The Coming Influenza Pandemic?

March 30 Flu Update

Yi Guan is a genuine expert in the virology of H5N1 and an expert in the Art of Surveillance as we now practice it. Surveillance is of supreme importance in global preparation to face a potential pandemic with a very dangerous virus. But just because it is his opinion that the hammer he wields will hit all the nails on the head doesn't mean that a good hammer is even close to being a sufficient tool even under the best of circumstances.

posted by Orange @ 10:32 AM 1 comments

On the road...

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March 25 Flu Update

Turkish authorities have reported that the source of the recent outbreak of avian influenza in Ipsala/Edirne (Western Turkey) was "Fomites (humans, vehicles, feed, etc.)" (OIE-World Organization for Animal Health report 6907, report date: 18 Mar 2008). Ukraine has come to the same conclusion regarding the recent outbreaks in Crimea [see comment]. (OIE report 6909, report date: 19 Mar 2008).

High concentrations of ducks, rice fields, and human populations—rather than chickens—pose the highest risk of sparking deadly H5N1 avian influenza outbreaks in Southeast Asia, according to a recent study.

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March 25 Flu Update

But in an epidemic, there could be a severe shortage of machines and, more important, doctors and nurses to run them. At that point, the new report says, doctors and hospitals would have no choice but to start taking some people off the machines so that others could live.

Removal “is absolutely the crux of the problem,” said a lead author of the study, Dr. Tia Powell, who has spent much of her career studying medical ethics. “There are people who might survive who won’t get a chance at a ventilator if someone who is likely to die even with a vent is using it.”

"What we recognize is that in the midst of a large event, there's a tyranny of the urgent that overcomes the groups, where there's a constant need to respond and react," Jernigan said. "And we felt it was vitally important to have a group of people that were removed from the constant pressure of the urgent so they could have a thoughtful approach to the development of policy on the fly."

posted by Orange @ 9:59 PM 2 comments

March 24 Flu Update

Researchers at the Erasmus Medical Center in Rotterdam experimentally infected six wild-duck species with H5N1 to determine which were capable of excreting the virus without succumbing to the disease. Pochards and tufted ducks shed the most virus, though tend to become ill or die earlier, they said.

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March 23 Flu Update

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Easter Break.....

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March 21 Flu Update

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March 20 Flu Update

Finally, the argument that the history of having been in Bangladesh is not relevant because there is no reported or confirmed human bird flu there is, at best, misleading. Almost everyone who knows about the situation there assumes there have been at least some cases. They just weren't recognized. Anyway, health officials are fond of saying, and the media dutifully repeats it, that almost all cases to date give a history of contact with sick poultry (even though it's not really true; a substantial fraction of cases have no such history), then it's irrelevant there are no human cases. There are a lot of birds dying from H5N1 in Bangladesh.

posted by Orange @ 8:56 AM 1 comments

March 19 Flu Update

So far this bird flu season is looking a lot like previous ones. That's bad because previous seasons all were freighted with the potential for disaster. So is this one.

posted by Orange @ 10:47 PM 2 comments

March 18 Flu Update

"This is the first case-report of a human with both influenza A/H5N1 and H3N2 co-infection," the paper states. "Such infections are of great concern due to the possibility of genetic reassortment leading to the emergence of a H5N1 strain that is more easily transmitted human to human, and emphasizes the importance of advanced laboratory-based surveillance in geographic regions where both human and avian influenza viruses are co-circulating."

Some of this is good and goes in the right direction. Planning, in itself, is a big step forward. But the plan on paper will go out the window in the first week (the old military saying applies: no battle plan survives the first engagement with the enemy), even while the planning is valuable by envisioning what is ahead, meeting your counterparts in other agencies, thinking it through, all tremendously valuable. States and localities need to be strongly and forcefully encouraged to do this. But most states and communities are also fully engaged in the desperate business of trying to keep people alive day to day and until they can get out from the falling debris of a system disintegrating about their ears. In those circumstances, pandemic planning is a luxury, even harmful to the extent it pulls people away from other urgent business.

posted by Orange @ 9:15 AM 1 comments

March 17 Flu Update

The question of school closings and related "community mitigation" (CM) measures (also known as nonpharmaceutical interventions, or NPIs) arose early and often. At the first morning press briefing, Gerberding said, "As of this morning we're not recommending widespread school closures or other measures to reduce spread in crowds, but those measures are likely." She added that actual closings would be local decisions.

When she was asked what should trigger CM measures, Gerberding said, "When a community begins to see acceleration in the number of cases that suggests that transmission is really taking off, that's when closing schools and avoiding crowds can help. It's important to do it early, because if you wait till you have 1,000 or 10,000 cases, it's too late."

Hesitation and concerns about CM measures emerged in an hour-long Tuesday afternoon teleconference between senior CDC staffers and health officials from states affected by the pandemic. (The state officials were mostly played by CDC staffers in the Exercise Control Group, but three people from state health departments had joined the group for the exercise, according to Jerry Jones, director of the group.)

