Wednesday, February 28, 2007

February 27 Flu Update

A new human case has been reported in Egypt, a 4-year old girl.

The US has approved the bird flu vaccine, which is safe, but, as noted earlier, may not be very effective.

CIDRAP on the FDA Approval.

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.

This report gives a little more nuanced reading to the vaccine story.

“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.

Effect Measure also blogs on this vaccine. Here is the salient paragraph.

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.

Helen Branswell on a GSK plan to sell a pre-pandemic vaccine in the marketplace.

7 more birds have died in Kuwait.

However, Kuwait says there are no human cases.

Northern Vietnam is at high risk of bird flu after their first case emerged...spraying disinfectant is recommended.

The UN is investigating in Laos where the first case has emerged.

ProMed on Hong Kong and Vietnam.

Story in Nigeria notes that the bird flu hits the poor hardest.

Turkey has claimed to have "medically screened" 44,000 people.

EU has a "swat" team ready for winter flu outbreaks (just in time).

The NHS in the UK is coordinating a pandemic summit.

A province in the Philippines says it is bird flu free.

Tuesday, February 27, 2007

February 26 Flu Update

Setback on the vaccine front. The first tests from FDA show a 45% protection rate, and that is from a two-shot series. It would appear from this article that the vaccine does not use an adjuvant.

There are some outbreaks, starting in Afghanistan, where birds have been quarantined.

Bird flu has been confirmed in Northern Vietnam (in poultry)

The first reported human case in Laos has been confirmed.

More on Kuwait, with bird flu in the zoo and on the farm

CIDRAP also weighs in on Kuwait.

There are also reports of an outbreak in Hong Kong.

Egyptian officials are denying that there is a new human case.

There are no new cases in Moscow, however, or so they say.

The United Arab Emirates are prepared to fight bird flu.

This article says we have our first glimpse into the influenza replication machine.

Correctly, officials in the Philippines note that poultry farms are the biggest risk for bird flu.

Australian professor writes that bird flu has not gone away.

Is the Internet causing officials to lose important flu developments in the background noise as a European official suggests. Revere doubts it, noting:

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.

Finally, Dr. Osterholm writes in Foreign Affairs about how we are unprepared for a flu pandemic (preview only).

Sunday, February 25, 2007

February 25 Flu Update

A first human case is suspected in Laos. Note ProMed mod comment...

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.
Avian cases discovered in a zoo in Kuwait.

ProMed on Kuwait and Pakistan.

The government confirms bird flu in Afghanistan.

Russia finds bird flu in new region.

War of the Worlds? Hoax email purporting BBC confirmation of human cases in Sussex causes concern if not panic.

Egypt has banned duckling imports to fight bird flu.
A school in Oxford has banned its pet chickens due to bird flu fears.

In Fredericksburg, VA, a new health educator is charged with educating the public on pandemic flu.

Parents in Indonesia are taking their message directly to the grassroots that they say are not being hit by government flu programs.

Effect Measure on an email from a tabletop simulation in the Maldives being sent out as "real." The government was quick to respond....would they have been so quick in a real pandemic.

February 24 Flu Update

ProMed has news on what appears to be a new case in Indonesia. 26 year old man died of suspected bird flu, a couple of days after his chickens began to die.

The boy in Egypt who was H5N1+ has survived.

The Zoo in Pakistan will test bird and employees every three months for bird flu...

which started, as it turns out, with a peacock.

Another Nigerian state says it is planning to fight the flu.

Thailand is producing its own Tamiflu, saying there is no patent protection in its country.

We ran the American Public Health Association's stuff a couple days ago....their pandemic plan. Revere doesn't think much of it.

Saturday, February 24, 2007

February 23 Flu Update

FDA experts are going to pass muster on the Sanofi Aventis flu virus.

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.

Meanwhile, the EU has backed the vaccine from Novartis.

Afghanistan has confimed high path H5N1.

ProMed on Afghanistan.

Pakistan has bird flu outbreaks in two provinces.

CIDRAP on Afghanistan, Russia and the Eu.

The Philippines has moved its flu program into a new province.

