

Later update: flu reported to be tracked to market SW of City.

More on WHO and Indonesia reaching agreement on samples.

The Lancet wants this agreement to be extended to include the entire developing world.

Here's a good one for people interested in flu prep. One of the most fearsome parts of a worst case flu scenario is collapse of our just in time delivery system, creating immediate shortages of food, etc. The Grocers of America are preparing....

"The food supply is essential to the well-being of the community," said Hammonds. "We've been through a lot about what we need to do as a supermarket."

That includes urging wholesalers and retailers to talk with their suppliers about alternative sources for their products and to anticipate what products will be in high demand in a pandemic situation, such as medicines and food staples.

This article on flu in Nigeria says a woman died of bird flu in Lagos.

Afghanistan has stopped importing poultry on fears of bird flu.

An Egyptian minister denied the flu virus "could" mutate in the country.

Orlando paper has review of the role a local lab plays in the ongoing fight against animal diseases--including bird flu--in the country.

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February 17 Flu Update

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February 16 Flu Update

“For the first time, results presented at the meeting have convincingly demonstrated that vaccination with newly developed avian influenza vaccines can bring about a potentially protective immune response against strains of H5N1 virus found in a variety of geographical locations,” WHO said in a news release.

“Some of the vaccines work with low doses of antigen, which means that significantly more vaccine doses can be available in case of a pandemic,” it added.

posted by Orange @ 9:47 AM 4 comments

February 15 Flu Update

The current vaccines are based on strains of the H5N1 bird-flu virus
from recent years; should the virus mutate, as it would need to do to
spread among humans, it isn't clear that it would fully protect people.
Still, some experts think the current vaccine probably would protect
against severe illness and death, even if the victim still got sick.
Governments are proceeding on that assumption, and millions of doses
have been produced.

posted by Orange @ 9:07 AM 3 comments

February 14 Flu Update

"I've gotten at least 10 media calls in the last few months asking me to deliver the death sentence for avian flu," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "But at any conference, if you get a group of virologists at the bar, after the fourth beer, they let their hair down and admit it — they don't know what is happening. They've been incredibly humbled by this virus.

posted by Orange @ 11:22 PM 1 comments

February 13 Flu Update--snowbound edition

"Just this morning on one of the television stations we saw wrong messages being transmitted, people talking about vaccines when there are no yet available. The vaccines are for birds not for humans," he told reporters.

Questions which remain unresolved, and which may not be resolved by sequence analysis alone, are firstly the origin of this unique turkey/goose strain of virus and secondly the direction of travel of the infection -- from Hungary to England as presently supposed or from England to Hungary.

posted by Orange @ 9:10 AM 1 comments

February 12 Flu Update

The U.S. researchers said that years of exposure to the human flu subtype H1N1 - one of two types of influenza A viruses that circulate in flu season - may provide some protection against the H5N1 virus that has ravaged poultry flocks in large parts of Asia and killed at least 166 people over the last three years.

"It has the capacity to undermine the capacity of the world to produce pandemic vaccines if they proceed in a conventional, business-as-usual way," says Dr. David Fedson, a retired academic and flu vaccine industry expert.

Others point out that the guidelines, which advise people to avoid crowded spaces such as train cars or offices, do not address the needs of poorer Americans (among others) who must take public transportation or who can't telecommute. As the CDC gathers comment and updates its interim guidelines, it must consider how state and local governments might deal with the potentially massive social costs of school closures and work stoppages.

posted by Orange @ 8:46 AM 1 comments

February 11 Flu Update

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."

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.

posted by Orange @ 11:09 PM 1 comments

February 10 Flu Update

Nearly 90 per cent of the people who’ve been diagnosed so far with H5N1 avian flu were under age 40, a new analysis from the World Health Organization shows.

And two British scientists suggest that as yet unexplained phenomenon could be a clue that widespread immunity to infection with this virus may exist in people aged 35 and older.

In a letter to the March issue of the journal Emerging Infectious Diseases, Matthew Smallman-Raynor of the University of Nottingham and Andrew Cliff of the University of Cambridge note that the age distribution of H5N1 human cases is "consistent with a biological model of geographically widespread immunity to avian influenza A (H5N1) in persons born before 1969.

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February 9 Flu Update

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February 8 Flu Update

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February 7 Flu Update

Under the memorandum of understanding, Indonesia will provide strains of the H5N1 virus circulating in the country and Baxter will offer technical expertise to produce the vaccine, said Indonesia's Health Minister Siti Fadilah Supari.

What's the solution? Here's one suggestion. Influenza vaccine is too important to be in private hands. This episode is a good example of what happens. WHO should set up a dozen or so geographically distributed international vaccine institutes whose task it is to manufacture and provide at cost seasonal and pandemic vaccines for their regions. The vaccine would be distributed according to need to countries in the region of the institute.

ARE you one of those who drink fresh eggs? If your answer is yes, you had better desist from doing so until further notice to prevent getting infected with the dreaded bird flu virus.

He took his "fog of pandemic preparedness" concept from the theory of the "fog of war," a state of ambiguity soldiers can find themselves in when they doubt their own capabilities and feel unsure of their adversary's capabilities and intentions.