The Michigan official wanted to know if the CDC could recommend any particular NPIs as better than others. He said the state had a case-fatality rate of 7% in its 100 cases, signaling a severe pandemic under the CDC's community mitigation plan, so the state needed to launch mitigation steps. "But the local health departments are telling us they don't want to do all that work," he said. "So if there's one thing working better than others, we'd like to recommend it."

posted by Orange @ 9:26 AM 1 comments

March 16 Flu Update

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March 15 Flu Update

Public health experts are still worried, however, that the current flu outbreak will lead to even greater use of the antiflu drug Tamiflu. The powerful treatment has been proven particularly effective against H5N1 and has become widely prescribed in Hong Kong — it is increasingly available illegally, without prescription, in pharmacies — so resistance to the drug is growing fast here. Doctors say the overuse of Tamiflu is creating a manifold risk, not only of weakening a weapon against a potential bird flu outbreak, but also of helping to spread a virulent strain of drug-resistant common flu in the wider population. "It's not a good thing to abuse," says Yuen.

But it's hard to keep a community still scarred by recent medical history from doing whatever it can to protect itself. Samuel Ho, a professor of psychology at Hong Kong University, says that during the SARS epidemic, Hong Kong residents were exceedingly concerned about infecting their families and loved ones with the virus. "People were worried about whether they would get the flu," says Ho, "But they worried more about their relations. ... How can I protect my wife? My kids?" He says that to help alleviate the kind of mass insecurity that recurs in Hong Kong during bad flu seasons like this one, doctors need to inform people not only of the true risks they face, but also what they can do to control them.

posted by Orange @ 9:59 AM 1 comments

March 14 Flu Update

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March 13 Flu Update

The second question about the Vietnam civets is this: how did they get infected? They weren't fed poultry (as least as far as anyone knows, and this was explicitly considered) nor were they in contact with poultry. It sounds like these animals were semi-confined, so the virus would have to have been brought to them somehow. Wild birds? Possibly, although there is no evidence in this case. Humans? But how? On boots or shoes? Possibly. But this virus has shown transmissibility to mammals to be difficult, and unless it has changed in that respect, doesn't seem so likely. Other civets in the same enclosure were apparently unaffected. Or is their yet another vector. Bats? It might be. Bats are now implicated as an important source in SARS, not palm civets.

This case needs to be examined carefully. It is these often seemingly anomalous instances which are the most informative.

posted by Orange @ 10:04 PM 1 comments

March 12 Flu Update

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March 11 Flu Update

And in each of the simulations run for the city of 8.6 million people, a rational use of preemptive household antivirals combined with a consistent program aimed at reducing human contact helped contain the spread of disease. The key, the researchers said, lay in timely initiation of a pandemic plan that included shuttering schools.

posted by Orange @ 9:51 PM 1 comments

March 10 Flu Update

In the meantime, however, clinicians are concerned about the impression that the vaccine mismatch and the resulting flu cases will leave. Several times over the past decade, flu-vaccine problems—manufacturing problems, late vaccine delivery, an early-arriving season—have dented flu-vaccine uptake the following year.

"We will need to really clearly and plainly explain that each year, the experts make their best educated guess . . . and some years are spot-on and some years are a mismatch," said Dr. David Kimberlin, professor of pediatrics at the University of Alabama at Birmingham. "The burden is on the medical community to say that, if we do not have a complete match, you are still getting some protection, and it is better to have partial protection than none."

Some say this flu season has more lessons to teach. In Florida, emergency physician Ramirez—also a disaster-readiness consultant—ticked off the components: a significant flu-virus drift, a vaccine-manufacturing system that could not keep up, seriously ill patients, and an overwhelmed healthcare system.

"These are exactly the things we ought to be prepared for in an influenza pandemic, and we were not prepared," he said. "We ought to consider this flu season as a warning to healthcare and industry. This is a gunshot across our bow.

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March 9 Flu Update

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March 8 Flu Update

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March 7 Flu Update

If a pandemic flu hits Quebec, airline passengers won't be able to freely travel between Nunavik and the South for three months or longer.

Isolating Nunavik is the cornerstone of the Nunavik regional health board's "regional preventive isolation" plan to stop a pandemic - a worldwide outbreak of illness - from entering the region.

The board's plan means that when airline passengers from Nunavik travel south during a pandemic, they will not be able to return without first going through a period of enforced isolation, called a quarantine.

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March 6 Flu Update

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Not today.....

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March 4 Flu Update

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March 3 Flu Update

After that the center introduced the use of special nets to contain the movement of chickens and ducks in backyard farms.

"We recommended they develop healthy backyard farming by installing the special net around the farm to minimize direct contact between human and fowls."

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March 2 Flu Update

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March 1 Flu Update

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February 29 Leap Day Flu Update

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