Russian government vets say that bird flu is likely to keep reoccurring there.

Yemen says it is bird flu free.

Kazakhstan is preparing for the bird flu.

"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.

Here, Anthony Fauci interviews on why the flu is still a threat.

Top North American foreign officials, include flu in discussions.

You may recall that Hungary has a flu vaccine that was tested in human clincial trials. WHO is using that data for purposes of comparison in new flu programs.

The US is providing flu assistance to Egypt.

From Midland, MI, the question is asked: if a pandemic hits, will we be ready?

"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.

CIDRAP on the APHA plan covered here yesterday.

Friday, February 23, 2007

February 22 Flu Update

From Moscow with flu? There are reports of eight or nine outbreaks of bird flu in suburban Moscow.

More on the new siege of Moscow...(their metaphor, not mine).

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.

The EU is years away from being ready for a pandemic, says this report.

ProMed on confirmed avian cases in Pakistan, Russia and Hong Kong.

Rajasthan (a state in India and a "haven" for migratory birds) is on guard for bird flu.

Egypt is going to compensate farmers for the bird culling campaign--not with cash, but with a vaccinated chick.

The American Public Health Association is releasing its pandemic prep story here...

and link to document here.

People in Pakistan are urged to be vigilant.

CIDRAP has a report that 2,000 flu viruses have been sequenced.

In response to a question, a paper in the Poconos gives readers the basic poop on bird flu.

The Erie County Health Department (Buffalo) says it is preparing for a pandemic.

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).

Thursday, February 22, 2007

February 21 Flu Update

There are Internet rumors of a human bird flu case in Russia. The Russians are denying it.

Reports say that the bird flu has left the Moscow region and spread.

Bird flu confirmed (in birds) in Eastern Afghanistan.

The Russians claim that some reported outbreaks in the regions are not confirmed.

ProMed on outbreaks around the world.

Hungary says "blame game" going on in Suffolk.

The Sudan has banned poultry imports from countries affected by the flu.

Expert in Muskegon, MI, tells public there is no reason for alarm "now" over bird flu.

Meanwhile, a public health official in Ireland says that bird flu risk in that country has fallen over the last year. Check this out.

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

A photographic exhibit is being held that will use micro photos to illustrate the bird flu.

Houston company is selected to sequence influenza viruses.

Revere on a paper that talks about how to use social media sites to help during a pandemic. Interesting ideas.

Tuesday, February 20, 2007

February 20 Flu Update

Flu has been found in 19 of Nigeria's 36 regions, causing a worsening crisis.

CIDRAP has this story as well.

Interesting local article from Nigeria--scolds local people not to avoid culling.

Bird flu continues to pop up in Russia.

ProMed on Russia's response to the outbreaks--vaccination, tighter rules.

Sick birds in Pakistan have caused the zoo to close.

Ukraine brags about having no bird flu in birds.

Predictably, Ukraine is no longer accepting poultry from Russia.

OIE has given Africa 18.000,000 doses of avian vaccine. (So, I guess we decided the vaccination was a good idea).

Forbes says that flu prep lags around the world, lists tasks governments are expected to take.

Companies are reminded that, given the Matthews case, that they should all think about continuity planning.

A report blames factory farms for the bird flu.

People in Russia are reminded there is no vaccine for bird flu.

African paper wonders if, in a pandemic, the first world might need to go to the third world for help.

Revere on the announcement that stricken Turkey company in Britain is laying off workers due to low sales.

February 19 Flu Update

According to this, 5,000 people were tested in Moscow for bird flu following an outbreak (only 20 were in direct contact with birds.)

ProMed on the sick 5 year old boy in Egypt. He is stable.

In Britain, the controversy rages. Government says there is "no reason to think" that the bird flu reached the human food chain.

Reduced turkey sales have caused layoffs at Bernard Matthews.

Students at the University of Michigan are wearing masks to test flu protection measures.

The bird flu in Britain is a teachable moment in classrooms.

Indonesia is planning on relocating its bird markets in 2008. I'm not clear on where they are going.

