Tuesday, January 01, 2008

December 31 Flu Update

Happy New Year!!

CIDRAP reports---2 to 3 new deaths in Egypt.
ProMed on Egypt.

Three of the 43 cases of human H5N1 avian influenza recorded in Egypt since the beginning of 2006, and 3 of the 18 deaths, have occurred during the past 7 days. The 3 cases appear to be unconnected. The high mortality rate is worrying in view of the previous success of the Egyptian authorities in treating avian influenza virus patients. Hopefully this is a statistical aberration and it does not herald the appearance of a virus endowed with enhanced virulence for humans.

For pessimists only....MSNBC says 2008 already worth forgetting.

Bangladesh says bird flu has now spread to more farms.

New outbreak in Burma as well.

Revere year end post on pandemic potential, with his rock-solid message: prepare for flu by building communities and public health systems. Note:

...we also don't know the relationship between transmissibility and virulence. They are logically and biologically independent in general, but changes that affect transmissibility might also affect virulence. Because we don't know any of these things (and lots more besides), it is not possible at the moment to quantify the probability of one or another (or any) subtype to "go pandemic."
Because perseveration is a characteristic and privilege of the aged, we will repeat again in this last bird flu post of 2007 what we have been saying here since late 2004. The best way to prepare for an influenza pandemic is to do those things which make for a robust community, especially building and strengthening the public health and social service infrastructure.


At 5:18 PM, Blogger Wulfgang said...


Good choice of two very appropriate articles to start your new year off on the right tone. Art Caplan says to beware of the H5N1 ticking time bomb in 2008, and Revere says H5N1 is the 800 pound Gorilla, amongst a few other nasty avian viruses (little primates I guess) which all represent a threat of some magnitude, and science still can’t predict which is more likely to spark a pandemic. Also, since yet another person has died in Egypt in the last 24 hours since the ProMED article was written, and many more suspect individuals there are being tested for possible infection. It now appears that we are somewhere between two extreme thoughts on the situation going on in Egypt: rational concern or a near Niman-like belief that an exothermic viral flashpoint is about ready to occur there.

These kinds of commentaries and news reports lead me to believe that 2008 will be an extremely tumultuous year on the influenza front. In fact, I have pulled together what I call my “Top ten influenza predictions for the year 2008”. Granted, a couple of my thoughts are really far out, but it should be interesting over the next twelve months to see if any of them come to fruition: Here goes…if I hit on two or three of them I will be ecstatic, five or more, and I guess I’m some sort of Forest Gump genius…

1. The largest H5N1 infected human cluster to date will appear in a Middle Eastern country or Bangladesh. It will have a complex but sustained B2H and H2H infection chain of more than 200 individuals falling ill. It will be stopped by a massive Tamiflu blanket and imposed quarantines. The WHO steadfastly will not raise the pandemic threat level and will view the event as “isolated and successful and tout it as evidence that they have sufficient and effective surveillance and response procedures in place”. The WHO will also state that it is “extremely thin horizontal transmission and there should be no major cause for concern”.

2. Indonesia will announce without any advance notification, limited human vaccination of its population in selected geographical areas against the H5N1 virus, using its own developed vaccine. It still does not officially release any H5N1 virus samples to the WHO in 2008.

3. Either Russia or China will record a record number of illnesses and deaths due to severe seasonal influenza. It will be exceptionally severe influenza Type A, and of the H1 or H3 subtypes. The US will avoid severe ILI and deaths throughout 2008 due to the high number of vaccinations in its population.

4. There will be more reports of massive numbers of swine deaths throughout China due to the mysterious PRRS disease and speculation of further mutated influenza cross infections in pigs. China will not be able stop the spread and this will result in sporadic food shortages and unrest in some cities. Countries sending athletes to the Olympics in Beijing will be extremely nervous and express concern. China will continue to deny any public health problem.

5. A scientific study or research paper by a well known scientific researcher will be released which indicates that Oseltamivir resistance against some sub-strains of the H5N1 virus in Indonesia and Egypt has now increased to as high as 50%, and makes a prediction that total resistance is likely by the end of 2009.

6. The Swiss government will announce plans to proceed to inoculate and prime all of its citizens beginning in 2009 with a pre-pandemic H5N1 vaccine in order to protect its citizens. The Geneva WHO Headquarters located in Geneva, Switzerland will issue a strongly worded objection since they still have not raised the pandemic alert level to Level IV and there is still no confirmed evidence of efficient sustained human to human transmission of the virus. Other countries will announce plans to follow suit – led by Japan, Australia, and Great Britain. China, Russia and the US decide to delay the decision.

7. The first case of a HPAI H5N1 infected wild bird will be confirmed in North America and this will occur either in a Canadian province or along the Eastern seaboard of the US. It will be a duck and it will make national headline coverage on TV and in the newspapers. A second much larger case of HPAI in a commercial farm will occur in either Maryland, North Carolina or Texas.

8. The WHO will be drawn into a major controversy with independent scientists who question the accuracy of their H5N1 human infection test results, due to the prolific use of Tamiflu, resulting in reduced RNA levels. The WHO position will be that the test data is the “best available” and will refute all criticism over the large number of false negatives.

9. An entire cruise liner will have to be quarantined due to an extremely contagious influenza outbreak. This news will also make national headlines and bring the risk of an influenza epidemic and pandemic into the forefront. Congress will conduct an inquiry and public hearings and propose new quarantine regulations for international travelers. ( I know, this one’s a real stretch, but it’s what the stars alignment tells me).

10. The head of the CDC and DHS will announce their resignations in the latter part of 2008. The newly elected administration will announce their replacements in early 2009 and place a renewed emphasis on public health care and CDC oversight and control of communicable animal and human diseases in the US. The HHS Secretary will be asked to remain on board by the new administration. The HHS Secretary will also be asked by the new administration to lead and coordinate final preparation efforts for a deadly series of influenza pandemics, including the immediate production of quantities of vaccines sufficient enough to inoculate the entire US population on short notice.



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