Pandemic planning can produce its own haze as planners grapple with issues like ensuring their supply chain or determining government's role. "We talk about what we might do or can do, but we really don't know," Osterholm said. "There are so many uncertainties."

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Shining some light into the pandemic cloud, however, is the recent document on community mitigation measures by the US Department of Health and Human Services (see links below). "You don't want to have a [pandemic planning] policy inconsistent with this document," Osterholm said.

posted by Orange @ 8:42 AM 3 comments

February 6 Flu Update

"We are sending our virus (samples) to the rich countries to produce antivirals and vaccines. And when the pandemic occurs, they survive and we die," Suwit Wibulpolprasert told the meeting.

"It is unfair to let the poor die and the rich survive. . . . We are not opposing the sharing of information and virus, but on the condition that every country will have equal opportunity to get access to vaccine and anti-virals if such a pandemic occurs."

At this early stage, we do not know how this disease arrived in Suffolk. A full epidemiological report will be produced by our experts as soon as possible and made publicly available The State Veterinary Service is carrying out rapid and urgent investigations both on the infected premises themselves and by testing poultry farms and collecting dead wild birds in the protection and surveillance zones

“If [the bird flu] hits the DoD, they’re expecting a 35 percent attack rate with 40 percent of the force out sick,” Hachey said. “But the force still has to provide defense, as well as health care.”

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February 5 Flu Update

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February 4 Flu Update

Nabarro said a recent spike in human deaths in Indonesia meant the country must do more to fight the virus despite improving its efforts in recent months, including the cull of backyard chickens in the capital last week.

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February 3 Flu Update

A 22-year-old Georgetown University swim team member just back from Indonesia eats dinner with his teammates but then develops a fever and doesn't accompany them to a meet in New York.

That is how a flu pandemic in the United States started.

A winter storm bears down on saltless and plowless Atlanta, closing schools and scaring commuters.

posted by Orange @ 11:07 PM 1 comments

February 2 Bird Flu Hits Britain.

Too early for clear-cut conclusions; however,in view of the fact that both cases have taken place on UK's eastern coasts, one is inclined to wonder if this is a mere coincidence or indicative of the wild-bird origin of thecurrent outbreak. - Mod. AS

Michael T. Osterholm, PhD, MPH, praised the CDC for devising a simple, clear approach to an extremely difficult public health problem.

"Now how do we take it to the next level? This is a work in progress and process," said Osterholm, director of the University of Minnesota Center for infectious Disease Research and Policy, publisher of the CIDRAP Web site. The onus is now on states and cities, which must take the plan and assess how they would make it work in their localities, he said.

Osterholm says he's not worried that officials would be reluctant to close schools in the event of an influenza pandemic, because parents will probably force the issue by keeping children home. But when to reopen schools may be a tricky question, he said. "How do you unring the bell? How do you make the school decisions if there are multiple waves?" he asked.

The community mitigation strategies such as school closures and social distancing for adults will have a big impact on businesses, Osterholm said. He added that it's positive that the CDC guidance does not mention closing borders. Closing borders is unlikely to slow a pandemic, and keeping them open will ease some of the supply-chain concerns that corporations will have, in his view

"I can guarantee there are no backyard birds in Central Jakarta," said Muhayat, the mayor, who uses a single name. "The people here are now fully aware of the disease and voluntarily culled their birds.

posted by Orange @ 9:38 AM 2 comments

February 1 Flu Update--US report leads big news day.

American cities should close schools for as long as three months in the event of a severe flu outbreak, sports events and movies should be canceled and working hours should be staggered so subways and buses are less crowded, the federal government advised Thursday in issuing new pandemic flu guidelines to states and cities.

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In an innovation, the new guidelines are modeled on the five levels of hurricanes, but ranked by lethality instead of wind speed. Category 1, which assumes 90,000 Americans would die, is equivalent to a bad year for seasonal flu, said Glen Nowak, a spokesman for the agency. About 36,000 Americans die of flu in an average year. Category 5, which assumes 1.8 million dead, is the equivalent of the 1918 Spanish flu pandemic. (That flu killed about 2 percent of those infected; the H5N1 flu now circulating in Asia has killed more than 50 percent but is not easily transmitted.)

The recommended measures won't protect everyone and won't eliminate deaths in a pandemic, Gerberding warned. But they could reduce the death toll and soften the blow a pandemic would level on other aspects of life, such as the delivery of essential services and the transport of essential goods.

Each outbreak of the flu in birds, people and animals such as cats and pigs raises the possibility that it will mutate into a form that spreads quickly in people, Webster said. A resurgence of infections in countries such as Japan, South Korea and Thailand confirms that control efforts that appeared effective still need to be strengthened, he said.

``To me it means that we've failed,'' Webster said today in an interview in Washington. ``It's a lack of knowledge and political will to get at the source of the virus.''

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``It's a general failure,'' Webster said. ``I'm not pointing the finger at anyone; I've also failed. We as a whole have failed to understand the ecology of H5N1 well enough to control it.''

The virus undergoes so many mutations that it may already exist in a form that's transmissible in humans, said Ron Fouchier, a virologist at Erasmus University in the Netherlands.

``Chances are it would be out there somewhere,'' he said yesterday in a telephone interview. ``It just isn't in mammals yet; it's somewhere in a bird or poultry.''

posted by Orange @ 8:46 AM 2 comments