Scary headline from Russia actually merely confirms bird flu there is high path.

Russia is going to begin vaccinating poultry.

CIDRAP on Moscow outbreaks.

The Philippines are identifying the four areas most likely to have bird flu in one region.

Educational materials have been developed in Barbados for bird flu.

Armenia got $2 million in bird flu grants.

Monday, February 19, 2007

February 18 Flu Update

Biggest story of the day comes through Effect Measure. Did contaminated waste from the turkey factory leave there and spread the disease around the country? This article shows how vulnerable our food system is to contamination.

Here is Revere's source article.

More on the Russian outbreak, quarantines, etc. No word on where the flu came from, so everyone is still being cautious.

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

ProMed on the apparent spread of bird flu in Russia.

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.

African nations recognize teamwork is key to fighting bird flu.

The owner of the Turkey farm in Suffolk apologizes for flu problems. (I am continuing to include these interminable stories for a couple reasons. First, because the presence of flu in a country with a well-developed scientific infrastructure and high regard for openness gives us a look we normally don't get. And second, because it demonstrates the finger pointing and animosity you might see in a larger pandemic.

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.

The Episcopals have pandemic news out today, as well. Interesting read. Note emphasis on how the Church will care for its own.

I missed this from our earlier story about the Archdiocese of confession during a pandemic.

Sunday, February 18, 2007

February 17 Flu Update

ProMed with the day's news...potential outbreak on Papua, and apparent spread in Turkey, along with more on Laos and Russia.

Russia is reacting strongly as bird flu reaches near the capital.

Russia is not "ruling out" bio terrorism for the bird flu outbreak.

5 year old boy who died in Egypt was taking Tamiflu.

New Scientist on poor countries and the vaccine.

Bird in Hong Kong is positive for low path H5N1.

Another girl has fallen to her death in Japan with a potential Tamiflu link.

People in Bangladesh are reminded they are still at risk for bird flu.

Saturday, February 17, 2007

February 16 Flu Update

The biggest flu news remains on the vaccine front. The UN says a bunch of things, most notably that vaccine could be available within three months of a pandemic beginning. How much...different question. Note that this quote seems to hint that we're talking multiple strains, too.

“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.

CIDRAP on the vaccine story. Emphasizes current production capacity of 400 million in world of 6 billion. Note also that CIDRAP cites a difference between the tone of WHO's November vaccine release and this release.

Here's the official WHO report.

Effect Measure decries WHO for seeking good news headlines which are supported by carefully measured words that don't promise very much....and with strong emphasis on the lack of production capacity. (My note is this: isn't it true that we could make real progress without vaccinating everyone in the world? Couldn't we at least head off the apocalyptic predictions we have seen in the last few years? Couldn't it be 1968 instead of 1918?).

For those who are really into vaccines, here is a table of all ongoing flu vaccine trials.

A five-year old in Egypt is now confirmed H5N1 positive.

CIDRAP on Egypt, and other countries. Note the death is confirmed H5N1 from a couple of days ago. Note outbreaks in Laos (new) and Turkey.

There is an outbreak in Moscow among birds. This is the first time the bird flu has been found in the capital region.

Indonesia will resume sending samples to WHO....once it has guarantees it will have access to the vaccine produced from the samples.

CIDRAP has this story, as well.

ProMed has a Japanese report on rodents spreading bird flu there. Note skeptical mod comment.

With bird flu breaking out in new countries each week, Revere looks back one year and sees what he was writing then...the most things change (you know the rest).

Britain hastily changes its regulations in response to the Suffolk update.

Mexico is looking to prevent bird flu with some new animal health rules.

The Ivory Coast is also stepping up its surveillance program.

Here's a story from the local press on flu prep in Louisiana.

Roche has filed to sell lower dose Tamiflu in Europe, partly for children in an influenza pandemic.

The Society of Human Resource Managers looks at the recent hurricane-style pandemic rating from the US.

The Archdiocese of Edmonton says it is planning for a pandemic. They are prepared to cancel Church in a worst case scenario.

Professor tells Whitewater, Wisconsin audience about the uncertainty of a pandemic.

