Sunday, February 17, 2008

February 16 Flu Update

A 3-year old has died in Indonesia of bird flu.

A third man in Vietnam has died of bird flu.

ProMed tracks the human cases in Vietnam and Indonesia.

Bird flu reaches another part of Bangladesh.

There is also a new outbreak in Pakistan.

South African cricket players are not eating chicken while in Bangladesh.

The United Arab Emirates are bird flu free, they say.


At 12:34 PM, Blogger Wulfgang said...


I see another Indonesian youngster has died due to H5N1. This has me really thinking about what is going on in the world (I know that is dangerous with a mind like mine).

What seems like a startling rise to world scientists and the CDC, is the H5N1 and H1N1 virus strain resistance to Oseltamivir in strange places, like Vietnam, Egypt, Norway, Indonesia and even Chicago. This seems quite logical when one considers two things: first is of course the blanket use of massive amounts Tamiflu to treat H5N1 and seasonal flu’s in countries like Japan, China and the Indo-Asian areas. The second critical factor that I believe everyone is failing to appreciate is the effects of ethic populations and international air travel in the spread and co-mingling of influenza strains in countries. In my view, this largely accounts for the sudden Tamiflu resistance virus strains that we are starting to recognize as popping up in seemingly strange locations – Chicago and Norway, for example.

To illustrate, a snapshot of the US population of 302 million people shows that it is comprised of approximately 13-14 million Asian Americans, and an estimated 4-5 million (conservatively) from Middle Eastern or Muslim countries. In 2007, the number of foreign students registered in the US was approximately 583,000, mainly from guess where – Asia and China. During 2007, there were 1.50 million international airline flights into and out of the US, and this represents 56% of the total of all US-world international airline traffic, with 156.1 million international passengers arriving or departing the “big five” international airports: NY (JFK), LA (LAX), Miami (MIA), Chicago (ORD) and Newwark (EWR). This is an amazing number of potential travelers entering and leaving the US into many of the H5N1 infected countries where the widespread use of Tamiflu is being encouraged.

In my opinion, the extensive use of Tamiflu and international air travel is not only contributing to the emergence of influenza strains being resistant to Tamiflu, but it is accelerating it. This situation is also complicating the WHO database that the world depends upon to select (i.e. fingerprint) seasonal influenza strains in advance, for annual flu shots – hence, we will see more “mis-matches”. I believe what we are seeing currently is actually subtle and sudden genetic drift or mutations occurring in these viruses in the H and N molecules which are conferring resistance. Significantly, in both the H1, H3 and H5 virus, the H hemagglutinin protein is evolving rapidly, and this drifting usually signals the early onset of more severe influenza epidemics like we are now seeing, or even the start of pandemics. What is deceiving is that these change changes usually do not result in the appearance of a new virus strain.

I believe we all may be missing the forest for the trees, by concentrating on the wrong type of international surveillance, Indonesian and Vietnamese death counts, culling of poultry in India and Bangladesh, and the sampling of wild birds and domestic poultry for the H5N1 virus, almost exclusively. We should also be conducting a sampling of our ethnic populations (especially international air travelers), by the use of sophisticated reverse transcription-polymerase chain reaction (RT-PCR) techniques, to check the influenza antibodies for protein key mutations which might indicate further rapid resistance changes to antivirals in progress, like Tamiflu and Zanamivir.

The unexpectedly high number of human flu and avianviruses that are suddenly appearing to be resistant to Tamiflu is no accident. We need to take this situation a lot more seriously than we are, since pandemic viruses can be the descendents of previous ones, and we still haven’t quite learned the sobering lesson from 1918.



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