Tuesday, January 22, 2008

January 21 Flu Update

Three children are in the hospital in Indonesia with suspected bird flu.

There's an avian outbreak in Turkey.

The situation in India continues to deteriorate. There are reports of people eating sick birds or selling them at discounts, and yet the outbreak continues. Here, we see 5 people with bird flu symptoms...time will tell, often these are panic-induced.

A seventh district in India is now effected.

ProMed looks at the issue in India with some alarm. Note mod comment.

The extensive spread of H5N1 in India, reportedly involving very large number of small backyard holdings, is bad news, from the perspectives both of disease control and of potential infection in humans. The Indian authorities will have to make soon a decision between continuing the stamping-out policy and the possible implementation of mass vaccinations.

A porous border between India and Bangladesh is part of the problem for bird flu.

Random sampling of humans shows no human interaction with bird flu, according to report.

Nepal has banned imports of Indian poultry.

Today's most reflective story. Donald McNeil of the New York Times looks at the declining media coverage of the bird flu, and what is really going on today. Note Nabarro optimistic, Osterholm less so.

Dr. Paul A. Offit, a vaccine specialist at Children’s Hospital in Philadelphia, was one of those who, he jokes, “dared to be stupid” by bucking the alarmist trend in 2005.

“H5 viruses have been around for 100 years and never caused a pandemic and probably never will,” he said.

Progress on the virus sharing front. Apparently, more than 700 strains have been shared, and there is now a system in place to track viruses as they go through the system.

Effect Measure blogs this report, noting progress but that some larger systems are still broken.

Revere notes that whenever someone says the virus is stable, things are certain to go crazy.

A poll in Canada says that people are worried about pandemic prep in that country.

China says it still supports WHO (note yesterday's story about Taiwan being out of WHO meetings).

The United Arab Emirates are strengthening their bird flu defenses.

Article from Carnegie Mellon student paper on bird flu.


At 6:21 PM, Blogger Wulfgang said...


Judging from your news articles out of India, it is becoming very apparent that the only option they have to avoid decimation of their free-range poultry, is to abandon their national policy of non-vaccination, and to begin a major campaign in the West Bengal regions immediately and commence massive poultry vaccination efforts. This will require a significant up-front investment in vaccines, which they have been reluctant to make, but I believe they are now seeing the folly of this failure, when they compare that cost against what they are up against now: upset poor villagers, who now are more of an impediment to the process, than assisting or being cooperative. What’s more, India should to be teaming up with Bangladesh in this vaccination effort, to achieve economies of scale and price discounts.

Thus far, the Indian management (or lack thereof) of the West Bengal bird flu outbreak has been less than stellar – probably dismal, is more appropriate. The government was several weeks late in implementing any kind of concerted or serious culling operation, and once they did, the locals already were hiding their infected fowls, eating them, selling them in market places, disposing of them improperly, moving them to alternate locations, and have been downright hostile to the veterinary authorities in many instances. To make matters worse, the compensation fund is inadequate and reimbursement procedures to the farmers not guaranteed in most instances. In addition, contrary to government reports, there has been very little H5N1 tests performed on the fowls, or on humans, and what has been conducted appears to be questionable. It also appears that the likelihood of undetected or misdiagnosed of humans is also occurring. I have even read articles describing plans to market potential infected eggs to other third world countries, rather than destroy them. Finally, if this wasn’t bad enough, the spread of the disease is continuing almost unabated. India needs to move swiftly like Vietnam in order to squash this outbreak by the infusion of massive amounts of vaccines immediately, or the H5N1 virus will spread to every province in their homeland and cost many hundreds of millions of dollars and cause unnecessary human misery. The bird flu infections of poultry in both Bangladesh and India are currently out of control and there is no way of denying or disguising it with PR spin releases.

I found your New York Times article about Dr. Paul Offit and Dr Bernard Vallat’s pandemic skepticism, to be an interesting reflection of human nature in general: I guess it all depends on ones assessment of the H5N1 virus as a human risk or a threat just to poultry. The biggest problem I have with individuals like Offit and Vallat, is that like classical engineers, they do not view the H5N1 virus as a complex threat, which has many disturbing and lethal aspects and unique mutational properties which are alarming. I have seen many brilliant engineers fail to recognize the dangers of a flaw in their individual designs, until a total flight vehicle (costing many hundreds of millions of dollars) failed and caused deaths and destruction. Complex viruses like H5N1 must be viewed like a complex engineering problem, in a total life cycle and systems engineering sense: it requires new methods and modeling techniques to assess and appreciate the pandemic risk correctly and scientifically – assessing all available information, defining effectiveness measures, creating accurate behavioral models for different scenarios, performing trade-off analysis, and adequate testing of plans and procedures. To simply assert that the “virus is stable” and “H5 viruses have never caused a pandemic”, doesn’t even come close in my book to a convincing medical or scientific argument. In fact, in my opinion the H5N1 virus represents the clear potential to be one mean human killing machine – minus the “wheels” of efficient human to human transmission at the present time.

In my view, the Carnegie Mellon student who wrote the paper about the bird flu threat “gets it”, and she deserves a “A-“. Oddly enough, Drs. Offit and Vallat do not see the integrated big picture, and they get a “D”.



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