Friday, February 16, 2007

February 15 Flu Update

Nick Zamiska of the WSJ has an article in today's paper about bird flu vaccines. It is a must read. Notes that even as vaccines are being developed, questions arise. Do you cut regulatory corners when a pandemic is only theoretical? Do you take production capacity away from seasonal flu to make a pandemic flu vaccine? Here's the key question.

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.

Bird flu has been found in three new villages in Turkey.

Surveillance in US has shown no evidence of H5N1 in migratory birds, leading to evidence in favor of the poultry trade argument.

ProMed surveys the world....including an interesting post on what poultry farmers should do to protect their flocks.

A lab in the Philippines is designed to help fight the bird flu.

South Korea is also launching a major effort to prevent bird flu.

The Socialist Party of Britain says that the government puts profits ahead of health.

The World Bank is donating $2M to Armenia to fight the bird flu.

Wednesday, February 14, 2007

February 14 Flu Update

A woman in Egypt has tested positive for bird flu. I believe this is a unique and new case.

ProMed on Egypt.

ABC News on the immunity story. Provocative quotes from Dr. Webster.

Back in 2003, the idea that some people might have limited immunity from the deadly H5N1 bird flu virus seemed almost impossible. I had a chance to ask one of the leading experts, Dr. Richard Webby of St. Jude's Children's Research Hospital, about the theory, and at the time he had doubts.

"I admit I was skeptical," he said now. "It did not seem likely, and that's one reason it took us so long to do the experiments."

Despite the contention that bird flu moved from Hungary to England, the EU sees no reason to change its approach.

A Thai expert says bird flu should go global no later than next year.

A bird flu simulation will be held in the Philippines.

WHO also says bird flu strikes the young more.

New York Times features an article that says people still need to pay attention to the bird flu. Here's a quote from Dr. Osterholm, the quote maker.

"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.

Remember last year when Kleiner Perkins, a venture fund, announced $200M bird flu fund? Big splash, Daily Source Code, everything. This article looks back a year and says that KP obviously got into a risky business.

The news in Britain was a pandemic---a news pandemic.

Editorial urges Nigeria to fight the bird flu--including coming through with promised compensation for culled birds.

Ottawa Citizen author plays SARS forward to the current bird flu threat.

With bird flu in Pakistan, it is now noted that it is knocking on India's door.

OK--you can make your own mind up on this from Hungary's "underground" paper.

Yesterday in ProMed, there was a strong statement in favor of poultry trade--as opposed to migratory birds--being at the root of bird flu. The mod speculated that US surveillance would be clear, as it was in Canada. Today, the data (Hint--it was).

February 13 Flu Update--snowbound edition

More quarantines are called in Turkey due to bird flu fears.

The latest bird flu deaths in Egypt were from a tamiflu-sensitive version of the virus. Are there really two strains running around Egypt?

WHO has urged the media not to spread bird flu panic.

"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.

No surprise here. CIDRAP says that the American Public Health Association has interviewed people about their home emergency prep and "the cupboard is bare."

Hard hitting article from the Asia Times says Indonesia is "dithering at ground zero."

International Herald Tribune with story on the Lunar New Year and how it might spread bird flu (this is an annual story).

More on research at St. Jude that shows N1 vaccine may provide some bird flu protection.

Scientific American also writes on this story.

Finally, Revere blogs this study, too. Interesting post on what he views as an area of inquiry which has some promise, but is one of many facing an overstretched medical research commnity.

The Guardian (UK) says that the bird flu in Britain is more than 99% related to the virus in Hungary.

ProMed says this doesn't solve the mystery. Note mod comment:

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.

Vietnam says it has contained bird flu in the southern part of the country, but warns that trade demand for poultry means the virus will probably re-emerge.

ProMed runs article that points finger at poultry trade--not migration--for bird flu.

The Philippines have opened a flu lab that New Zealand paid for.

In Britain, this article says the Suffolk incident was all about the government protecting the interests of the industry.

Greece is urging precaution against the bird flu.

WHO has told the Nigerian state of Ogun that it has the agency's full cooperation.

North Dakota has hired a company to run its tabletop exercise.

Tuesday, February 13, 2007

February 12 Flu Update

CIDRAP reports two deaths in Indonesia, one reported previously. Also news from South Korea and Pakistan.

Helen Branswell must read on more research on the issue of immunity. Does ongoing exposure to H1N1 help to protect people from H5N1?

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.

Pakistan says it is watching closely, and has no human cases.

Helen Branswell with more follow up from Indonesia drawing a line in the sand.

"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.

Excellent Washington Post editorial on the bird flu prep, urging CDC to reconsider some of its recommendations during the comment period.

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.

I don't know how much longer I am going to keep blogging this, but a brouhaha has erupted in Britain over the Hungarian poultry. Hungary disputes that it was the problem. Apparently, it all came down to a discarded wrapper (doesn't it always).

Lunar New Year is starting, which means feasts. Which has Hong Kong on alert.

Bird vaccine patch would allow supplies to stretch 10X.

From Britain, during a pandemic those who are infected will be asked to send a friend to the drug store or the mail box.

Story posted in Tennessee about how ready we are for the bird flu.

Effect Measure on telecommuting in a pandemic. Could bandwidth demands cause low-priority hogs like YouTube to go dark?

Revere also notes that the US poultry industry continues to insist that it couldn't happen here.

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.

February 10 Flu Update

Helen Branswell here with an article that has the potential to be the most important development in avian flu in many months. If it bears out, it could mean even more than that. She reports that scientists studying the prevalence of flu deaths in young people wonder if there is not widespread existing immunity in people over 35. Entire article is a must read.

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.

West Java woman dies of bird flu in Indonesia. She is from a village where four other people are sick.

Scandal ensues in Britain concerning the Bernard Matthews turkey company and its imports of Hungarian fowl, which continued after Hungarian birds were the suspected cause of the Suffolk outbreak.

More on the hospitalized cases in Turkey, reported yesterday. This report says there are 3, not 4.

The source of the infection for the deaths in Nigeria has not been determined yet. The birds there appear to be domestically raised.

Meanwhile, efforts are underway on the ground to stem the tide of the bird flu.

A third avian outbreak is reported in Pakistan.

South Korea found its sixth outbreak of bird flu among birds, and the culling begins.

A dead magpie in Hong Kong is H5N1 positive.

Dr. Nabarro says outbreaks are less than last year, but more widespread...

he also says H2H is a possibility.

The NHS is Scotland is preparing for bird flu.

More Branswell, here on wild bird surveillance.

A man who had cycled in SE Asia came home to Cyprus with flu symptoms, but has now tested negative. Note that this didn't come until after panic had ensued.

A media guide for journalists is now available on line.

A graduate of Illinois Wesleyan who works at the Mayo Clinic returned to his alma mater to warn of bird flu risks.

Saturday, February 10, 2007

February 9 Flu Update

Four children have been taken to the hospital in Batman, Turkey with suspected bird flu. There was an avian outbreak in that area.

UK poultry sales are not seeing any effect from the bird flu.

UK is checking for infected birds in the "human food chain."

Revere on Britain...and how all the assurances were passed by the facts.

Additional farmer is being tested for bird flu in Britain.

H5 confirmed in Hong Kong, further testing underway.

CIDRAP on Turkey, Turkey in England, etc.

A British and Greek study says that it is smart to have two sets of anti virals to help hold off a pandemic.

Britain is also upping its Tamiflu stockpile.

The Wild Bird Survey says Canada is safe from bird flu.

Speaking of wild birds. Dr. Nabarro at the UN says that recent outbreaks are the result of smuggling infected birds...not migration.

Same presser, Nabarro says that the countries have to cooperate to fight the bird flu.

Council of Foreign Relations updates its readers on the bird flu.

Nigeria looks back at one year of the bird flu.

China is going to work on fighting fake and counterfeit drugs.

More on a trial for fake Tamiflu in China.

Grants awarded in Illinois for bird flu.

Revere blogs the cats, again, stating that needed research should be done.

Friday, February 09, 2007

February 8 Flu Update

Not surprisingly, three poultry workers have now tested negative for bird flu.

Here's one for your migratory bird debate. The current theory is that the bird flu got to England via Hungary and the import of infected birds following their outbreak there. (This will also lead to quicker import bans when a country has an outbreak.)

Here is more from the Guardian on this suspected link.

South Africa is banning import of British poultry.

There's an outbreak in SE Turkey (among birds).

The government in Pakistan, as governments do everywhere, is downplaying the risk of bird flu.

ProMed on Turkey, Britain and Pakistan.

ProMed on the second confirmed patient in Indonesia, also reported yesterday.

African author notes that the media must be involved in pandemic prep. (Personal note: this is completely true. Changing or influencing human behavior is a major part of the equation).

CIDRAP weighs in now with notable quotes from its conference in Orlando. Note, with alarm, that Margaret Chen says global spread will take three months. Article is chock full on nuggets of wisdom, including from Peter Sandman, Risk Communication Guru.

CIDRAP on OSHA guidelines mentioned here previously.

From Southern Mississippi, an excellent story on pandemic prep for a local audience.

Same paper: personal tips on preparing for a pandemic.

Here's an interesting piece. Freeman, a company that produces "face to face events" (ie, conferences), is wondering how pandemic will effect its business.

Nice story from Britain on the nuanced reaction to bird flu that is appropriate.

Revere blogs (again) the Indonesian virus story. I agree with Revere. While I understand the nation trying to protect its interests, a virus is not property...and it isn't intellectual. You didn't create it with your brain (my comment).

Thursday, February 08, 2007

February 7 Flu Update

A second vet in UK is being tested for bird flu symptoms.

An MP says Britain should provide some of its Tamiflu stock to poultry workers in Suffolk (note incorrect use of the word vaccine.)

The cull in Britain is fingers are crossed that the virus did not spread.

There is now an outbreak in Pakistan, but the government says it is nothing to worry about.

ProMed on the outbreak in Pakistan.

The US Embassy in Indonesia has warned US Citizens to stay away from cats because they can carry H5N1. This is an unusual warning that could portend that there is something going on that has been underplayed.

Yesterday's controversy was over the Indonesian samples. Indonesia is refusing to share samples gathered in its countries--and for some solid reasons. There was also dispute over whether the country had an exclusive deal with Baxter to use the samples. Helen Branswell today says the company says No.

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.

Experts in this story say Indonesia's actions could slow efforts for a vaccine.

Effect Measure blog this story, noting the good arguments on both sides. Here's a potential solution.

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.

ProMed on two new cases in Indonesia, noting that one is exceptional because the woman reportedly caught the disease from a wild bird.

The new US budget has pandemic prep in it, but cuts biosecurity.

ProMed on the new case in Egypt.

FAO is confident Britain can handle bird flu outbreak.

GSK says it will begin human vaccine trials in the second quarter.

Nigerian citizens are educated on how to stay safe from bird flu. We have no idea what challenges are entailed in these issues, across cultures.

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.

New Zealand said yesterday it's pandemic prep was best in the world. Not so fast, say some. What about a Command Centre.

Forbes reminds people of the obvious--bird flu has not gone away.

UNICEF is spending money to fight the bird flu in Kazakhstan.

More on the CIDRAP business summit. The key question is, how do you prepare for something when you don't know--and we really mean DON'T KNOW--what could happen and what you might have to prepare for.

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."


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.

Consumer Reports answers bird flu questions.

Tuesday, February 06, 2007

February 6 Flu Update

A vet who worked in the cull in Suffolk is now hospitalized....

Indonesia has been withholding flu data from the world to protect intellectual property rights. Branswell reports...this is a huge political issues. Read this rhetoric, and then the entire article....

"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."

CIDRAP weighs in on this as well...noting that the entire International system is being challenged.

NY Times on this new development.

There are two more human cases in Indonesia.

WHO confirms H5N1 cause of young girl's death. (ProMed)

WHO also confirms a sick girl in Nigeria.

The Guardian (UK) notes, correctly, that the pandemic will emerge from Java, not Suffolk.

Nigerians are told to expect more bird flu outbreaks.

Indonesia has been urged to do more against bird flu.

OSHA has issued guidelines designed to help employers stand up against the bird flu.

David Milliband, UK, Minister made this statement before the House of Commons.

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

Shanghai has a new bird flu plan....

People keeping "fancy" birds in Pakistan are being asked (nicely) to get them vaccinated.

Good day on the stock market for companies promising bird flu vaccines.

At the CIDRAP conference, CDC Chief calls flu prep a marathon (note: good thing for us.)

Revere blogs on a new entrant in the anti-viral offerings.

The US Military has to prepare for a pandemic like everyone else....and they revised their plan recently.

“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.”

Monday, February 05, 2007

February 5 Flu Update

Chock full of info in this story. 12-year old girl died of bird flu in Egypt. Her initial tests were (wait for it) negative, so she may not have received Tamiflu...and her strain might or might not be resistant anyway.

Bird flu in British Turkeys leads to lower share prices for American chickens. Go figure.

Russia has banned the import of poultry from the UK.

Conversely, Brits are still eating turkey.

Of course, the ultimate question...where did it come from.

ProMed: Britain spawns precautions in Norway and the Netherlands, and a possible new outbreak in Russia.

CIDRAP rounds around the world, including a new outbreak in Japan.

ABC News reports that US hospitals are unprepared for a pandemic surge (personal note: of all the unknowns in this field, this is something I am sure of)

With a 60% fatality rate, physicians are looking to new options, trying to find something that will stem the tide of death.

Local op-ed piece on bird flu in Nigeria.

Malaysia says that the it does not restrict travel from countries stricken with bird flu.

Japan is conducting exercises to deal with human bird flu.

In Ireland, the Derry City Council is being trained to bury dead bodies in a pandemic.

New Zealand says its pandemic prep is among the best in the world.

The Welsh say their bird flu plan is ready, too.

CIDRAP reports on its business summit...says businesses are becoming more aware of bird flu threat.

Revere...eating undercooked poultry can lead to salmonella....or H5N1. Yet, people still get salmonella. Draw your own conclusions.

Sunday, February 04, 2007

February 4 Flu Update

Dr. Nabarro says the flu should not spread in Britain due to quick containment there, but that overall cases should be expected to spike in the coming weeks.

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.

Perhaps. The Guardian weighs in with this well-reasoned leader. However, note that the turkey farm did not report the disease for 48 hours.

From Britain, risk of disease to humans "very low."

Britain has widened the bird flu containment zone.

Now that H5N1 has hit Britain, people are asking if the country has enough drugs.

From Australia, a reminder that bird flu left the headlines, not the world.

Revere reviews the pandemic plan from CDC. Basically, it is positive, though it falls short of calling for the nation to rebuild its public health infrastructure.

Saturday, February 03, 2007

February 3 Flu Update

Just checked the log, and searches and traffic are way up from the UK. No surprise there. Feel free to check back here...we cover the flu news each day, with an eye toward providing the facts as they are.

159,000 birds are being culled on that farm in Britain. Workers were offered Tamiflu, and the government is reminding people to remain calm.

More...BBC on how the virus got there, since migratory birds are considered to be weeks away. They believe maybe a bird arrived early, but there could be other sources...

Of course, there's no immediate risk to people, BBC again.

Some of the people in the village in Suffolk where this is going on are worried.

Effect Measure with short post to remind those that the flu was always lurking, even when it left the headlines.

My opinion...and it's just that. The outbreak may well end up being a "one off" as they say, in the short term. But in the long term, this signals a widening geographic spread of the disease (at least in birds), and probably will not be reversed in the long term.

Death in Nigeria is confirmed H5N1 by WHO.

Official WHO update from Nigeria.

ProMed on Vietnam, where most birds died and are being tested, and Japan, where H5N1 was confirmed on a previously reported outbreak.

The CDC held a pandemic exercise. The framing scenario for these always fascinate for the results, they feel it was a success.

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.

February 2 Bird Flu Hits Britain.

1,000 turkeys died in Suffolk and H5N1 is confirmed. Revere reports.

These links are from before confirmation was public...

A thousand turkeys died in Suffolk (UK), bird flu is being probed.

Promed with this story. Note mod comment:

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

Research indicates now that the H5N1 virus can infect cells in the upper respiratory path--in the past, some felt that the virus had not gone H2H because it had to infect deep lower lung tissue. However, the report says that alone has not made it more transmissible.

Revere blogs this study---must read. Research is important, but more steps needed.

CIDRAP has expert reviews of the bird flu plan CDC put out yesterday. Here's what Dr. Osterholm had to say.

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

Crofsblogs found this less positive report from an epidemiologist.

Revere comments on the Indonesian story that the capital had been cleared of backyard fowl. Swallow any beverages before you read the quote below....

"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.

Here is the story that Revere refers to.

Japan confirms presence of virulent H5N1.

WHO is in Nigeria to help.

CIDRAP weighs in on the report about small changes that effect transmissibility.

Another downside of stockpiling Tamiflu...Asian countries will soon see there stockpiles pass their expiration dates.
The World Bank is supporting a flu program in Kosovo.

US experts apparently view Toronto as a model of pandemic preparedness.

Local doc updates Montana readers on bird flu.

Friday, February 02, 2007

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

The US bird flu effort is on display today as the US released new pandemic flu guidelines to cities and states. As usual, this generates many headlines.

Here's the New York Times' take....the plan calls for major disruptions in everyday life in order to buy time to get a vaccine produced. This is, in concept, similar to the containment strategy, which, as we know, included saturating an area with Tamiflu in order to keep flu from spreading out. This plan is a little more realistic in that it aims to lessen the severity of the first wave in the hope of stopping a second wave. I see the major problem in this plan as maintaining social order when the plan does not "appear" to work.

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.


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.)

More on flu news from the conference. The US says its goal is to have enough vaccine to cover the entire US population within six months of an outbreak. And that could be years away.

Helen Branswell, as always, has the best take on this. Note that the plan is based on severity of the pandemic. I believe the US plan sounds as if it is tailored to respond to the kinds of concerns Dr. Osterholm has raised. Here is what CDC had to say:

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.

CIDRAP also weighs in. Note that severity of cases is based on CFR--case to fatality ratio.

Here is a link to the full report (I haven't read the report yet, perhaps tonight and tomorrow....

Here is a link to the HHS press release.

Here is a link to the transcript of the press conference CDC held.

The Wall Street Journal also says has triggered an immunity clause for companies making vaccines in response to the avian flu fear.

Leaving the US....

WHO says if pandemic risk grows, it will speed the release of viruses for vaccine development purposes.

A third outbreak has been reported in Thailand.

Meanwhile Phuket City in Thailand says it is bird flu free. So there.

Indonesia says it has a human bird flu vaccine in the "experimental" stages.

Nigerians unfazed by bird flu death, business at poultry market goes on as normal.

ProMed on Nigeria...note WHO has not confirmed the death there.

ProMed has this report from four countries, including a possible outbreak in Georgia.

Ukraine now has blocked bird flu imports from Russia as well as from Hungary.

Researchers says altering the "coat" of a virus could stop it from spreading.

Scientific American on this report as well.

An alert reader sent this along...note these quotes from Dr. Webster....

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.''


``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.''

Note this quote, too, not from Dr. Webster, but from a Dutch scientist:

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.''

Provincial officials in the Philippines met to prepare for the bird flu.

More on local preparations in the Philippines.

Continued vigilance is urged in Hong Kong.

A University of Chicago Economist have a speech on controlling bird flu, partly focusing on the need for proper compensation for third world poultry farmers.

Bird flu training is being conducted in Shreveport.

Scientific American reports that it is wise for flu fighters to keep less virulent strains are more likely to spread because they don't kill the hosts as fast. Note that some people believe H5N1 could adapt to human transmission without becoming less virulent.

Effect Measure on why all those suspected cases in Thailand were likely to be H5N1 negative.